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Monday, August 31, 2015

Dying and the Politics of Nostalgia

How we die has changed since the 1950s, and for the better

In a recent article, I discussed the nostalgia people many, especially on the left, seem to have for the economy of the 1950s. This debate came up again later in a social media discussion.

The conversation turned to disease and the claim that certain diseases are more common today so we shouldn’t count the availability of medication to treat those diseases as a gain for life today. This led me to look at the causes of death in 1950 versus 2013 just to see the comparison.

Here’s what I found:

Leading causes of death in the US in 1950 and their frequency per 100,000 people:

  1. Diseases of heart (355.5)
  2. Malignant neoplasms (cancer) (139.8)
  3. Vascular lesions affecting central nervous system (104.0)
  4. Accidents (60.6 – 27.1 were car accidents)
  5. Certain diseases of early infancy (40.5)
  6. Influenza and pneumonia, except pneumonia of newborn (31.3)
  7. Tuberculosis, all forms (22.5)
  8. General arteriosclerosis (20.4)
  9. Chronic and unspecified nephritis and other renal sclerosis (16.4)
  10. Diabetes mellitus (16.2)

Leading causes of death in the US in 2013 and their frequency per 100,000 people:

  1. Diseases of heart (193.3)
  2. Malignant neoplasms (cancer) (185.0)
  3. Chronic lower respiratory diseases (47.2)
  4. Accidents (unintentional injuries) (41.3)
  5. Cerebrovascular diseases (40.8)
  6. Alzheimer’s disease (26.8)
  7. Diabetes mellitus (23.9)
  8. Influenza and pneumonia (18.0)
  9. Nephritis, nephrotic syndrome and nephrosis (14.9)
  10. Intentional self-harm (suicide) (13.0)

I would just make a few observations about these two lists.

First, what’s disappeared over those 63 years?

“Certain diseases of early infancy” for one thing, and tuberculosis for another. Neither of those two make even the top 15 in 2013. That diseases of early infancy was the number 5 killer of Americans in 1950 should give us pause to think about how much better life is now than it was back then.

This is not even the bad old days of the 19th century or earlier. This is within the lifetimes of a good number of living Americans.

The near-eradication of tuberculosis is another huge gain for life today. Even the flu and pneumonia are half as likely to kill you today as in 1950. And of course the overall death rate is down from 963.8 to 821.5 per 100,000. Fewer people dying in general is a good thing too.

Heart disease and cancer remain at the top of the list, but heart disease death rates have been cut almost in half and the stroke rate is down. Diabetes and cancer are both up, the former being unfortunate but controllable for those who know they have it.

Cancer, of course, has risen because everything else has fallen. The more we conquer other causes of death, the longer we live and the more likely we are to die of cancer. Or, it should be noted, of Alzheimer’s disease. The shift over these 63 years is a movement from diseases that killed us prematurely to ones that kill us in our old age. Even diabetes is, arguably, a disease of affluence.

Nonetheless, age-adjusted cancer rates have been falling since the early 1990s, and survival rates are up.

The death rate from accidents has fallen as well, suggesting our world is safer today. The rate of death from car accident is particularly noteworthy, having fallen from 27.1 to (according to the Insurance Institute for Highway Safety) 10.3 per 100,000 people in 2013. If you account for the vast increase in the number of miles people drive, you are much less likely to die of a car crash today than in 1950.

Lastly, note what’s missing on both lists: murder. According to the FBI’s Uniform Crime Reports, the murder rate per 100,000 in the US in 1950 was 4.6. In 2013 it was 4.5. So nostalgia for the 1950s can’t even use an increase in violent death as an argument for the good old days.

Life today isn’t perfect. There are ways we could improve this comparison even more. But if you want to talk about health and medicine and get beyond the obvious increase in life expectancy, you have to consider data like these.

Death sucks, but when death increasingly comes from diseases of old age like cancer and Alzheimer’s, rather than the diseases of infancy, or infectious killers like tuberculosis, or even the age-independent accidental deaths, we should call that progress.

When we cut the death rate for the number one killer in half, that’s progress too. The medicines we have that did not exist then are a big part of that, and those should count as progress, even if we have to spend on them in ways we did not before.

Why anyone would want to go back to a world where the diseases of infancy and tuberculosis were top 10 killers and where you were twice as likely to die of heart disease is not at all clear to me. Spending pennies a day on my metoprolol and dyazide to control my blood pressure seems like the bargain of the century.

  • Steven Horwitz was the Distinguished Professor of Free Enterprise in the Department of Economics at Ball State University, where he was also Director of the Institute for the Study of Political Economy. He is the author of Austrian Economics: An Introduction.