A fantastic graphical representation of this is "The Conquest of Pestilence in New York City", produced by the Department of Health & Mental Hygine, showing progress from 1800 to 2002:
This tracks mortality (rather than life expectency), but shows clearly the tremendous progress made from 1850, with a peak mortality rate approaching 50 deaths per thousand peak (from a baseline of ~30 - 40 per mille) to about 12/mm in 1920, and the present rate of about 6/mm.
From 1950-1970, and for a briefer period in the 1980s, progress was reversed with mortality increasing. There's actually been an impressive (though small realtive to 19th century improvements) reduction since 1990.
Looking at that chart, realise that virtually all the improvement through about 1950 precedes most of what we consider to be modern medicine: advanced cancer treatments, antibiotics, most vaccines, transplant surgeries, genetic therapy, pacemakers, and more. The progress instead comes mostly through increased sanitation and hygiene, as well as reduced environmental contaminations and hazards, though it includes both antisceptics and anesthesia.
We've been paying a tremendous amount in medical advances for a very slight improvement in outcomes.
Wouldn't you really need a log scale or further interrogation to make that claim? To me it seems mortality dropped about 40% in last 50 years which is quite substantial.
Absolute vs relative improvements, vs cost of attainment, are two different questions. The largest overall reductions, and increases in life expectancy, come from very basic interventions.
The problem w/ efficiency measures generally is that there's progress to some theoretical maximum, and it comes with diminishing returns.
Breaking down life expectancy gains by demographics, the've moved more for men than women (since 1920, far more the reverse before), largely due to workplace risk, violence, and military service), and the poor/minorities rather than wealthy/majority (access, preventive care, environment, violence, stress).
The upper bound's moved little. Exceptional longevity is profoundly correlated geographically with poor recordkeeping.
Note that whilst at-birth increases (1850) from about 40 to 80, a 40 year old gains only 67 - 82 or so (15 years). It's early-life mortality that's changed most.
There are also hidden costs: mortality is selective pressure, and we've lifted much of that for about 5 generations. I have concerns. (I'll also note this generally impacts the wealthy more than poor, within and between countries.)
It looks like the decline at the end of the 19th century coincides with our ability to vaccinate against cholera, diphtheria, smallpox, and the other major epidemics listed on the chart.
- Sewerage systems (New York's came relatively late).
- As the somewhat provocative title of this article suggests, draining of swamps and other means of disease vector control.
- Refrigeration. General food safety improvements.
- Pasteurising milk. That would cut the transmission of TB markedly.
- Indoor plumbing.
- Indoor bathing -- showers and baths.
I haven't seen a breakdown. Laurie Garrett (NYTimes contributor) has long written on public health and epidemics, had a couple of books in the 1990s / early 2000s:
http://1.bp.blogspot.com/-uTWEATUzgxk/TXQoTibILtI/AAAAAAAAAA...
This tracks mortality (rather than life expectency), but shows clearly the tremendous progress made from 1850, with a peak mortality rate approaching 50 deaths per thousand peak (from a baseline of ~30 - 40 per mille) to about 12/mm in 1920, and the present rate of about 6/mm.
From 1950-1970, and for a briefer period in the 1980s, progress was reversed with mortality increasing. There's actually been an impressive (though small realtive to 19th century improvements) reduction since 1990.
Looking at that chart, realise that virtually all the improvement through about 1950 precedes most of what we consider to be modern medicine: advanced cancer treatments, antibiotics, most vaccines, transplant surgeries, genetic therapy, pacemakers, and more. The progress instead comes mostly through increased sanitation and hygiene, as well as reduced environmental contaminations and hazards, though it includes both antisceptics and anesthesia.
We've been paying a tremendous amount in medical advances for a very slight improvement in outcomes.