June 14, 2019

Health care and longevity: the work of David Cutler

By Austin Frakt

Much of what I’ve learned about the effect of health care on longevity comes from the work of David Cutler. He’s one of our speakers at the Princeton meeting. This post a preview of some of what he might say.

Cutler makes two points in his work on longevity. One is that in the second half of the 20th century, there’s good reason to believe the health system contributed 40-50% of longevity gains. The second is that, though we spent a lot for this care, with that much bang for the buck, the spending was worth it.

In a paper published in the New England Journal of Medicine by Cutler, with co-authors Allison Rosen, and Sandeep Vijan cite studies to back the notion that about 50% of longevity gains since 1950 are attributable to health care, including work by Bunker, Frazier, and Mosteller. Most of these gains were due to better care for premature infants and cardiovascular disease.

About cardiovascular disease in particular, Cutler, Deaton, and Lleras-Muney write in a 2006 Journal of Economics Perspectives article,

Since 1960, cardiovascular disease mortality has declined by over 50 percent, and cardiovascular disease mortality reductions account for 70 percent of the seven-year increase in life expectancy between 1960 and 2000. Cutler (2004) matches the results of clinical trials to actual mortality declines, and attributes the bulk of the decline in cardiovascular disease mortality—as much as two-thirds of the reduction— to medical advance.

If all this supporting evidence is sound and convincing, medical care is holding its own. It’s even worth the price, say Cutler and colleagues.

According to virtually any commonly cited value of a year of life, we found that if medical care accounts for about half the gains in life expectancy, then the increased spending has, on average, been worth it.

Even if health care is responsible for half of longevity (and other health) gains, this still leaves plenty of room for other things to make major impacts on our health, which, given his work on social determinants of health, I am confident David Cutler would not deny.

You can join us in person or via live stream at the Princeton meeting to hear David Cutler (and others) speak on these topics (and others).