Philip Alcabes discusses myths of health, disease and risk.

Life Expectancy Goes Up but Risk-reduction lectures Continue

Bravo! to Rob Lyons at Spiked. Since it’s now apparent that life expectancy has increased almost everywhere and is at historic high levels in much of the developed world, Lyons asks the logical question:  why is the public health system still scolding everyone about what people eat and how fat the average person is?

A paper by David Leon in this month’s International Journal of Epidemiology showed the dramatic increase in life expectancy — the median age at death, that is.  It has reached over 85 years for women in Japan, but it’s high even in countries where longevity was relatively low a generation ago.  Cheeringly, US life expectancy at birth is now 78 years; in the UK it’s 80.  And it’s even higher in some countries of western continental Europe.  Here are the graphs for different parts of the world from Leon’s paper, showing trends since 1970:

Life expectancy since 1970

Lyons has gone after the anti-obesity crusaders before (as well as related topics at his smart blog on contemporary food confusion, Panic On A Plate).  Now, he’s particularly disturbed by the sermonizing about eating. “You can’t even have a pie and a pint without someone telling you it will kill you, it seems,” Lyons writes at Spiked.

And, really, it’s even worse than that — because it’s not just eating that’s the subject of the lecturing.  It might be true that you will live longer if you give up smoking, cut your salt intake, drop your BMI down to 24.99, exercise four times per week for at least 20 minutes each time, get immunized against flu and human papillomavirus, drink in moderation, and take naps.  But unfortunately there’s not a bit of evidence that any of that — apart from the decline in smoking — has contributed to increasing longevity.

And of course, even with smoking cessation, there’s no telling whether it would make any difference to you — only on average.

So why are the public health messages so far away from what really matters — basically, prenatal care, postnatal care, and wealth (with its concomitant, standard of living)?  Well, there’s a puzzle.

What’s the point of having an industry whose main aim is to make sure that people are constantly in fear that they are doing something that will kill them — even as it becomes apparent that most of what people do is only making us live longer?   Lyons calls it Good News Omission Mentality Syndrome (GNOMES).

I ask you:  could it have something to do with control?  And the desire to sell products?

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This entry was posted on Friday, March 25th, 2011 at 10:43 am and is filed under Behavior, Health Professions, obesity, public health, Risk. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

8 Responses to “Life Expectancy Goes Up but Risk-reduction lectures Continue”

tooearly says:

Why is prenatal care in your list? Do you have good evidence that it has contributed to longevity?

tooearly says:

“Prenatal care has not been demonstrated to improve birth outcomes conclusively. However, policymakers deciding on funding for prenatal care must consider these findings in the context of prenatal care’s overall benefits and potential cost-effectiveness. Cost-effective reductions in low birth weight deliveries may be beyond the statistical powers of detection of current studies.”

    Philip Alcabes says:

    You raise the question of the effectiveness of prenatal care in increasing longevity, Tooearly, but the one paper you cite is a review of studies from 1966 through 1994, and it was inconclusive about the role of prenatal care. To take your perspective, i.e., looking for controlled quasi-experimental or structured epidemiologic studies as evidence: the literature pointing to prenatal care as a determinant of reduced rates of low birthweight is voluminous. You might look especially at assessments based on very large datasets by Mathews and MacDorman, and references therein. In general, researchers acknowledge that it’s impossible to disentangle the specific impacts (“main effects,” in statistical jargon) of prenatal care, the settings in which prenatal care is given, prenatal nutrition, general health-care-seeking behavior, maternal age, and other sometimes-pertinent aspects of pregnancy. But nobody thinks prenatal care is a bad idea.

    More pertinent to my post would be ecological evidence: countries with long lifespans (high life expectancy) are generally those with low infant mortality rates. Countries with low infant mortality rates are generally those with free and easy-to-obtain prenatal care. Perhaps it’s a coincidence — but would you recommend that prenatal care not be offered?

tooearly says:

No, in general I think it is a good thing and I provide it regularly to my patients as I do well-child care and a host of other medical services which are , to my mind at least ,not conclusively linked to increasing longevity. Not sure i still see why you would choose prenatal care and postnatla care to highlight as examples of what really matters? I have no problem with the choice of the wealth.
Do you have a link to the Mathews and MacDorman assessments? Thanks!

tooearly says:

A good summary of this issue:
“The rising rate of low-birthweight births in the United States is a vexing and persistent medical
and social problem—but not an unsolvable one. There is growing consensus that the complex
issues surrounding LBW and preterm births call for a broad strategy, one that addresses a wide
range of risk factors. Just-in-time solutions—those introduced during pregnancy—are not
sufficient. Preventing LBW requires a lifespan approach to the health of women and men, one
that takes full account of socioeconomic and environmental as well as medical issues and
incorporates powerful public education campaigns (Johnson et al., 2006).”
So is prenatal care a good thing. More than likely. Is it one of the three most important issues confronting the public health? Don’t think the evidence supports that.

    Philip Alcabes says:

    We’re agreed that prenatal care is a good idea. You ask, skeptically, if it’s one of the three most important issues confronting public health. I concur in your skepticism — essentially because impairment of the public’s health is so dramatically influenced by wealth disparity and ancillary structural problems (e.g., housing inadequacy) that it’s impossible to know what else would be important. All determinants are overshadowed by the problem of poverty.

    The question I posed is a little different: I wondered, in the light of the finding that people are living longer than ever, what accounts for differences between wealthy populations and poor ones in life expectancy. Okay, one answer is obvious: the rich people are richer. What about the rest? Part of the difference is clearly infant mortality. Beyond funding for medical facilities, what else makes a difference to infant mortality? Prenatal care, including nutrition and simple safety for the mother.

    So no claim here that prenatal care is one of the most important solutions to public health problems. Rather, a simpler statement that it’s one of the (few) things that can be done to overcome differences in average lifespan between the wealthy and the not-wealthy.

Geof says:

I was having a brief look at your book and thought I would see what else you were writing about. Unfortunately you hang around with some strange bedfellows. Anyone who quotes Spiked Online should recognise that this bunch of reactionaries (formerly Trotskyites) have been harping on about the public being scared into supporting public health measures for years is their way of destabilising public health.
I had supposed you were offering us something better and slightly more refined. By the way they are funded – and to use the expression again – ‘in bed with’ corporations who sell us the junk that they (and since you agree with them ‘you’) tell us does people no harm. This is shameful of course but entirely fits in with their ideological system. They are not as whacky as Lyndon LaRouche but certainly travel in the same direction. If LaRouche was less mad these same companies would be supporting him in the US.

Of course population weight does matter, salt matters, etc. (and you should really check on the evidence before looking such a nincompoop) and I agree — lecturing people does nothing. Of course inequality should be addressed but tell me who else but the public health movement talks about equality?

If you want to associate yourself with reactionary contrarians that is fine. But don’t expect anyone in the public health movement in the US or internationally will give much credence to your ideas. That’s a pity because I had hoped you had something novel to say.

    Philip Alcabes says:

    You and I agree that reducing inequality ought to be a goal of public policy, Geof. Even if rejecting the received wisdom on risk makes me seem (as you say) a nincompoop, I stand by my epidemiologic assessments and my analysis of the failures of risk-reduction rhetoric to address more fundamental problems, like poverty. I’m pleased to know you read some of my book, and that it stimulated your interest enough for you to take a look at the blog. So, welcome.