Peak health?

Something I’ve often wondered about before, and now a paper’s been published that touches on it (in terms of cardiovascular health, at least).

What happens next, in terms of life expectancy, in the developed world? First of all there was sanitation and better housing to reduce the disease burden from infectious diseases. And immunisation, of course. Then economic development and societal changes drive gains from the third stage of the demographic transition (ie better maternal and childhood nutrition reaps more healthy years of life decades later in the lifecourse). And we start to identify some of the big risk factors for disease, and belatedly, deal with them in a meaningful society-wide way (eg smoking bans).

Some of the benefit from these changes is yet to filter through to the life expectancy figures of course, but the era of big improvements is probably drawing to a close. Meanwhile, an overweight younger generation is coming through which is steadily accumulating a hefty burden of future cardiovascular risk.

So how are we going to sustain those improvements in life expectancy in the future?

It may not be that bad, of course. There are some signs of serious effort and intent to reduce childhood obesity in the UK, for example. And still plenty of scope to improve cancer survival in much of the developed world. But still- there will come a point, probably not that many decades away, when all the easy health gains will have been “mined”. Nor will any of the old health threats be far away, being kept at bay in the developed world by lots of complex, interdependent and potentially vulnerable sociotechnical systems.

Big new breakthroughs may keep the graph trending up, of course. There have been plenty of exciting new biotechnologies in the headlines over the years, but as great as the long-promised gene therapies may be, there’s nothing immediately on the horizon that can really drive big population level health gains. There seems to be a good chance we may hit peak health before anything like that arrives.



Hulsegge G, Susan H, Picavet J, et al. Today’s adult generations are less healthy than their predecessors: Generation shifts in metabolic risk factors: the Doetinchem Cohort Study. Eur J Prevent Cardiol 10 April 2013; doi: 10.1177/2047487313485512.

(as summarised here)


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