Public health, private lives

In last Sunday’s Observer Professor Steve Field, chairman of the Royal College of General Practitioners, attacks our unhealthy, irresponsible lifestyles. "The truth is that too many of us neglect our health, and this is leading to increasing levels of illness and early death," he writes, clearly unaware of the recent announcement that death rates have fallen yet again (even in Scotland!) and that increasing numbers of us can expect to live into our nineties and beyond.

Professor Field berates us for not taking the repeated advice of doctors, scientists and official health campaigners to live longer by cutting out the stuff that makes us unhealthy. After all, who is unaware these days that smoking reduces your life expectancy? And yet, around 20 per cent of adults continue to do it.

Public health, however, use to be relatively straightforward. In 1901 a newborn British child could expect to live for 49 years (girls) or 45 years (boys). I say “expect”, but they probably didn’t expect the first and second world wars or, for that matter, hot running water, or the NHS. But 49 (or 45) years was what they got, on average.

This is largely because in 1901 14 per cent of those newborns would die in infancy. Read that again: 14 per cent. By 1930 it was 6 per cent. And today it’s less than 0.5 per cent. Simple public health measures like better hygiene and the conquest of infectious diseases, combined with improved nutrition and sanitation, saved millions of lives.

Between 1911 and 1915, 63 per cent of deaths happened before the age of 60. Today only 10 per cent of women and 15 per cent of men can expect to die before the age of 65. Chances are, you will be needing that pension after all.

Life expectancy in the UK is rising so fast that in the hour it takes to watch the production we’re performing at the Edinburgh Festival this year—Your Days Are Numbered: the maths of death—the average lifespan of the audience has risen by 12 minutes. So in effect, they’ve only expended 48 minutes enjoying topical comedy about maths and death.

In fact, other lifestyle decisions are less clear cut, medically speaking. Becoming enormously obese, or drinking like George Best, will certainly tend to reduce your life expectancy. But a closer look at the research reveals that those who regularly drink moderate amounts of alcohol are less likely to die than those who abstain completely. And being slightly underweight is worse for your life expectancy than being slightly overweight. A little of what you fancy does, quite literally, do you good.

But even where the science is clear cut, how far should we go to cut our life according to its (potential) optimum length? Is it not a matter of personal choice whether we choose to risk our life and health by indulging in pies, whisky and cigarettes (or, for that matter, canoeing, ecstasy and hang gliding)?

It may be frustrating for a doctor that we make their job harder by being so wilfully human. But the sole purpose of our lives should not be to make our doctor’s life easier. Life’s not a one-dimensional function, measured along the axis of time. What counts is the area under the curve.