Living Longer Yes, But Why Not Healthier?

Average lifespans continue to rise, but surveys indicate that Americans don’t feel healthier.

I often say that Americans are getting healthier and living longer.  The living-longer part I am sure about.  Life expectancy for men at 65 increased from 15.9 to 18.3 years between the 2000 and 2014 report issued by the Social Security Trustees.  It’s true that virtually all the gains in life expectancy accrued to the better-educated, better-paid portion of the population, but the bottom line is that – on average – we are living longer.  All the demographers agree this trend will continue; the only question is how fast life expectancy will continue to increase. 

Given the improvement in life expectancy, I thought that people would report that they felt healthier.  That does not appear to be the case.   Since the early 1970s, the National Health Interview Survey has asked the question: “Would you say your health in general is excellent, very good, good, fair, or poor?”  A response of fair or poor is an indication of serious problems and is correlated with subsequent mortality.  Pooling data for four time periods (1974-76, 1994-96, 2004-06, and 2011-13) shows a big decline in the percentage of respondents with fair or poor health between 1974-76 and 1994-96, then very little improvement thereafter (see Figure 1).  Data from the Current Population Survey (CPS), which includes an identical question, shows a clustering of responses from the mid-1990s through today. 

Moreover, the Health and Retirement Study (HRS), the gold standard for anyone examining the behavior of older Americans, presents a similar picture.  The HRS follows people 50 and older, interviewing them every two years.  The first group was interviewed in 1992, and additional cohorts have been added over time.  Participants in the HRS are also asked to classify their health as excellent, very good, good, fair, or poor.  As Figure 2 indicates, the percentage of men between the ages of 55 and 65 classifying their health as fair or poor has remained virtually unchanged between 1994-1996 and 2010-12.  Several other indicators, such as incidence of various diseases, also suggest little improvement in health.  Interestingly, in contrast to the NHIS and the CPS, the percentage of HRS respondents reporting fair or poor health does not increase with age.

What is going on? Why aren’t people reporting improved health?  One answer may be that medical technology allows people with chronic diseases to live longer, and these people are likely to report being in fair or poor health – depressing the average.