I have been reading a book on the “Other Renaissance”. We tend to associate the Renaissance with Italy. This book argues that many of the ideas came from Northern Europe. I was struck by the story of Nicholas of Cusa who was born near the Rhine valley in 1401. He was clearly a genius and a polymath. Amongst other things he is credited with the invention of reading glasses. He enabled generations of older scholars to carry on working and writing. I am personally grateful to him!
He was ahead of his time in understanding that science can never truly understand a phenomenon. As he put it:
“ As a polygon inscribed in a circle increases in number of sides.. so the mind approximates to truth but never coincides with it… Thus knowledge is at best conjecture”.
The Other Rennaissance by Paul Strathern
The quote came to my mind when reviewing the latest data on UK life expectancy.
The UK Census takes place once every ten years. It gives an accurate measure of the size of the population and the age profile. Between the Censuses there are estimates published. These are based on births, deaths, and estimated migration. The 2021 Census produced an interesting finding. There were 300,000 LESS people than the extrapolations based on the 2011 data. The overestimate was not evenly spread. The biggest over-estimates where in the young and the very old.
A recent guest blog for the International Longevity Centre highlighted the implications.
Living Longer.
In the early decades of this century life was extending by over 2% per year. There was already some concern that this number was plateauing. Estimates suggested that it might have fallen to 0.5% per year. It is not obvious but these numbers depended on the estimates of the size of the population.
To create life expectancy numbers actuaries calculated a mortality rate. This is the number of people of a given age who die, divided by the number of people of that age. Age of death is captured from death certificates. The mortality ratio therefore hinges on the very estimates that have now been shown to be wrong. Except of course in the year of a census.
When the new population data was incorporated any improvement in life expectancy disappeared. During the decade leading up to the Covid epidemic life hardly extended at all. Improvements stalled.
Predicting the Post-COVID Future
COVID created a major problem for the actuaries and statisticians. They are charged with forecasting mortality rates. During the peak years “excess” deaths were huge. These are deaths compared with a five-year average pre-COVID. Most forecasters are now ignoring those COVID years. What is worrying is that there were still “excess” deaths in 2022 and 2023. No one knows whether this is still an aberration or the start of a long new run trend.
UK “Excess Deaths”
The World Health Organization declared the COVID pandemic to be over on May 5th, 2023. However the UK Office for National Statistics estimates there were still excess deaths. In fact 44,255 more deaths in the UK in 2022 than would have been predicted from the five years pre-COVID. That is a 7.2% excess. The comparable number for the first half of 2023 is 8.6%, when COVID was supposed to be over The causes of these excesses could be many.
There are still people who after a long fight are losing the battle against COVID itself. The NHS is still under considerable pressure. That can itself cause problems. Early detection of chronic disease may have failed. Even if patients make it to hospital the pressure may result in poorer care. All have been implicated. The result is probably some combination although there are indications in the data.
Excess deaths are not concentrated where COVID hit the hardest. Instead the peaks are in the young (20-24) and middles aged (45-64). Surprisingly respiratory diseases are only part of the story. Heart diseases of all kinds show abnormal increases. Particularly heart failure. So too do renal diseases and diabetes. Deaths from respiratory diseases where 44% above the pre COVID trend for the middle aged. Deaths from heart diseases were at the same level. Far more people died at home rather than hospital compared to before COVID.
COVID may not have finished with us.
All of the UK data suggests that many of the existing theories only offer partial answers. We could blame our National Health Service but this is not only a UK problem. Most Western countries are still showing excess deaths above pre-COVID levels. The EU as a whole is still showing excess mortality. There are huge variations across countries. In October 2023 seven EU countries reported no excess deaths. Twenty countries did. The highest rate was in Finland at 19.8%. Ireland was at 17.8% and the Netherland at 15.1%. These numbers are nowhere near the peaks within the Covid pandemic. However they are high. Th UK does reasonably well by comparison.
Actuaries can worry whether this is a new trend to be modelled. For the rest of us we need to be concerned about the cause and whether it is temporary or permanent. in any case we need a new impetus for life expectancy. It can come from medical innovation. It can come from changing our behaviour. It can come from reducing inequality. Reducing the twelve year gap in life expectancy between the most and least deprived in the UK.