Living longer not the same as living healthy longer

Winnipeg Free Press logo

Originally published at Winnipeg Free Press


Of the terms used in the health-care lexicon, “compressed morbidity” is one of the more curious.

Though it sounds rather gruesome, it represents the optimal ending for beings of the mortal persuasion.

The term originated with Dr. James Fries, a professor at Stanford University School of Medicine. Compressing morbidity implies squeezing or compressing the length of time between the onset of chronic illness and death.

Let’s face the stark truth that nothing in life is more certain than our eventual death — taxes are a distant second, despite what Benjamin Franklin claimed.

Realistically, the best any of us can hope for is a long life with a relatively short period of morbidity at the end.

The glass-half-full corollary here is sometimes called “healthspan,” which is the healthy part of the lifespan. You can be excused for assuming that our healthspans have been increasing in lockstep with longer life expectancies in recent years.

Unfortunately, the evidence suggests we’ve been more successful at adding years of chronic illness to the end of life than adding years of health in the middle.

Many jurisdictions track a healthspan statistic called “health-adjusted life expectancy” (HALE) which measures the average length of time people can expect to live in a healthy state, essentially without illnesses such as diabetes, heart disease and cancer. For Manitoba, Statistics Canada reports a HALE of 67 for males and 70 for females, more than 10 years short of life expectancy.

A quick history of life expectancy for homo sapiens is in order here. Long ago, humans often died rather early — and quickly — from childbirth (both mother and child), trauma caused by accidents or conflicts, infections, contagious diseases, bacteria, viruses and parasites.

As Thomas Hobbes might have put it, life tended to be “nasty, brutish and short.”

Early in the 20th century, worldwide advances occurred in public health, which included immunization, pasteurization and chlorination.

Big increases in life expectancy came simply from more people making it to middle age, never mind old age.

Today, the biggest threats to our health are chronic diseases, with onset typically occurring in adulthood. These illnesses account for most deaths worldwide, but the incidence is even higher in developed countries such as Canada. Here, rates of chronic disease are now on the rise in the younger adult population as well, due to factors such as obesity.

So, is it feasible that we push out the onset of chronic illness?

The clear answer from the public health sector is that we can, with fitness, diet and lifestyle playing key roles. Most of us deal with these issues as daily challenges, though our success varies individually.

A more complicated question is whether delaying chronic illness actually shortens it or just shifts it out in time. In other words, if we can forestall chronic illness until we are, say, 80, will we simply experience its full wrath later?

The implications here are profound, including for health economics. Fries and others have argued the lifespan has certain limits, as evidenced by mortality rates that naturally accelerate as we age. Therefore, if we can extend our healthspan, we will necessarily bump into these lifespan limits, thereby compressing the morbidity phase of chronic illness.

Here, my thoughts turn to Ed Whitlock, whom I regarded as a modern-day hero.

Ed was the Canadian who rewrote the record book in masters distance running, most famously running a sub-three-hour marathon when he was 73 — and then again at 74. Sadly, Ed died last year at the age of 86.

While his lifespan was not exceptionally long, his healthspan was impressive.

In fact, he set another world record for his age group in the Scotiabank marathon just six months before his death.

We can’t live forever — and perhaps don’t want to — but health research tells us that postponing chronic illness can bring important advances in quality of life, even without extending total lifespan.

Health researchers may never win any awards for the terms they introduce — there’s probably no market for “compressed morbidity” T-shirts and collectibles — but the concept itself may lead us to health care’s pot of gold.

 


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