I tell you that average life expectancy in ancient Rome was 25 years, what kind of Society do you imagine? How many 40-year-olds? How many 60-year-olds?

I am fortunate enough to be a Trustee of the Royal College of Physicians. It was founded in 1518 by Henry VIII. Its role is to ensure professional medical standards. Fellowship of the College is its highest accolade. We can look at the life expectancy of those fellows over the centuries from the college records. Between 1500 and 1640 their life expectancy was 67. Between 1720 and 1800 it was 63 and from 1800 to 1840 it was 72. We can go further back with other data. The ancient Roman philosophers, poets and politicians lived between 30BC and 120 AD. Their average life expectancy was 56. The kings of Judah between 1000 and 6000 BC had an expectancy of 52.

Alternative Perspectives

A population pyramid is far from a normal curve. It is “distorted” by the deaths of the children. Especially the under-fives. These destroy any idea of a mean or average. It can distort our view of the adult experience even of something as recent as the Victorian era.

Last weeks chart of American data probably applies to the Victorians. In the US, even in 1750 if you made it to 45 you could live until 70. In Victorian Britain there would be massive differences between the economic strata. Your life as a parent would be full of death. The death of your children. Archbishop Tait, the Archbishop of Canterbury, lost five of his seven children in five weeks in the 1850’s. They all died of scarlet fever. Death came quickly and many children died within a single day. It had respect for wealth, rank ot status.

If you had survived childhood infectious diseases, there were still bouts of contagious disease to contend with. Cholera arrived in the UK in 1831 and was known as an “Asiatic disease” because it was new and foreign. It was followed in 1837 and 1838 by epidemics of influenza and typhoid. Childbirth was a lot more dangerous. Death rates were as high as breast cancer today. Accidents at home and at work were much more common. Victoria England did not have the “Health & Safety” regulations of today.

There is good news. There is evidence that many cancers were less prevalent than today. The industrialization of cigarette smoking did not arrive until the 1890’s. This is when the manufacture of cigarettes was mechanized. Processed foods were unknown. They did not need to restrict their consumption of red meat to 70g per day! (Recommended to avoid bowel cancer). Some argue that asthma and allergies were less common. They point out that the population ate a lot more yeast. It was still in the bread and the beer that they consumed. This helped to avoid allergies. Most people were a lot more active and worked longer and harder hours. Obesity is a modern “invention” even though they were consuming 4000 calories a day.

A Perspective on the Power of Medicine

The increase in life expectancy around the world in a generation is rightly one of mankind’s greatest achievements. The largest and earliest successes were against contagious diseases. Sanitation improvements, anti-biotics and immunization have irradicated diseases. A recent study looked at thirteen developed countries. Each had been on the journey since the nineteenth century. It identified from which age groups the improvements to life expectancy had come.

From 1850 to 1900 two thirds of all improvements in life expectancy came from the Under-15 age group. Only three percent of the improvement coming from those above sixty-five. In the period 1925-1950 the under fifteens still accounted for a third of the improvement. This is before the massive improvements in the prevention of childhood diseases that came from vaccination. Polio, whooping cough, mumps, and measles all were beaten in the nineteen fifties and sixties.

Not all improvements came from such medical breakthroughs. Often basic improvements in nutrition and public health were enough.Cholera was tamed with public sanitation. There have been huge changes in only one generation. When my father was seven, he was placed in an isolation hospital and kept separate from his parents. At that time, there was still no known treatment for scarlet fever. The same scarlet fever that had carried off Archbishop Taits children. That was seventy years earlier. He recovered after three months alone. Today it can be simply treated with an antibiotic.

After the 1950’s the emphasis shifts to people who are over fifty. The under fifteens only contributed six percent to the overall improvement by the last period reviewed. Eighty percent of the improvement came from the over sixty-fives. Forty two percent came from the over eighty age group.

Of course, the war on infectious diseases continues. Many parts of the world are still benefitting. Smallpox killed three hundred million people in the twentieth century alone. It was eradicated in 1977 when the last outbreak in Somalia ended. On August 25th, 2020, the World Health Organization declared the African Region as free of wild polio. Malaria vaccines are finally becoming a reality.

Extending healthy living not life

Despite all of this success there is still no evidence of life extension. We can spend more of our lives active and with a worthwhile existence. Yet we cannot extend life itself. Our bodies and minds do wear out. We can keeping them going longer. How much longer is still being debated. Jeanne Calment lived to the age of 122 and is the oldest documented person. Researchers suggest a range of 120-150 for the maximum we can stretch our existing lifespan. We can avoid those things that would normally kill us. Others suggest that Jeanne represented the limit and that her 125 is as far as we can go. After that we will need to treat ageing as a disease and develop drugs to extend life