LIFE EXPECTANCY VERSUS HEALTH EXPECTANCY
Prof B M Hegde
Vice Chancellor
MAHE University
Manipal - 576119
Modern
hi-tech medicine claims that it has increased human life expectancy. In
fact, the life expectancy started increasing with better food supply, control of
communicable diseases, and better education of the masses making them live a
healthier life style. In developing poor countries life expectancy could have a
quantum jump if only infant mortality
comes down. Life expectancy is
a statistical term, which does not mean that human
life span has increased in this century due to all the hi-tech stuff that we
are trying to sell to the gullible public! On the contrary, life span has, if
anything, come down from the usual 120-140 years that some of the aboriginal
races in certain pockets of the world still enjoy. It is now estimated that the
average American life expectancy can not go beyond 89 years even in the next
millennium.
What
is life expectancy ?
What
is life span ?
The
maximum number of years any species (Homo sapiens) could live is called life
span. This is fixed, as early as the day one is made in the mother's womb,
in the genetic material. This can not and would not change with even the highest
tech. efforts. The Hayflick's rule gives each cell its maximum capacity to
reproduce and apoptosis tells the cells when to die (in certain cells like
the heart muscle cell there is no apoptosis under normal circumstances). Recent
efforts to increase the life span by genetic engineering also have come to
naught, as senescence could not be halted in those modified cells. It is no use
having a 150-year-old very senile vegetable in society! The latter would be a
burden on society, any way. Life span has remained the same since the dawn of
the human race.
What
is health expectancy ?
It
is the time interval between birth and the end of healthy life-before
the onset of any major incapacitating illness. Man is healthy only when he is creative in society. Absence of physical illness
is not the complete definition of health. In fact, many people with physical
diseases are more creative, and consequently healthier, than their counterparts
in society without any physical disease, but having no enthusiasm.Thus
defined, health becomes a very useful commodity in society. In fact, healthy
people in society could even make society more tranquil. Crime of every kind
from petty theft to murder and terrorism are all signs of disease (dis-ease)-not
of the body but of the mind. Mental illnesses are not only depression and
schizophrenia. Aberrant behaviour patterns should also fall into that category.
Now
let us critically examine if the present day scientific hi-tech methods have
increased health expectancy in society. The most advanced country in the world,
United States of America, probably is the most
unhealthy country in the world with the lowest health expectancy. Health screening surveys there have shown,
in larger cities like NewYork, that every other man
had either high blood pressure, heart disease or diabetes. There is
hardly anyone who has not seen a doctor for a major illness or has had some
surgical procedure done on him or is taking some kind of a medicine or the other
at a given time. Crime is on the increase, novel methods are being discovered
now and then. Even high school students resort to shooting their own classmates
in school!
Time
has come for us to ponder over this tragedy very seriously. Professor Eiesenburg,
an American professor of medicine, recently wrote to say that a
truly well man is not available in America. If all the available screening
tests are used on every American all of them will have some sort of an
abnormality or the other requiring intervention. In an interesting article
The Last Well Man the author, an American doctor, laments on the present
state of the art in this field.
Our
aim should be see that majority of people in society have at least half their
lifetime free of disease. Next millennium should aim at having the populations
health expectancy come up to, at least, fifty years.
What
are the prerequisites for attaining decent health expectancy ?
Clean
water, adequate food supply, care of the pregnant women, adequate pacing of
pregnancy, universal literacy so that every one has access to information,
avoiding tobacco and alcohol, avoiding dependence on others for any reason
including religion, avoiding unhealthy competition in life which begets
hostility, hard physical work or regular exercise for all,
proper immunization methods in childhood, trying to live in a clean
atmosphere without excess pollution, controlling the world population by
reassuring the poor man that his children need not die prematurely in the new
set up rather than selling contraceptive methods to him, empowering the poor man
economically by narrowing the gulf between the haves and the have-nots in
society and bringing up children, especially our adolescents, correctly should
go a long way in achieving the health expectancy for the population of, at
least, 50 years.
To
cap it, we have to make man more tranquil by the ancient Indian methods of
meditation and breathing techniques; the latter go a long way in postponing the
onset of illness thereby increasing health expectancy. Prevention is
better than cure may not be true always, but changing the mode of living
of people is definitely cheaper than both the former. Hope we channalise our
efforts in this direction rather than continuing the rat race of more and more
technology for fire fighting (curative methods). The fire fighting hose seems to
be perpetually short of its target!
Trying
to change the mode of living of society is much cheaper in the long run and more
effective than screening large populations for diseases and then trying to set
them right. There is no guarantee that the change in the initial state of the
organism (man) due to drug treatment or surgical intervention of the apparently
healthy population is going to do good in the long run. Human body does not
follow the linear mathematical rules! To give a concrete example: if one brings
down the mildly elevated blood pressure in an apparently healthy man might not
do any good; on the contrary it may do more harm due to the side effects of long
term drugging. Whereas trying to change his mode of living might bring the
pressure down by the natural means for the long term good of the victim. Similar
is the story with diabetes or even cancer.
Screening
large populations is prohibitively expensive and only increases anxiety in
society resulting in large-scale sick absenteeism. In a well-researched
editorial in The Lancet the authors make out a good case against screening. The
heading is very interesting to read: Do
Epidemiologists cause Epidemics? I
think they do! At the same
wavelength is an editorial in the British
Medical Journal entitled Screening
Could Seriously Damage Your Health. I must congratulate the authors for
their courage! They could not be more correct.
Why
do we, then, advocate routine screening of health people ?
I
strongly feel, I may be wrong though, that is how the medi-business thrives. If
the medical establishment were to tell the public the truth, the whole truth and
nothing but the truth, then we should be content with treating the sick
population only. There may be only a few million clients for the curative
business at any given time. If on the other hand, we target the whole population
there is a huge stock of six billion to draw from. The latter makes lot of
business sense. Logically the latter is better business. The multibillion-dollar
drug industry, equipment manufacturing industry and also the corporate hospital
industry should thrive on this business and it makes sense that they target a
larger clientele.
Well
meaning NGOs and the governments of the poorer countries should read the writing
on the wall that hi-tech top heavy modern medical interventions are not a
panacea for man's ills but are a good quick fix for mending damaged organs. The
long-term outcomes are anybody's guess. Doctors have been predicting the
unpredictable! Let us put our heads together to see how best we could change the
mode of living of man in the present world of cutthroat competition.