The clock is ticking, a friend casually remarked this week. A few years younger than me, he is already contemplating how much life he has left. His mother died at 76; his father, in his fifties. Meanwhile, an acquaintance still lives alone at 99, still drives, and writes cogent letters to the editor. My relations tend to make it into their nineties. Genetics is a crap shoot. For now.
The period immediately after the Spanish Flu pandemic of a century ago was the last time life spans dipped around the world. The New York Times reposts to its landing page today a story from last month about the doubling of life spans in the century since. The reasons are traceable to a myriad of little-noticed changes along the way that helped us dodge death early in life: “the smallpox infection that didn’t kill you at age 2; the accidental scrape that didn’t give you a lethal bacterial infection; the drinking water that didn’t poison you with cholera,” etc. The rates of death in childbirth and infant mortality have plummeted. My mother at nearly 90 just discovered an aunt she never knew about who died at the age of two over a century ago.
Infant-mortality rates in the United States dropped by half between 1915 and 1935, the Times adds:
One strange thing about the story of global life expectancy is how steady the number was for almost the entirety of human history. Until the middle of the 18th century, the figure appears to have rarely exceeded a ceiling of about 35 years, rising or falling with a good harvest or a disease outbreak but never showing long-term signs of improvement. A key factor keeping average life expectancy low was the shockingly high rates of infant and childhood mortality: Two in five children perished before reaching adulthood. Human beings had spent 10,000 years inventing agriculture, gunpowder, double-entry accounting, perspective in painting — but these undeniable advances in collective human knowledge failed to move the needle in one critical category: how long the average person could expect to live.
But germ theory, pasteurized milk, chlorination, antibiotics, the smallpox vaccine, and more were life-changing and life-extending. When life spans exceeded 50 for the first time in human history, Nobel-laureate economist Angus Deaton has called it “the great escape.” Discovering that bread mold had antibacterial properties was one thing. Engineering how to produce penicillin at scale the way the world just produced COVID-19 drugs at scale saved millions of lives.
The history books tend to spotlight major scientific breakthroughs, but little things like mechanics and social habits add up. One engineering professor noted how even everyday things like better personal hygiene and inventions like the washing machine and refrigerator are contributors.
The consequences of extending life spans, however, have led to a new set of issues with which to grapple:
All those brilliant solutions we engineered to reduce or eliminate threats like smallpox created a new, higher-level threat: ourselves. Many of the key problems we now face as a species are second-order effects of reduced mortality. For understandable reasons, climate change is usually understood as a byproduct of the Industrial Revolution, but had we somehow managed to adopt a lifestyle powered by fossil fuels without reducing mortality rates — in other words, if we had invented steam engines and coal-powered electrical grids and automobiles but kept global population at 1800 levels — climate change would be much less of an issue. There simply wouldn’t be enough humans to make a meaningful impact on carbon levels in the atmosphere.
Runaway population growth — and the environmental crisis it has helped produce — should remind us that continued advances in life expectancy are not inevitable. We know from our recent history during the industrial age that scientific and technological progress alone do not guarantee positive trends in human health. Perhaps our increasingly interconnected world — and dependence on industrial livestock, particularly chickens — may lead us into what some have called an age of pandemics, in which Covid-19 is only a preview of even more deadly avian-flu outbreaks. Perhaps some rogue technology — nuclear weapons, bioterror attacks — will kill enough people to reverse the great escape. Or perhaps it will be the environmental impact of 10 billion people living in industrial societies that will send us backward. Extending our lives helped give us the climate crisis. Perhaps the climate crisis will ultimately trigger a reversion to the mean.
In a companion story, the Times examines how birth rates and fertility rates have dropped as the world population grows older. “Maternity wards are already shutting down in Italy. Ghost cities are appearing in northeastern China. Universities in South Korea can’t find enough students, and in Germany, hundreds of thousands of properties have been razed, with the land turned into parks,” proving again there is no free lunch. For every action, etc.
Most everywhere, “the era of high fertility is ending,” the Times reports:
That declining birthrate, coupled with a rapid industrialization that has pushed people from rural towns to big cities, has created what can feel like a two-tiered society. While major metropolises like Seoul continue to grow, putting intense pressure on infrastructure and housing, in regional towns it’s easy to find schools shut and abandoned, their playgrounds overgrown with weeds, because there are not enough children.
Expectant mothers in many areas can no longer find obstetricians or postnatal care centers. Universities below the elite level, especially outside Seoul, find it increasingly hard to fill their ranks — the number of 18-year-olds in South Korea has fallen from about 900,000 in 1992 to 500,000 today. To attract students, some schools have offered scholarships and even iPhones.
To goose the birthrate, the government has handed out baby bonuses. It increased child allowances and medical subsidies for fertility treatments and pregnancy. Health officials have showered newborns with gifts of beef, baby clothes and toys. The government is also building kindergartens and day care centers by the hundreds. In Seoul, every bus and subway car has pink seats reserved for pregnant women.
There are political repercussions, of course, especially with shifting ethnic populations in this diverse nation. And political challenges:
Many countries are beginning to accept the need to adapt, not just resist. South Korea is pushing for universities to merge. In Japan, where adult diapers now outsell ones for babies, municipalities have been consolidated as towns age and shrink. In Sweden, some cities have shifted resources from schools to elder care. And almost everywhere, older people are being asked to keep working. Germany, which previously raised its retirement age to 67, is now considering a bump to 69.
Going further than many other nations, Germany has also worked through a program of urban contraction: Demolitions have removed around 330,000 units from the housing stock since 2002.
In this country, consolidation in the cities has closed rural hospitals and created housing shortages in cities, with competition for eager buyers and unaffordability for paycheck workers.
Postscript:
About those little things reducing infant mortality. One of my clients was a former classmate. She came in one Monday looking tired and drawn. One of her twins had come down with a form of pneumonia infants get that landed her in the intensive care ward over the weekend. It was frightening, she said.
“Was it RSV?” I asked. Respiratory syncytial virus.
“Yes,” she said. “But they gave her this shot. It was like a miracle. It cleared up overnight and we took her home.”
“Synagis. Monoclonal antibodies. MedImmune. Frederick, Maryland,” I said. I’d done some design work on their biotech lab in Gaithersburg.
She looked me square in the eye and said quietly, “Thank you.”
Update: I’d reversed the cities above in the original post.