The new demography of death
Today’s post is by Dr. George W. Leeson, Co-Director and Senior Research Fellow in Demography, at the Oxford Institute of Population Ageing (OIPA), as well as co-editor of the Journal of Population Ageing and chair of the editorial board of Ageing Horizons.
In Europe, population ageing continues and brings with it increasing numbers of centenarians and supercentenarians as well as a new demography of death. In the mid-19th century, European populations were young and short-lived with high levels of infant mortality. More than half of the almost 370,000 deaths in England and Wales in 1850 would have occurred among people aged less than 60 years. By the early 21st century, these same populations have become old and long-lived, and almost 90 per cent of the deaths in England and Wales now occur among people aged over 60 years.
Of course, the absolute number of deaths as a demographic measure is not a helpful measure, but in this context we are considering mortality in simple absolute terms to reveal the changing composition of the demography of death behind the story of improving survivorship which is a part of population ageing. In the middle of the 19th century, the absolute number of deaths per year in England & Wales was increasing from around 350,000 to around 600,000 by the end of the 19th century. The number peaked in 1918 at just over 610,000, after which deaths in absolute terms declined to around 440,000.
An element of the dramatic changes in the structural development of death and the demography of death was the decline in infant mortality in England and Wales throughout the 20th century. At the turn of the 20th century, infant mortality had been as high as 154 deaths under 1year per 1000 live births. This rate has been halving every 25 years roughly except for the period from1975 to 1990, where the halving time decreased to around 15 years, returning thereafter to be on track for 25 years halving again, ending at just 4.4 deaths under 1 year per 1000 live births in 2011.
Declines in mortality among the extreme aged have been striking. One hundred and seventy years have seen late-life life expectancy increase by just over 7 years for males and almost 9 years for females—something of an achievement given the previous conviction that mortality at older ages was intractable.
Population ageing is often equated with an increasing number and proportion of frail, dependent older people who become an increasing burden on society and family. The numbers themselves are a warning that societies need to change with the changing demography. One consequence of the numbers change is the new demography of death. Mortality at advanced ages is being delayed and although the future remains difficult to predict, there does seem to be an increasing body of evidence that around the world lives will continue to be extended for some time to come. By the turn of the next century, life expectancies at birth are predicted to be 93 years for males and 95.6 years for females in England and Wales, while at age 65 years, life expectancies are expected to be 29.9 years for males and 31.1 years for females.
The number of people aged 100 years and over in England and Wales increased from less than 200 in 1922 to 570 in 1961. By 1981, this number had climbed to 2,418 and to 12,318 in 2012 and by the middle of the century the number is expected to be close to 300,000 and more than 1 million by 2100.
So more people are living longer and the longest lived are living longer too.
What then of the future and the new demography of death?
The development of this demography of death over the 200 year period from the mid-19th to the mid-21st century is striking. The total number of deaths in England and Wales increases from 342,760 in 1838, when 50 percent of a cohort was dead by age 45 years, to almost twice that number, 666,253 in 2050,when 50 percent of a cohort will be surviving to age 90 years.
It is the structure of this new demography of death that is interesting.
Since 1959, death has been dominated by deaths of people aged 60 years and over and this domination has increased and will continue to increase at least until the middle of this century. In 1959, 78 percent of deaths were people aged 60 years and over. This had increased to 88 percent by 2009 and is predicted to reach 94 percent by 2050. And in line with the ageing of the population of England and Wales, the proportion of the 60-plus deaths aged 80 years and over has also increased and continues to increase—from 34 percent in 1959 to 60 percent in 2009 and 78 percent in 2050.
While this is in all respects a natural consequence of the ongoing demographic development in England and Wales and similar developed economies, there remains the question: are we prepared for this new demography death, its scale and structure, as individuals, families, communities, and societies?
The ageing of European populations in the latter part of the 20th century was a demographic surprise brought about by a combination of demographic resistance to dismissing the idea of a limit to human longevity and the creeping decline in mid- and late-life mortality as the prevention and treatment of, for example, heart disease improved. Experience proved we had pushed old age into our 80s. The future could be an equal demographic surprise if we ignore the evidence of the new demography of death, which also would suggest that the lives of more and more people will continue to be extended and centenarians and supercentenarians would comprise an increasing number and proportion of our populations.
The new demography of death is also a 21st century challenge for the emerging economies of the world, where life expectancies continue to increase. However, these economies are challenged additionally by the speed of their fertility transitions, which in many instances are occurring in one or at most two generations.
How could/should we begin to prepare ourselves for this new demography of death?
It is clearly a challenge to longstanding concepts of old age and retirement – indeed one could ask whether retirement even at age 75 years is sustainable. Family dynamics will be challenged by the survival of extreme aged generations delaying intergenerational succession and depending on smaller families for support in frail and dependent old age.
The additional and confounding prospect of declining population size raises different issues as the workforce contracts. This would lead to policy discussions about controlled labour immigration, perhaps, to compensate for the declining local workforce.
Buried in this demography of death is, however, a success story of survival. Let us not be dismayed by that but let us begin to discuss what it means.
Dr. Leeson is a leading member of The Complex Environmental Population Interactions Project which unites key demographers, economists, anthropologists, philosophers and environmentalists.
The video below, introducing population growth and global ageing, is part of the e-learning programme GOTO – Global Opportunities and Threats – by Said Business School. It includes contributions by George Leeson as well as Sarah Harper and Kenneth Howse, also from OIPA.
Solving the super-ageing challenge by Katsutoshi Saito, Chairman, Dai-ichi Life Insurance Company, Ltd at OECD Forum 2014