Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

Photo of Michael J. Joyner, M.D.

The Politics of Life Expectancy & Lifestyle

Eventually the official retirement age for things like Social Security and Medicare is going to have to rise. The simple reason is that the ratio of workers to “retired people” will drop low enough (about 2 to 1 in the U.S. by the middle 2030s) that the programs will be unsustainable both financially and politically as younger generations balk at paying the bill for a wave of older baby boomers.


A related topic is that increasing the retirement age is fundamentally unfair to baby boomers who are less well educated and less well off.  The idea is that the big increases in life expectancy projected for the boomers will go mostly to people who are better off and stagnate for the less well off.  Also the US is not alone and the problem of keeping “state sponsored pensions” solvent is occurring all over the developed world.  There is no easy way out of this and none of the solutions like reducing benefits, raising the retirement age or raising taxes are exactly politically attractive.


Life Expectancy Differences: Who is Responsible?

The effects of socioeconomic status on life expectancy are also complex, but at least some of it has to do with straight forward behaviors like not smoking.   Incredibly, the poor who can least afford to smoke, continue to smoke at high rates while smoking among the well off and well educated has fallen dramatically:


“Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile.”


You can basically modify this paragraph for almost any relevant health behavior and come up with similar conclusions about who is “doing better” where; or what socioeconomic subgroup is following health guidelines about body weight, diet and exercise as well as smoking.


Sooner or Later

It is just a matter of time until Social Security and Medicare along with similar social insurance and state sponsored pension schemes in other countries will bump up against a demographic wall. So, in the discussion about the changes needed to keep these programs viable, at what point does personal responsibility factor into the policy discussion and political debate?  This is especially important because almost all key health behaviors are independent of access to medical care.



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