AVERAGE life expectancy in the year 1900 was 49 years the figure than today is slightly better 75 years. It is widely as summed that this impressive improvement has been effected by modern medicine, improved standards of nutrition, and good hygiene practices.
Among these three factors, pride of place is given to modern medicine. But there is evidence to indicate that modern medicine, nutrition and hygiene have not played such leading roles in improving life expectancy. The American epidemiologist Leonard Sagan (The Health of Nations, Basic Books, 1987) and others argue that our improved longevity is mainly due to psychological factors which have developed and strengthened over the past 150 years.
Sagan quotes lifespan statistics among different social classes in Britain. Before the introduction of the National Health Service in 1946, the lowest socioeconomic groups had long experienced much worse life expectancy compared to the most affluent groups.
This effect was assumed to be caused by economic barriers preventing poorer people from access to medical care. But today 50 years later, the relative disparity in life expectancy between the most affluent and the least affluent groups in Britain remains, despite open access by all to full medical care.
The introduction of antibiotics into clinical medicine during the 1940s is generally reckoned to mark the turning point in human kind's fight against infectious diseases.
Clearly, diseases such as tuberculosis and typhoid no longer claim lives at the rate they did in the past. But death rates from these diseases had been declining in Scandinavia and the English speaking countries since the middle of the 19th century, long before antibiotics were available.
By the time the first antibiotics were introduced, the death rates had dwindled to a mere fraction of what they once had been.
Antibiotics were spectacularly effective for a time after their introduction. But by now their effectiveness has been seriously compromised by over prescription by the medical profession. Antibiotics are frequently administered to treat, colds and flu, although there is no evidence they have any effectiveness in such cases.
Over prescription of antibiotics allows the bacteria against which these drugs are directed to gradually develop resistance against the drugs.
Immunisation is also widely believed to enhance life expectancy. There is no doubt vaccines against infectious diseases such as polio, whooping cough and diphtheria do protect people from these diseases and so save lives and spare many people permanent disabilities, but there is little evidence that immunisation has caused a decline in overall mortality rates.
Deaths from whooping cough, measles and diphtheria, for example, were already under control by the end of the second World War when vaccines began to appear. That said, vaccination of children is very important. Childhood illness is traumatic for both parent and child the fear of such illness is also a big burden and if the risk of death is small, it is nonetheless real.
Cancer has been under intensive medical attack for the past several decades. Progress is claimed in the fight against it by pointing out that the average interval between cancer diagnosis and death has increased significantly in recent years. But this effect may be explained, at least partially, by the fact that the disease is now usually diagnosed at an earlier stage.
Although some cancers respond well to treatment for example, the relatively rare cancers of childhood age adjusted cancer mortality statistics for the United States show little change over the past 50 years.
It is not my purpose here to support claims that medicine is of little value. There are many things it can do very well. Chief amongst these, in my opinion, is the repair of things mechanically broken in the body and the surgical removal of things either causing obstruction or not functioning properly.
Modern medicine can greatly improve the quality of life. Examples range from the soothing of an itch to the control of serious mental illness by a mini altering drug. Immunisation relieves childhood of the distressing experience of many infectious diseases and undoubtedly saves lives. But it is not as clear, as is widely assumed, that medicine has played such a prominent part in improving life expectancy.
Neither is there conclusive evidence to show that improved nutrition or better hygiene standards are responsible for improving life expectancy. For example, it has been noted that in past ages, when general life expectancy was low, members of royal families also lived short lives. It can be safely assumed that they did not lack for adequate nutrition.
Also, it is pretty well established at this stage that a meagre diet, once it is above a certain minimum level, promotes rather than hinders longevity. On the question of improved hygiene, it has been noted that, once mortality rates from certain infectious diseases began to decline 200 years ago, this decline continued despite prolonged periods of deterioration in hygiene standards associated with the development of urban slums.
So, to what does Leonard Sagan attribute the remarkable improvement in average life expectancy over the past 150 years? As life expectancy improved, average family size decreased, positive and loving interest in children's welfare increased. In past ages, children were begat largely out of a sense of duty they tended to be regarded as property assets, and strict discipline and obedience were emphasised.
The recognition that childhood is a special stage of development at which people should be nurtured with loving care is historically a recent development.
Children who are loved and looked after thrive physically and mentally, compared to children who do not receive such care. Many studies demonstrate this. Also, the modern man or woman feels much more secure in the world than people did in ages past, when no average person could feel he or she had much control over their life. This must have produced incomparably greater stress than the average person will encounter today.
Imagine how you would feel as you buried your child while at the same time glancing nervously over your shoulder to check how your but and your crops are coping with the uncontrollable floods. Makes the modern rat race look pretty tame doesn't that argument, in a nut shell the enhanced self esteem, self confidence and feeling of security which has been nurtured in people over the past 200 years has improved natural resistance to debilitation and disease, and has been largely responsible for increased life expectancy.
If this is the case, it follows that society will be much more successful at promoting positive health and further improved life expectancy by providing all the necessary supports for secure and happy family life rather than by throwing ever increasing resources at high technology medicine.
In this respect, some current trends are worrying. High rates of breakdown in marriage and of children born to teenage unwed mothers are rife in some countries. We have nothing to be complacent about in Ireland. At present, 20 per cent of births here are to single mothers. The corresponding figure for 1988 was 11.7 per cent and for 1961 it was only 1.6 per cent.
While it is undoubtedly possible for both mother and child to prosper in every way in such cases, it is equally true that the odds in many instances are heavily stacked against such an outcome.