Source: The Weekend Australian, 16 August, 1997, (Australia Today: An 8-page special) p.8


Living longer takes its toll

Chronic disease is taking some of the shine off increases in life expectancy rates,
reports medical writer JUSTINE FERRARI

   BABIES born in the closing years 
of this century can expect to live 
almost twice as long as babies born 
100 years ago. However, the 
pay-off for longevity is living with 
a chronic disease or disability.

   Australians are living longer, with 
the average life expectancy for men 
rising from about 51 years at the 
beginning of the century to 75 
years in the 1990s.

   Women continue to outlive men 
and the gap in life expectancy 
between the sexes has widened, 
with women living an average 54 
years in 1900 compared with 81 
years today.

   But as the population has aged, the 
level of illness has grown.

   The lightning strike of deaths 
caused by infectious diseases or 
childbirth has been replaced by 
chronic, degenerative diseases, 
such as cancer and heart disease, 
which march more slowly towards 
death.

   The gains in life expectancy in the 
first half of the century were largely 
a result of rapid declines in
deaths from infectious diseases and 
improved maternal and child 
health.

   Better nutrition and public 
infrastructure such as a clean water 
supply, sewerage and improved and 
less crowded housing assisted 
medical advances in antibiotics and 
vaccines to keep infectious 
diseases under control. Polio, 
tuberculosis, bubonic plague-
even influenza, pneumonia and 
whooping cough were far more 
lethal.

   Advances in medical treatments 
have been important. particularly 
in making childbirth safer and 
causing infant death rates to 
plummet, while improved education 
standards have aided people's 
ability to understand and adopt 
good health practices.

   Injuries were a common cause of 
death in the first half of the century 
with unsafe working conditions the 
main culprit, but any 
improvements have been offset by 
the rise in deaths from car 
accidents, which only recently 
have started to drop, and a rise in 
suicide rates.

   The increase in life expectancy 
slowed during the 1940s and 1950s 
and even reversed in some age 
groups because of a dramatic rise in 
heart disease and lung cancer caused 
by smoking.

   Chronic diseases such as cancer, 
heart disease and musculoskeletal 
conditions like arthritis and 
osteoporosis have become more 
prominent as people live longer.

   Cardiovascular disease, particularly 
deaths from heart attacks and 
strokes, rose after World War II and 
peaked in the 1960s.

   While Australian Institute of Health 
and Welfare researcher Colin 
Mathers says some of the rise was 
due to changes in diagnosis, there 
was a real increase related to 
changes in lifestyle-the 
introduction of saturated fats and 
processed foods into the diet, 
smoking, less exercise and the 
weight that Australians, like other 
developed nations, continue to 
stack on.

   Cancer has remained fairly static, 
affecting about the same 
proportion of the population, but 
as more people live into old age, 
the actual number of people with 
cancer has surged.

   Some cancers have increased 
dramatically because of lifestyle 
changes, with smoking 
responsible for an 11 fold increase 
in lung cancer deaths among 
Australian men between World War 
II and the 1980s.

   The number of years spent suffering 
a disability that limits everyday 
activities has increased with longer 
life, rising from almost 14 per cent 
of people to more than 16 per cent 
just over the past decade.

   Similarly, the number of people 
suffering a long-term health con-
dition (one lasting more than six 
months) rose from one in two 
people in 1978 to two in three in 1990 
to three in four in 1995. The average 
number of conditions also rose 
from 1.78 per person in 1978 to 
2.25 in 1990. While some of the 
rise in morbidity is slated to 
improved diagnosis and greater 
awareness of diseases, real 
increases have occurred in asthma 
during the past 20 years-with 
asthma symptoms now affecting 
one in five schoolchildren-and in 
mental illness, particularly 
depression.

   The incidence of heart disease has 
started to fall, but cancer will 
remain a significant cause of 
illness and death into the next 
century.

   Lower levels of immunisation mean 
infectious diseases still pose a 
threat and the recent emergence of 
new viruses highlights the need for 
eternal vigilance against the 
microbe world.

   Scientists have hypothesised that 
the biological limit of life is about 
85 years, but so far Australian life 
expectancy shows no sign of 
slowing down with death rates 
falling in older people as well as 
among the young.

   But as people continue to live 
longer, the real challenge, as the 
Gerontological Society of America 
succinctly puts it, lies in adding 
life to years, not years to life.


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