In previous Newsletters I have pointed out the constraints of thinking in terms of countries. It leads us to focus on country averages. I have shown that a city focus gives a different perspective. There are old and young cities in all countries (Newsletter #032 The Power of the Cities). There are cities in China that are already older than the retirement communities in Florida. The McKinsey Health Institute has recently published “Pixels of Progress”. They have broken the world into 40,000 microregions. Each is only about 30,000 sq Km and have around 180,000 inhabitants. At this “micro level” our perspective changes again.

The Mapusa micro region is on the historic trading route to Goa, India. It has the same level of prosperity as Porto, the second city of Portugal. Both have a GDP per head of $33,000. India and Portugal have hugely different prosperity levels as countries. There are 360m in China living in 8 regions that have a life expectancy of 78.7 years. That is close to a quarter of the population. India is often thought of as a very young country. But there are 34m people in Kerala and Andaman and Nicobar who now have a life expectancy of 76. This is higher than many microregions in the US.

Prosperity does not grow evenly.

It is generally accepted that life expectancy follows prosperity. Even within countries economic growth is not spread evenly. Half of all economic global growth in the last twenty years has come from only 3,600 microregions. That is less than 10% of all McKinsey defined regions. Surprisingly those regions are spread over 130 different countries. Mapusa in India is one of those micro regions. They account for less than 1% of the earth’s landmass. The world population has increased by 1.5BN in the last twenty years. Half of those people are concentrated in microregions representing just 1.1% of planetary landmass. There are pockets of prosperity everywhere.

McKinsey organized their regions according to prosperity. There are 228m Chinese in the top two global deciles of GDP per head. They live in 194 prefectures. There are 311m Americans in those same deciles in 2600 counties. Bao’an in Shenzhen has the same real GDP per head as Queens in New York.

Progress is being made. The top 5% of all microregions have an average GDP per head of $45,000. They have a life expectancy of 79.5 years. In 2000 that small group of micro regions contained 85m of the world’s population. By 2019 that had become 440m. The bottom thirty percent in prosperity and life expectancy had shrunk. It had gone from 1.1Bn down to 405m people.

Life Expectancy is Improving.

The microregions provide a different perspective on life expectancy changes. Across all microregions the gap in life expectancy is shrinking. In 2000 there was a 30-year gap in life expectancy between the top 5% of regions and the bottom. By 2019 that gap had shrunk to 23 years. The bottom microregions are catching up. The curve for those with higher life expectancy is widening. There are more people living to older ages. There are, however, more people falling behind the curve. Prosperity has a downside. Everywhere you look at the microregional level there are pockets of healthy ageing people.

Unpicking Prosperity and Innovation in Medicine

There is sufficient data to unpick a fundamental problem. There is a strong relationship between prosperity and life expectancy. But there is something else going on. There are lots of places where longevity is increasing but prosperity has hardly grown. There is another major factor at work. Innovation in health science is providing the same longevity benefit at lower cost.

We think of innovation as new medicines. Some of the latest immunotherapy cancer treatments are specific to an individual. The costs can be £60,000 per person per year. There is a different kind of innovation going on. The efficacy of drugs is increasing. It is lowering the cost per person of achieving the same health result. Innovations in public health and nutrition are doing the same thing.

The McKinsey Health Institute was able to unpick the problem. It turns out innovation is providing nearly half of all life expectancy improvements. Even regions with no increase in prosperity can afford more “medicine”. Innovative “health technology” is improving longevity benefits everywhere. The health of the whole world is rising on a tide of innovation.

A Country Fit for All Ages

In last weeks Newsletter I talked about Singapore. How the Government is making it a better place to live for older citizens. It seemed a logical thing to do when faced with 25% of their population over 65 by 2030. For many other countries that might seem a distant problem. The tyranny of averages hides reality. There is virtually no country in the world that does not have ageing micro regions. They are prosperous and that brings with it an increase in life expectancy. Their populations are ageing healthily. They face the same challenges as the citizens of Singapore.

For those countries the problem is far more complex. They also have regions with low prosperity and life expectancy. They need the programs to speed up “health technology transfer”. They need programs to reduce economic inequality. They need to focus on youth employment. At the same time, they have other regions where the focus should be on the old rather than the young. That is compounded by internal migration. In places like Italy and Spain the young are migrating to more prosperous areas. They are leaving the countryside. All that remains are the old people.