How do we measure human prosperity? Doctors might choose health over wealth. So might patients. The people of Bhutan might choose happiness, being by some accounts the happiest people on our planet. In Japan, long life is expected – as is a long working life. A general practitioner aged 107 years is still in practice in Tokyo. Elsewhere, generational gains on life expectancy continue relentlessly. But progress isn’t inevitable. In the United States, wealth and high expenditure on healthcare have not delivered expected improvements in life expectancy. Indeed, worsening or stalled health indicators are likely to signify deeper and broader problems.
In a pair of remarkable papers published in this issue of JRSM, Lucinda Hiam and colleagues examine the life expectancy changes in England and Wales between 2013 and 2015. Surprisingly, they identify that the long-term decline in mortality, standardised by age, was reversed, and the death rates increased in 2015. By their calculation, 30,000 extra deaths occurred compared with the expected number based on the trend from 2006 to 2014.1
The authors estimate that these excess deaths were largely in the older population. But why should this happen? The authors examine the causes in an accompanying commentary and argue that since the deaths were among people most dependent on health and social care, the failings of the health and social care system are contributors.2 These are controversial claims in a political climate of restricted funding of health and social care, and bitter disputes about the effects of the government’s austerity measures.
One effect of austerity might be on allocative value, which Muir Gray et al. describe as how well assets are distributed to different subgroups in the population.3 While these ‘allocative’ decisions are difficult, the authors argue that clinicians must be involved in decisions about allocation of resources and feel a sense of stewardship. Another effect might be the promotion of miracle cures. Iain Donaldson describes the scientific work and intrigue that accompanied a Royal Commission’s debunking of Anton Mesmer’s claims about the cure-all benefits of Animal Magnetism.4
References
- 1.Hiam L, Dorling D, Harrison D and McKee M. Why has mortality in England and Wales been increasing? An iterative demographic analysis. J R Soc Med 2017; 110: 153–162. [DOI] [PMC free article] [PubMed]
- 2.Hiam L, Dorling D, Harrison D and McKee M. What caused the spike in mortality in England and Wales in January 2015? J R Soc Med 2017; 110: 129–135. [DOI] [PMC free article] [PubMed]
- 3.Gray M, Wells G and Lagerberg T. Optimising allocative value for populations. J R Soc Med 2017; 110: 138–143. [DOI] [PMC free article] [PubMed]
- 4.Donaldson IML. Antoine de Lavoisier's role in designing a single-blind trial to assess whether ‘Animal Magnetism’ exists. J R Soc Med 2017; 110: 163–167. [DOI] [PMC free article] [PubMed]