27.02.2025

Albrecht Dürer ‘Portrait of the artist’s mother at age 63’ (1514)

Great expectations

One of the greatest achievements of capitalism is rising average life expectancy in developed countries. This has begun to stall, not because we have reached an upper limit - well, not yet, suggests Ian Spencer

Marx’s volume one of Capital has numerous references to the appalling figures for average life expectancy in the United Kingdom. Many of these were derived from Her Majesty’s Inspectorate of Factories and other official data. They showed that in some factory districts life expectancy had dropped to 15 and were cited as evidence for the destructive effect on health of capitalist industrial production.

Since 1867 there has been a steady improvement in average life expectancy at birth across society. Average life expectancy at birth in Britain today is 78.6 years for men and 82.6 years for women. However, the trend towards year-on-year improvement has started to stall. Current UK figures are derived from data collected in 2020-22, and represents a fall in life expectancy to levels of a decade earlier (2010‑12). Compared with 2017-19, it has fallen from 79.3 and 83.0 for men and women respectively.¹

Average life expectancy at birth is a measure which is greatly influenced by levels of infant mortality. The shocking figures in Marx’s Capital did not lead to a decline in industrial productivity because of the population that was brought into the industrial centres from the countryside, particularly from Ireland. Moreover, if you lived to be five in the 1840s, you were likely to live to be 45.

So, life expectancy at other ages can also be illuminating. Life expectancy at 65 years in 2020-22 was 18.3 years for men and 20.8 for women; this is a fall of 22 weeks for males and 15 weeks for females compared with life expectancy at age 65 in 2017-19.

The rate of improvement in a range of 17 countries across Europe has started to slow, according to a study published in The Lancet. Moreover, this is linked to government health policy decisions. The countries that maintained some sort of improvement (Denmark, Belgium, Norway, Sweden and Iceland) were those that had policies aimed at improving cardiovascular health and the prompt treatment of cancers.

In the UK, factors such as low levels of exercise, high rates of obesity, coupled with high rates of consumption of highly processed foods were implicated in worsening life expectancy. The UK is also bad at preventing and treating heart disease and cancer.²

Some of the decline in life expectancy is attributable to Covid 19 and the increase in mortality between 2020 and 2022. But the life expectancy improvements have been slow for a decade and not just in the UK. The US has seen similar declines and, as two of the most unequal countries in the world, the UK and US compare unfavourably with other countries with similar levels of economic development.

In the US, life expectancy for males is 74.8 years and 80.2 for females, or 77.5 for both sexes.³ This compares unfavourably with Trump’s would-be colony of Canada, which has a life expectancy of 81.3 years for both sexes. For comparison, Spain has a life expectancy of 83.08 years. Spain’s expenditure on health as a percentage of GDP is 7.13% compared with the USA, which spends 13.43% of GDP to achieve a much worse health outcome.

But does this mean that we are reaching some upper limit for the improvement of life expectancy? We may do one day, but not yet. The commonplace statement that we are ‘living to be older’ is not quite true. More may be living to be old, but the absolute limit may never increase beyond around 120. However, laboratory experiments with other species suggests that there may in future be ways of intervening in the process of aging, which may produce qualitative as well as quantitative improvements in longevity.⁴

Them and us

The likelihood of an absolute upper limit does not stop billionaires trying to live beyond it, any more than it stops other billionaires trying to be astronauts. American venture capitalist, Bryan Johnson, the subject of the Netflix documentary ‘Don’t die: the man who wants to live forever’, spends an estimated two million dollars a year on doctors and treatments aimed at prolonging his life, whatever their spurious efficacy. Perhaps one should not be surprised that one of the world’s leading centres for research into aging is the University of Southern California.

Meanwhile, elsewhere in the US, some of the most dramatic declines in life expectancy have been among indigenous Americans and native Alaskans who have seen declines of 6.6 years, down to 65.2 years. Among Black and Hispanic US citizens declines of around 4 years to 70.8 and 77.7 respectively have been recorded by the US National Centre for Health Statistics, which is a department of the Centre for Disease Control and Prevention (CDC).⁵

Low taxes

I daresay the fact that the CDC has dismissed 10% of its total staff and 45% of its probationary staff, in the wake of the Trump and Musk assault on the US civil service, is entirely coincidental.⁶ But data on the economic impact of conservative policy on the poorest in society is an inconvenient truth, running counter to the need to keep taxes low for the wealthy.

The human achievement of longevity is a good illustration of how capitalism on the one hand creates the conditions for abundance and the enhancement of human life but at a certain point in its development becomes an impediment to further improvement. ‘An ageing population’ is now often cited as a reason for why health and social care is seen as a problem and potentially unaffordable. Instead of being grounds for celebration, the fact that living to old age carries with it the possibility of neuro-degenerative decline is seen as something inherent in aging. This, in turn, finds its expression in several ways, including the callous indifference of the government of Boris Johnson to the death rates in care homes and, more recently, to the cautious acceptance of assisted dying.

To be clear, while the recent attempts at legalising ‘assisted dying’ are aimed at the terminally ill, particularly those with cancer, the fear among many is that it could eventually find acceptance for those with Alzheimer’s disease and other neuro-degenerative disorders.

The dementias, of one sort or another, are disease processes and not natural features of ageing. While a measure of cognitive decline in some areas may be an inevitable feature of ageing, most of the dementias have a clearly demonstrable pathology, which in many cases is preventable.

Some dementias have a clear genetic link. Huntington’s disease, for example, is the result of a faulty dominant gene, with its origins in Europe. It is unknown in Africa. The most common dementia, Alzheimer’s disease, in some cases has a genetic link, but most cases are linked to a complex array of epigenetic and environmental factors. Japan, with its world leading life expectancy of 85.27 years as an average of both sexes, is the focus of research into the management of the dementias.⁷

The second most common form of dementia, arterio-sclerotic, is highly preventable. Broadly speaking, good heart health is good brain health, and actions to tackle high blood pressure, type-two diabetes and obesity will also prevent this form of dementia. All these conditions demonstrate a clear class gradient, in outcome and often in aetiology. Socio-economic deprivation is a factor in dementia in both the UK and the US, both of which have high levels of social inequality and relatively high levels of dementia.⁸

There is a tendency to assess dementia as a series of risk factors, which, in the context of capitalism, tends to be expressed as the outcome of lifestyle choices rather than something that could be the subject of worldwide social transformation. However, even if one looks at risk factors, age being by far and away the most important, the research results are important and instructive.

A World Dementia Council study into the management of dementia in Japan looks at biological, psychological and social environment factors in preventing dementia. Biological factors include good dental health, which is interesting when one considers the way that NHS dentistry has been left to rot, and one considers that the UK has relatively high levels of dementia. Diet and exercise are also important factors.

Psychological factors include the availability of good quality sleep, good psychological health and social contact. Social and environmental factors, including low social status (class, in other words) represents a major risk factor. Among the protective factors are plenty of cognitive activities, such as reading and writing, and high levels of social support, including that which is found in work.⁹ Marx’s comments in the 1844 manuscripts have never been more apposite. While work under capitalism may be experienced as an alienating experience, in a communist society it would be humanity’s ‘prime want’.

The population of UK care homes is 441,479, 70% of whom are memory impaired. They reside in around 16,700 care homes, 30% of which are designated as ‘nursing homes’ - that is, they must always have a registered nurse present. Half of residents are self-funded. Often that means their homes have had to be sold to pay for their care, until their personal estate dwindles to £23,250, when the local authority may contribute to the cost of care. When a resident’s estate reaches £14,250, they may be eligible for full funding by the local authority.

Privately owned

Most nursing and residential homes are privately owned. Charges are highly variable, but £1,000 a week would be at the cheaper end of the spectrum. The care home world is staffed by a workforce of around 745,392, many of whom are paid at the level of the national ‘living wage.’ There are 131,000 vacancies in social care.¹⁰

The UK is following the US pattern, where the private care home sector is seen as a backup to the secondary care sector. Successive governments have promised a solution to social care. Theresa May’s proposal for what became dubbed the ‘dementia tax’ was the rock on which her election gamble floundered. Boris Johnson made rash promises to cap residents’ contributions that he knew he would never have to honour. Starmer’s government has dealt with the question by kicking it into the long grass of yet another public enquiry. In any event, future proposals will have to compete with higher levels of military expenditure and perpetual war.

There is no chance that social care will be funded centrally by the state. In the meantime, most care homes are poor at managing decline, given staff shortages and minimal funding, where profit is the decisive motive. Capitalism has created another condition which, like climate change, it cannot solve. We can be sure that billionaires and their erstwhile servants in government won’t solve it either.