tag:theconversation.com,2011:/africa/topics/mortality-17246/articlesMortality – The Conversation2024-03-18T12:23:59Ztag:theconversation.com,2011:article/2251532024-03-18T12:23:59Z2024-03-18T12:23:59ZBiden and Trump, though old, are both likely to survive to the end of the next president’s term, demographers explain<figure><img src="https://images.theconversation.com/files/581396/original/file-20240312-16-ug5e1v.jpg?ixlib=rb-1.1.0&rect=6%2C6%2C4247%2C2965&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Both Joe Biden and Donald Trump are nearly twice the median age of the U.S. population.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Election2024ChinaUnitedStates/46152c599dd14340abc0595fca447682/photo">AP Photo</a></span></figcaption></figure><p><a href="https://poll.qu.edu/poll-release?releaseid=3890">In a recent poll</a>, 67% of Americans surveyed believe that President Joe Biden, 81, is too old to serve another term as president. But only 41% of respondents said they feel that way about former President Donald Trump, who is 77. Both men have stumbled around and have forgotten or mixed up names and events, <a href="https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-problems-forgetfulness-and-aging">which are behaviors that characterize some older people</a>.</p>
<p><a href="https://scholar.google.com/citations?user=jAfhO2YAAAAJ&hl=en">We</a> are <a href="https://scholar.google.com/citations?user=OBIxsGQAAAAJ&hl=en">demographers</a> – not <a href="https://www.salon.com/2024/02/23/dr-john-gartner-on-a-tale-of-two-brains-bidens-brain-is-aging-brain-is-dementing/">scholars of brain function</a> considering people’s cognitive abilities. But there is a question we can answer, one that speaks to concerns about both men’s ages: their life expectancy.</p>
<p>And it turns out that the four-year age difference between Biden and Trump isn’t really much of a difference when it comes to their respective odds of surviving. The statistical odds are good that both would complete a four-year term as president.</p>
<p>We know this because of one of the most versatile <a href="https://www.cambridge.org/core/books/population-and-society/5D47EB8139ED72FD59F7379F7D41B4FB">tools of demography</a>, which is called a life table. It’s a table of age groups, usually from 0 to 100 years, showing the <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf#page=14">percentages of the population at any age</a> surviving to a later age. It is based on the age-specific death rates of the population.</p>
<h2>Early record-keeping</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A table of figures representing births and deaths." src="https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=716&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=716&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=716&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=899&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=899&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=899&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A bill of mortality for 1605 and 1606, by John Graunt, an early version of what is now known as a life table.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Bill_of_Mortality_1606.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The life table dates back to <a href="https://www.britannica.com/biography/John-Graunt">John Graunt, a self-educated citizen of London</a> in the 17th century who is known by many as the <a href="https://www.cambridge.org/core/books/abs/population-and-society/references/35C31BCEC27E2B0448B160414E1893BF">founder of demography</a>. <a href="https://www.jstor.org/stable/41138862">In 1662, Graunt produced and distributed the first life table</a>, showing the probabilities of London’s population surviving from one age to the next.</p>
<p>There are two kinds of life tables. The first is a cohort life table, which represents the death rates and ages for a specific group of people. A cohort table could, for example, document the deaths of all males born in the U.S. in 1940. That table would be very precise, but it wouldn’t be complete until every member of the group had died – so it’s not especially useful for examining the prospects of the living.</p>
<p>As a result, demographers more often use life tables for a current time period, such as the year 2021, which is the date of the most <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf">current period life table for the U.S.</a></p>
<p>It shows the probabilities of surviving from one age to another age based on the death rates in 2021. </p>
<h2>Statistical documentation</h2>
<p><a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf">A period life table for 2021</a> indicates that almost 99% of all people born in the U.S. survive from age 0 to age 20; just over 95% of them survive to age 40, and over 85% to age 60. More than 51% of them live to age 80.</p>
<p>But life tables get much more specific. It’s important to examine life tables’ data for each age, race and gender combination. This is because males don’t live as long as females, Black people don’t live as long as white people, and non-Hispanic people don’t live as long as Hispanic people. There are more specialized life tables that focus on education level and income, but they are not as current and complete as the broader tables.</p>
<p>Biden and Trump are both non-Hispanic white men. Biden is 81 and Trump is 77.</p>
<p>Based on the age-specific death rates of non-Hispanic white men in the U.S. in 2021, Biden has a 92.9% probability of surviving at least to age 82. Trump has a 95.1% probability of surviving to at least age 78. These odds are nearly identical, so each man is very likely to be alive on Inauguration Day 2025, regardless of which of them is being sworn in as president.</p>
<p>What about finishing out that four-year term? <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf#page=47">Our calculations from the life tables</a> reveal that there is a 63.3% probability that Biden will survive another five years – to at least 86. And there is a 73.6% probability for Trump to survive that period – to at least age 82. Of course, it’s possible either or both will die, but their odds of death are much lower than their odds of survival.</p>
<p>In general, the chances are a bit more favorable for Trump, because he is slightly younger.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A table of figures showing how many people of one age survive to a future age." src="https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The 2021 life table for the U.S. is the most recent available.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf#page=10">U.S. Centers for Disease Control and Prevention</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Precise calculations</h2>
<p>There are two factors that let us demographers get even more specific. </p>
<p>First, we measure age as exact years. Their age gap is not four years, but 3.5: <a href="https://www.whitehousehistory.org/bios/joseph-r-biden-jr">Biden was born on Nov. 20, 1942</a>, and <a href="https://www.whitehousehistory.org/bios/donald-j-trump">Trump on June 14, 1946</a>. That 10 percentage-point survival advantage for Trump over Biden was based on a four-year age difference. The real difference drops one or two points because they’re not quite so far apart in age.</p>
<p>Second, demographers have shown that <a href="https://doi.org/10.2307/2648114">people who attend church regularly live longer</a> than those who don’t. This is not because of some divine favor but because churchgoers tend to have more optimistic attitudes, clearer senses of purpose and more regular social interactions and connections. All of these factors extend people’s lives. Biden is a Catholic and <a href="https://www.reuters.com/article/idUSKBN2AC1X6/">attends Mass weekly, in general</a>. Trump was raised as a Presbyterian but now considers himself to be a “<a href="https://www.deseret.com/2023/10/22/23922731/biden-trump-faith-and-presidential-candidates/">nondenominational Christian</a>,” and he attends religious services very irregularly. So, Biden gets the survival advantage associated with churchgoing. </p>
<p>Other factors come into play with longevity as well, such as marital status, <a href="https://doi.org/10.1007/978-3-031-10936-2">body mass index scores</a>, diets and levels of physical fitness and exercise. </p>
<h2>A comparison with the American people</h2>
<p>Biden and Trump are <a href="https://theconversation.com/candidates-aging-brains-are-factors-in-the-presidential-race-4-essential-reads-223419">two of the three oldest people</a> ever to serve as president. The population they are seeking to lead is also older than ever before.</p>
<p>The median age of the nation’s population was <a href="https://www.census.gov/newsroom/press-releases/2023/population-estimates-characteristics.html">38.9 in 2022</a> compared with <a href="https://www.census.gov/library/publications/1972/dec/pc-s1-10.html">28.1 in 1970</a> and just <a href="https://www2.census.gov/programs-surveys/decennial/2000/phc/phc-t-09/tab07.pdf">16.7 in 1820</a>. </p>
<p>“<a href="https://www.nytimes.com/2024/03/06/opinion/biden-aging-america-population.html">Relative to the age of the population</a>, President Biden is no older than the country’s first presidents,” including Thomas Jefferson, wrote James Chappel, a scholar of aging and history at Duke University, in The New York Times. More recently, Reagan was older than the median American of his time than Biden and Trump are today.</p>
<p>At their second inaugurations, Jefferson was roughly 45 years older than the median age of the U.S. population then, and Reagan 43 years older. If Biden wins a second term, he will be 42 years older than today’s median. If Trump wins in 2024, he will be 38 years older than the current median. </p>
<p>As demographers, we can say it is likely that both Biden and Trump will be alive when the presidential term that begins in 2025 comes to an end in 2029. But as the U.S. population gets older too, the age factor may become less important to voters. This is not an immediate change, however, but one that will likely occur over the next decade or so.</p><img src="https://counter.theconversation.com/content/225153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Detailed data on the ages at which people die can give good indications of a person’s remaining life span.Dudley L. Poston Jr., Professor of Sociology, Texas A&M UniversityRogelio Sáenz, Professor of Demography, The University of Texas at San AntonioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231612024-03-08T13:37:29Z2024-03-08T13:37:29ZWhat families need to know about how to safely store firearms at home<figure><img src="https://images.theconversation.com/files/579045/original/file-20240229-20-8z3by2.jpg?ixlib=rb-1.1.0&rect=42%2C0%2C3430%2C2404&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Guns are the leading cause of death of children in the U.S.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/child-holding-gun-mid-section-b-w-royalty-free-image/pha184000035?phrase=kids+guns&adppopup=true">Laurent Hamels via Getty Images</a></span></figcaption></figure><p>For the past few years, <a href="https://www.nytimes.com/interactive/2022/12/14/magazine/gun-violence-children-data-statistics.html">guns have been identified</a> as the <a href="https://www.nytimes.com/interactive/2022/12/14/magazine/gun-violence-children-data-statistics.html">leading cause of death</a> for children in the United States.</p>
<p>There were <a href="https://www.kff.org/mental-health/issue-brief/child-and-teen-firearm-mortality-in-the-u-s-and-peer-countries/">2,571 children age 1 to 17 who died in shootings</a> in the U.S. in 2021, 68% more than the 1,531 that occurred in 2000.</p>
<p>To help reduce the number of firearm-related deaths and injuries among children, Secretary of Education Miguel Cardona in January 2024 <a href="https://www2.ed.gov/policy/gen/guid/secletter/012524.html">called upon school and district administrators</a> to talk with parents and guardians about safe firearm storage practices.</p>
<p>As <a href="https://scholar.google.com/citations?user=6kAiow8AAAAJ&hl=en">experts</a> on the <a href="https://scholar.google.com/citations?hl=en&user=r9lbnH0AAAAJ">safe storage of firearms</a> – and as leaders of the University of Connecticut’s <a href="https://arms.chip.uconn.edu/">ARMS Center for Gun Injury Prevention</a> – we often get questions about the best ways to keep guns out of the hands of children. We offer the following tips:</p>
<h2>1. Safely store all of your firearms</h2>
<p>Nearly half of the households in the U.S. have at least one firearm, but only about 40% of firearm owners store all of their guns when not in use, according to data in a survey we recently fielded. Unsecured firearms have been linked to <a href="https://doi.org/10.1007/s11524-018-0261-7">suicides, domestic homicides and accidental shootings</a>. They also heighten the risk of unauthorized use, which <a href="https://www.thetrace.org/2017/11/stolen-guns-violent-crime-america/">includes theft</a>.</p>
<h2>2. Don’t assume you can hide your guns</h2>
<p>Kids generally know the hiding spots for the things their parents or caretakers do not want them to find, such as holiday gifts or Halloween candy. The same is true with firearms.</p>
<p>In <a href="https://publications.aap.org/aapnews/news/13788?autologincheck=redirected">40% of gun-owning households</a> with children, adults said their children did not know where firearms were stored, a 2017 study found. However, many of the <a href="https://doi.org/10.1542/hpeds.2016-0146">children reported knowing</a> and being able to access the firearms.</p>
<p>Researchers estimate that <a href="https://www.nationwidechildrens.org/research/areas-of-research/center-for-injury-research-and-policy/injury-topics/general/gun-safety">75% of children</a> who live in homes with guns know where they are stored.</p>
<p>Adults may think they can instruct children to leave firearms alone, but the 2017 study also found that <a href="https://publications.aap.org/aapnews/news/13788?autologincheck=redirected">22% of parents</a> wrongly believed that their children had never handled their gun.</p>
<h2>3. Store ammunition separately</h2>
<p>Research shows that locking ammunition separately from firearms further <a href="https://doi.org/10.1001/jama.293.6.707">reduces the risk</a> of firearm injuries in homes with children and teenagers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bullets are scattered about a table top." src="https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579044/original/file-20240229-20-yhh7th.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Storing ammunition separately from firearms can help reduce the risk of injury.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/war-bullets-pistol-9-mm-royalty-free-image/1940835204?phrase=guns+ammunition&adppopup=true">Olena Domanytska via Getty Images</a></span>
</figcaption>
</figure>
<p>While storing an unreadied weapon locked away may feel counterintuitive to those who own guns for personal protection, research shows that keeping firearms locked or unloaded, or both, can also <a href="https://doi.org/10.1136%2Fjech.2003.017343">reduce risk of injury</a>. </p>
<h2>4. Learn to talk about firearm safety</h2>
<p>While some families may not have firearms in their home, eventually children go to other homes and, as they get older, go unsupervised.</p>
<p>Keeping children safe from gun violence requires normalizing conversations on firearm storage, even for people in households where no gun is present. </p>
<p>Approximately <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7250a1.htm#T2_down">45% of all unintentional shooting deaths</a> of children under 17 occurred outside of their own homes. When children visit friends, we believe it’s important for their parents to know if guns are present in the home they are visiting and, if present, whether those firearms are being safely stored.</p>
<p>For more information about how to discuss firearm safety, parents can visit websites such as <a href="https://besmartforkids.org/">BeSMART</a>, <a href="https://www.endfamilyfire.org/about">End Family Fire</a> and <a href="https://www.sandyhookpromise.org/blog/advocacy/how-secure-storage-of-guns-makes-children-and-families-safer/">Secure Storage of Lethal Means</a>.</p>
<h2>5. Know the law</h2>
<p><a href="https://www.aap.org/en/advocacy/state-advocacy/safe-storage-of-firearms/">Twenty-seven states</a> have some version of <a href="https://www.kff.org/other/state-indicator/firearms-and-children-legislation/">secure storage laws</a>.</p>
<p>Based on our calculations <a href="https://www.cdc.gov/nchs/pressroom/sosmap/firearm_mortality/firearm.htm">using data from the Centers for Disease Control and Prevention</a>, states with child access prevention laws – known as <a href="https://www.countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/child-firearm-access-prevention-laws#">CAP laws</a> – have a gun death rate that is 65% lower than states that do not have CAP laws (12.33 vs. 20.38 per 100,000). Of course, states with and without CAP laws have many differences; therefore, the lower rates cannot be attributed to CAP laws alone. However, the presence of CAP laws is protective and reduces gun death.</p>
<p>In the absence of a federal secure storage law, the legal requirements around firearm storage and preventing unauthorized children from accessing weapons vary by state or municipality.</p>
<p>For example, Connecticut <a href="https://www.cga.ct.gov/2019/act/pa/pdf/2019PA-00005-R00HB-07218-PA.pdf">requires firearms be in a locked device</a> when not in use. </p>
<p><a href="https://www.legis.iowa.gov/docs/iac/rule/07-01-2020.441.113.7.pdf">Iowa prohibits</a> the storing or leaving a loaded firearm around children 14 and younger if it is not secured by a trigger lock or a securely locked container or some other secure location.</p>
<p>Further, while Michigan only recently added a safe storage law, Jennifer Crumbley, the mother of a boy who committed a mass school shooting with his parents’ unsecured firearm, <a href="https://nymag.com/intelligencer/article/oxford-school-shooting-ethan-crumbley-parents.html">was recently convicted</a> of involuntary manslaughter in connection with the case. Her husband’s trial in the matter <a href="https://www.fox2detroit.com/news/james-crumbley-trial-date-lawyer-charges">began on March 5, 2024</a>.</p>
<h2>6. Invest in a quality safe and/or locking device</h2>
<p>There are various levels of locked gun storage, including <a href="https://health.ucdavis.edu/what-you-can-do/firearm-safety.html#">trigger locks</a>, <a href="https://health.ucdavis.edu/what-you-can-do/firearm-safety.html">metal cable locks</a>, <a href="https://www.atf.gov/firearms/qa/what-qualifies-secure-gun-storage-or-safety-device#">locked gun cases and gun safes</a>. While storing a firearm and the ammunition in a locked combination or biometric device <a href="https://doi.org/10.1007/978-3-030-62245-9_12">is safest</a>, all of these methods can reduce the risk of gun injury and death. These locking devices can be purchased online, through some gun sellers or at sporting goods stores.</p>
<p>A biometric safe for a handgun is about US$65, a gun lock runs $55 to $75 dollars, and combination safes for long guns range widely from a couple of hundred dollars to a few thousand dollars.</p>
<p>Family-school-community partnerships allow America’s children to grow and thrive. By asking schools to share resources for secure firearm storage and communicate evidence-based safety practices, the Department of Education is helping schools address the leading cause of death among American children.</p>
<p>But families have to do their part, too. It begins by normalizing firearm safety conversations and storing firearms properly to keep children safe.</p><img src="https://counter.theconversation.com/content/223161/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerri Raissian is affiliated with the Niskanen Center (Sr. Fellow) and Arnold Ventures (paid consultant).</span></em></p><p class="fine-print"><em><span>Jennifer Necci Dineen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that more children have handled household guns than their parents think.Kerri Raissian, Associate Professor of Public Policy, University of ConnecticutJennifer Necci Dineen, Associate Director of the ARMS Center for Gun Injury Prevention, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238792024-02-22T13:28:05Z2024-02-22T13:28:05ZThe UK government aims to stop publishing stats on homeless people’s deaths – here’s why that’s a problem<figure><img src="https://images.theconversation.com/files/577073/original/file-20240221-24-8jf0ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-united-kingdom-april-7-2018-1103636513">Shutterstock</a></span></figcaption></figure><p>The UK government is consulting on plans to <a href="https://www.gov.uk/government/consultations/health-and-social-care-statistical-outputs/health-and-social-care-statistical-outputs-published-by-dhsc-including-ohid-nhsbsa-ukhsa-ons-and-nhs-england#mortality">stop publishing</a> vital statistics from the Office for National Statistics (ONS) on deaths of homeless people. This is part of a wider review of mortality statistics including deaths in care homes and winter mortality. </p>
<p>Since 2018, the ONS in England and Wales and the National Records for Scotland (NRS) <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsofhomelesspeopleinenglandandwales/2021registrations">have published</a> annual reports about the deaths of <a href="https://theconversation.com/black-and-minoritised-ethnic-communities-at-disproportionate-risk-of-homelessness-in-the-uk-195254">homeless</a> people. This data offers insights into year-on-year changes in recorded deaths, including details about sex, age and cause of death. (There are plans to collate similar official data in Northern Ireland, but none has yet been published.)</p>
<p>The UK government <a href="https://www.gov.uk/government/consultations/health-and-social-care-statistical-outputs/health-and-social-care-statistical-outputs-published-by-dhsc-including-ohid-nhsbsa-ukhsa-ons-and-nhs-england#mortality">claims that</a> these statistics are “experimental” and that “further development work” is needed to bring them up to “national statistics status”. As part of its consultation, which closes on March 5 2024, the government is <a href="https://www.gov.uk/government/consultations/health-and-social-care-statistical-outputs/health-and-social-care-statistical-outputs-published-by-dhsc-including-ohid-nhsbsa-ukhsa-ons-and-nhs-england#mortality">looking for feedback</a> on “the relative importance” of these statistics. </p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/13576275.2023.2176214">Our research shows</a> that death is a constant threat for people experiencing homelessness. However, this is rarely considered, by the public or by politicians, as part of the plight of being unhoused. </p>
<figure class="align-center ">
<img alt="People in blue high-vis vests at a table with food for distribution." src="https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577074/original/file-20240221-22-t0dhjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Volunteers distribute food to homeless people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-uk-december-2022-refugee-network-2239056145">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Invisible in life and death</h2>
<p>Globally, homeless populations are <a href="https://sbdww.org/wp-content/uploads/2011/04/PrematureMortalityFinal.pdf">three-to-four times</a> more likely to die than the general population. Homelessness and health expert James J. O’Connell has said that despite the diverse methodologies different institutions across the world use to measure homelessness-related mortality, there is a “<a href="https://sbdww.org/wp-content/uploads/2011/04/PrematureMortalityFinal.pdf">remarkable consistency</a>” in death rates internationally – one that “<a href="https://sbdww.org/wp-content/uploads/2011/04/PrematureMortalityFinal.pdf">transcends borders, cultures and oceans</a>”. </p>
<p>Research shows that homeless adults and children are <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189938">more likely</a> to suffer underlying health conditions than the general population. Unhoused people are <a href="https://sbdww.org/wp-content/uploads/2011/04/PrematureMortalityFinal.pdf">disproportionately</a> likely to die due to violent accidents, such as being run over by a motor vehicle, or <a href="https://www.independent.co.uk/news/uk/home-news/russell-lane-death-inquest-kent-crushed-bin-sleeping-rough-a8887701.html">being crushed</a> in a bin lorry. </p>
<p>Until 2018, the UK government did not track the number of people dying while homeless. Only when the Bureau of Investigative Journalism and journalist Maeve McClenaghan, working with London-based group The Museum of Homelessness, <a href="https://museumofhomelessness.org/dhp">revealed</a> the profound invisibility of this precise issue as part of their Dying Homeless project, did the ONS in England and Wales and the NRS begin to tackle it.</p>
<p>To date, their data is the most accurate official data on homelessness-related deaths in the UK. It is, however, imperfect – the ONS <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsofhomelesspeopleinenglandandwales/2021registrations#deaths-among-homeless-people-in-england-and-wales">recognises</a> as much, and advises caution in how it is interpreted. </p>
<p>These <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/deathsofhomelesspeopleinenglandandwalesqmi">data limitations</a> include the unreliability of coroners’ reports, which do not always record the fact that the deceased was homeless. This might be due to incomplete information given to the registrar, or out of consideration for the person’s family. </p>
<p>There is also no specific question on a death certificate to ask if a person was homeless at the time of death. Instead, the ONS must search death certificate data for registered addresses specified as “no fixed abode” or that are of a known hostel. And the ONS does not yet have a comprehensive list of all homeless hostels and emergency shelters, although such a list is now in development.</p>
<figure class="align-center ">
<img alt="An orange tent under a brick passageway." src="https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577076/original/file-20240221-30-wnqbai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Unhoused people suffer from invisibility in both life and death.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/leeds-west-yorkshire-england-britain-november-1362066608">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why this matters</h2>
<p>The absence of data concerning homeless populations is not a new phenomenon. It underlines the wider invisibility from which unhoused people suffer. </p>
<p>The way people sleeping rough are counted involves less-than-perfect methods. In 2022, <a href="https://www.gov.uk/government/statistics/rough-sleeping-snapshot-in-england-autumn-2022/rough-sleeping-snapshot-in-england-autumn-2022#snapshot-approach">80% of local authorities</a> in England gauged numbers of rough sleepers using an “evidence-based estimate meeting”. This involves local agencies (such as charities, outreach teams and homelessness accommodation services) giving an informed estimate of how many people might be sleeping rough on a typical night. Only 20% of local authorities actually counted the people they saw sleeping rough. </p>
<p>And of course, homelessness covers more than rough sleeping. Statutory homelessness refers to people to whom local authorities owe either a main duty to house or a relief duty, whereby they work with applicants to attempt to prevent or relieve homelessness (for example, by developing a personalised plan to support an applicant). </p>
<p>Research shows the <a href="https://researchbriefings.files.parliament.uk/documents/SN01164/SN01164.pdf">tools used</a> to measure and assess homelessness and rough sleeping vastly <a href="https://www.insidehousing.co.uk/insight/no-way-through-33188">underestimate</a> how extensive it is. People who are not eligible for statutory support are not counted. </p>
<p>Further, not all homeless people will present themselves to local authorities, as some people – often referred to as the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/housing/articles/hiddenhomelessnessintheukevidencereview/2023-03-29#:%7E:text=The%20term%20can%20mean%20different,streets%20or%20in%20official%20statistics.">“hidden homeless”</a> – are put off from applying because of fears of being rejected. As data on statutory homelessness is compiled based on these applications, many homeless adults and children are excluded from official statistics.</p>
<p>Health <a href="https://www.bmj.com/content/360/bmj.k214">researchers</a> argue that homelessness presents a public health crisis. Gauging the extent of it – by publishing official statistics on the number of people who die while homeless – is the first step in combating it.</p>
<p>At a time when evictions are rising and the affordable housebuilding system is set to all but collapse, deaths of homeless people is a critical political issue. The UK <a href="https://theconversation.com/five-lessons-the-pandemic-taught-us-about-ending-homelessness-permanently-179994">government</a> needs to take responsibility for it.</p><img src="https://counter.theconversation.com/content/223879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The absence of data concerning homeless populations is not a new phenomenon. It underlines the wider invisibility of the unhoused.Daniel McCulloch, Lecturer in Criminology and Social Policy, The Open UniversityVictoria Cooper, Lecturer in Social Policy and Criminology, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2191552024-01-21T08:55:26Z2024-01-21T08:55:26ZSouth Africa’s ageing population comes with new challenges. How best to adapt to them<p><em>Young people – under the age of 15 – currently make up 29% of South Africa’s population. But this will soon change: the aged portion of the population is forecast to rise from 2030, bringing many challenges. Lauren Johnston, an economics and political economy expert, recently published a <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">paper</a> on the subject. We asked her to put the developments into perspective.</em></p>
<h2>What is South Africa’s current population profile?</h2>
<p>South Africa is “young” among the Brics countries (Brazil, Russia, India and China), but “old” by African standards. For example, seniors make up 5.9% of South Africa’s population and children 28.6%. This <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">compares</a> with Russia’s 15.8% seniors and 17.2% children, and China’s 13.7% seniors and 17.7% children. </p>
<p>The sub-Saharan average is 3.0% for seniors and 41.8% for children. </p>
<h2>What’s up ahead?</h2>
<p>South Africa faces no fears of a substantially diminished working-age population, unlike a number of high-income countries. Nonetheless, population structure estimates suggest that it will be home to a rising number of seniors. </p>
<p><strong>Projected population structure, South Africa</strong></p>
<p>In general, the increase in population share of seniors is driven by falling rates of mortality and birth, leading to fewer younger people relative to elders. In South Africa’s case, a falling fertility rate <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN">from over six births per woman in 1960 to just over two today</a> is a key driver. </p>
<p>An ageing population is statistically defined as a population with 7% or more of people aged 65 and over. </p>
<p>In 2022, seniors made up 5.9% of South Africa’s population. So, it is not yet home to an ageing population. But the <a href="https://population.un.org/wpp/">United Nations</a> forecasts it will join the “population ageing” club as early as 2030. By around 2060 it will be home to an “aged” population – with seniors accounting for 14% of the population. </p>
<h2>What unique challenges lie ahead?</h2>
<p>In general, an ageing population puts added pressure on the working-age population. Each worker has to be more productive, just to maintain total output. Fiscal resources also come under pressure because there are fewer people of working age – net contributors to the economy. There are also more seniors requiring resources for their health and welfare. </p>
<p>For developing countries this can be especially precarious because budgets are often under strain. So are the resources needed for pursuing basic national development. Moreover, a trend of population ageing arising in developing countries is relatively new – just a few decades old. </p>
<h2>How prepared is South Africa for the challenges?</h2>
<p>One challenge for “young” South Africa is that the slower pace of demographic change reduces imminent and more obvious demographic change pressure. The very steady increase in the share of elders alongside pressing broader socioeconomic challenges gives the government little incentive to prioritise social or economic ageing-related issues on its policy agenda.</p>
<p>The array of socioeconomic challenges, including <a href="https://www.parliament.gov.za/storage/app/media/1_Stock/Events_Institutional/2020/womens_charter_2020/docs/19-02-2021/20210212_Womens_Charter_Review_KZN_19th_of_Feb_afternoon_Session_Final.pdf">poverty</a>, <a href="https://theconversation.com/south-africas-police-are-losing-the-war-on-crime-heres-how-they-need-to-rethink-their-approach-218048">crime</a>, entrenched <a href="https://theconversation.com/south-africa-cant-crack-the-inequality-curse-why-and-what-can-be-done-213132">inequality</a> and <a href="https://kleinmanenergy.upenn.edu/news-insights/shedding-the-load-power-shortages-widen-divides-in-south-africa/">energy access</a>, means that the need to respond to the demographic transition is less of an immediate priority. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/millions-of-young-south-africans-are-jobless-study-finds-that-giving-them-soft-skills-like-networking-helps-their-prospects-202969">Millions of young South Africans are jobless: study finds that giving them 'soft' skills like networking helps their prospects</a>
</strong>
</em>
</p>
<hr>
<p>As a result, very few older South Africans benefit from aged care services, and then only the very frail, with inconsistent reach across provinces. Moreover, according to an October 2023 University of Cape Town study, there is little support for older persons who have high care needs and are at home, <a href="https://www.news.uct.ac.za/article/-2023-10-02-funding-elder-care-in-south-africa-new-report#:%7E:text=Based%20on%20estimates%2C%20it%20is,older%20persons%20who%20need%20it.">or for active older persons</a>. Most elders do not have access to services that support their needs, but also fear rising healthcare costs, owing to the rising incidence of non-communicable diseases. These include strokes, cancer and diabetes.</p>
<p>Overall the basic national social welfare net is inadequate. For example, retirees living off less than 16% of their pre-retirement salaries are among those with the highest risk of <a href="https://theconversation.com/retired-women-in-south-africa-carry-a-huge-burden-of-poverty-177379">living in poverty</a>. This group is three times more at risk of poverty than any other group in South Africa. Black female widows are most at risk.</p>
<p>While the economic value of support to older persons has grown over time, the increase has been insufficient to <a href="https://www.news.uct.ac.za/article/-2023-10-02-funding-elder-care-in-south-africa-new-report#:%7E:text=Based%20on%20estimates%2C%20it%20is,older%20persons%20who%20need%20it.">meet the needs of this growing population</a>. Statistics South Africa estimates that population ageing alone is already adding around 0.3% to <a href="https://www.statssa.gov.za/?p=13445">expected health-related expenditures annually</a>. These trends suggest that without change, South Africa’s seniors will become even less adequately served with time.</p>
<h2>What needs to be done to prepare better?</h2>
<p>South Africa has committed to establishing frameworks for healthy ageing based on the <a href="https://www.who.int/initiatives/decade-of-healthy-ageing#:%7E:text=The%20United%20Nations%20Decade%20of,communities%20in%20which%20they%20live.">United Nations Decade of Healthy Ageing from 2020 to 2030</a>. The agenda has four core areas of priority – age-friendly environments, combating ageism, integrated care, and long-term care. To realise these goals, difficult political decisions would need to be made around taxation and redistribution, as more revenue is required to ensure basic dignity for South African seniors. </p>
<p>Guided by the <a href="https://www.justice.gov.za/legislation/acts/2006-013_olderpersons.pdf">Older Persons Act</a> and the <a href="https://social.desa.un.org/issues/ageing/madrid-plan-of-action-and-its-implementation-main/madrid-plan-of-action-and-its">Madrid Plan of Action on Ageing</a>, the Department of Social Development in partnership with other departments, and the <a href="https://saopf.org.za/">South African Older Persons Forum</a> should further implement <a href="https://www.gov.za/news/media-advisories/government-activities/minister-lindiwe-zulu-officially-opens-2022-active">South Africa’s Active Ageing Programme</a> to empower senior citizens to stay physically and intellectually active, to continue to enjoying healthy, purposeful lives. This should help reduce pressure on more intensive care sectors and needs. </p>
<p>As explained in my <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">paper</a>, South Africa should take advantage of the Brics grouping’s new population structure and <a href="https://brics2023.gov.za/wp-content/uploads/2023/08/Jhb-II-Declaration-24-August-2023-%201.pdf">development cooperation agenda</a>. That way, state officials, civil society and entrepreneurs may be better positioned to take advantage of opportunities to reduce healthcare and aged care costs. </p>
<p>To direct sustain the economy as the population ages, South Africa needs to ensure that the economy is robust enough to accommodate a worsening dependency burden. For example, young people must be proportionately empowered to drive productivity growth and innovation. That way, the increasing costs associated with the ageing population could be accommodated while <a href="https://www.uneca.org/stories/eca-discusses-african-middle-income-countries%E2%80%99-challenges-and-solutions-to-accelerate">continuing to drive national development</a>. </p>
<p>Digitisation trends and the Brics population and development agenda may, as examples, also foster opportunities for education and training among not only young South Africans, but all working-age people. This will help raise productivity potential per worker and <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">extend productive working lifespans</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drc-has-one-of-the-fastest-growing-populations-in-the-world-why-this-isnt-good-news-209420">DRC has one of the fastest growing populations in the world – why this isn't good news</a>
</strong>
</em>
</p>
<hr>
<p>South African policy makers and entrepreneurs should also be cognisant of how population ageing affects <a href="https://saiia.org.za/wp-content/uploads/2023/11/OP-351-AGDP-Johnston-FINAL-WEB.pdf">not only other Brics economies</a>, but also patterns of trade and investment. For example, over the coming decades, population decline in middle-income China, and the rapid decline of its working-age population, is likely to push China away from labour-intensive industries, and <a href="https://www.econstor.eu/bitstream/10419/222235/1/GLO-DP-0593.pdf">towards capital-intensive industries and sectors</a>.</p>
<p>In other words, population ageing at home and abroad will shift economic demography-weighted opportunities and challenges at home. The more responsive South Africa can be to these changes, the better off will the nation be.</p><img src="https://counter.theconversation.com/content/219155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Johnston does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In general, an ageing population puts added pressure on the working-age population to be more productive – just to maintain total output – amid growing fiscal constraints.Lauren Johnston, Associate Professor, China Studies Centre, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2129532023-11-29T19:38:40Z2023-11-29T19:38:40ZCOP28: How 7 policies could help save a billion lives by 2100<p>In a <a href="https://doi.org/10.3390/en16166074">recent review</a> of more than 180 peer-reviewed articles — which I conducted with fellow researcher Richard Parncutt — we found that a scientific consensus has formed around the so-called <em>1,000-ton rule</em>. </p>
<p>The <a href="https://doi.org/10.3389/fpsyg.2019.02323">1,000-ton rule</a> states that a person is killed every time humanity burns 1,000 tons of fossil carbon. Shockingly, we found that a 2 C temperature rise equates to a billion prematurely dead people over the next century, killed as a result of a wide range of global warming related climate breakdowns. </p>
<p>These findings were derived from a review of the climate literature that attempted to quantify future human deaths from a long list of mechanisms. </p>
<p>This is a staggering body count, though however uncomfortable it may be, it is consistent with diverse evidence and arguments from multiple disciplines. </p>
<p>As world leaders gather for the COP28 climate conference in Dubai from Nov. 30-Dec. 12, we would do well to remember that their decisions will be directly responsible for killing, or saving, real human lives.</p>
<h2>How climate change will kill us</h2>
<p><a href="https://www.who.int/europe/news/item/07-11-2022-statement---climate-change-is-already-killing-us--but-strong-action-now-can-prevent-more-deaths">Human-caused climate change has killed</a> — and will continue to kill — many human beings by numerous climatic breakdowns caused through a complex web of direct, intermediate and indirect mechanisms. </p>
<p>Direct mortal effects of climate change include <a href="https://www.nationalgeographic.com/environment/article/heat-related-deaths-attributed-to-climate-change">heat waves</a>, which have already caused thousands of <a href="https://doi.org/10.1186/cc2404">human deaths by a combination of heat and humidity</a> and even threaten <a href="https://www.wired.co.uk/article/extreme-heat-threatens-the-health-of-unborn-babies">babies</a>. </p>
<p>Intermediate causes of death involve crop failures, droughts, flooding, extreme weather, wildfires and rising seas. Crop failures, in particular, can make <a href="https://doi.org/10.1098/rstb.2005.1751">global hunger and starvation</a> worse. </p>
<p><a href="https://doi.org/10.1002/wcc.81">More frequent and severe droughts</a> can lead to <a href="https://doi.org/10.1641/0006-3568(2001)051%5b0723:CCAFD%5d2.0.CO;2">more wildfires</a> that also cause human deaths, <a href="https://www.bbc.com/news/world-us-canada-66465570">as we saw in Hawaii</a>. Droughts can also lead to contaminated water, more frequent disease and <a href="https://doi.org/10.3389/fpubh.2022.782811">deaths from dehydration</a>. </p>
<p>The <a href="https://www.climate-refugees.org/spotlight/2022/3/3/ipcc-africa">2022 IPCC Report</a> predicted that drought would displace 700 million people in Africa by 2030. </p>
<p>On the other hand, climate change can also cause flooding (and crop failures from too much water), which also drives hunger and disease. Climate change <a href="https://doi.org/10.1023/A:1026015824714">drives sea level rise and the resultant submersion of low-lying coastal areas and storm surges exacerbate flood risks</a>, which are life-threatening for billions of people in coastal cities who face the prospect of forced migration. </p>
<p><a href="https://doi.org/10.1016/B978-0-12-822700-8.00007-X">Climate change also increases extreme weather events</a>, which kill and cause considerable damage to essential services such as the electric grid and medical facilities. <a href="https://www.climatehubs.usda.gov/hubs/northeast/topic/saltwater-intrusion-growing-threat-coastal-agriculture">Salt water intrusion also threatens coastal agriculture</a>, further reducing food supplies.</p>
<p>Finally, <a href="https://www.reuters.com/business/environment/climate-change-may-increase-conflict-deaths-says-imf-2023-08-30/">climate change also indirectly increases the probability of conflict and war</a>. Although the academic consensus on climate-change-induced war is far from settled, <a href="https://www.unep.org/news-and-stories/story/climate-action-holds-key-tackling-global-conflict">there is little doubt climate change amplifies stress and can cause more localized conflict</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/israel-palestine-conflict-how-sharing-the-waters-of-the-jordan-river-could-be-a-pathway-to-peace-216044">Israel-Palestine conflict: How sharing the waters of the Jordan River could be a pathway to peace</a>
</strong>
</em>
</p>
<hr>
<p>As the number of climate refugees increases, countries further from the equator might increasingly refuse to offer asylum. In a worst-case scenario, <a href="https://doi.org/10.1007/s10584-021-02957-w">social collapse is possible</a> and a <em>Proceeding of the National Academy of Science</em> <a href="https://doi.org/10.1073/pnas.2108146119">article reports it could be devastating</a>.</p>
<h2>There is still time</h2>
<p>A billion dead bodies is a scary prospect but not all of these deaths are predicted to occur at once. In fact, <a href="https://www.who.int/europe/news/item/07-11-2022-statement---climate-change-is-already-killing-us--but-strong-action-now-can-prevent-more-deaths">many people are already dying</a>. However, there is still time to protect those remaining from also being killed by climate change by rapidly transitioning away from carbon energy sources.</p>
<p>We need to implement aggressive energy policies today to eliminate carbon emissions in energy conservation, encourage the evolution of the energy mix to renewable energy, and manage carbon waste. We are already doing a lot of this – we just need to do it faster.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/uns-global-stocktake-on-climate-offers-a-sobering-emissions-reckoning-but-there-are-also-signs-of-progress-217093">UN's 'global stocktake' on climate offers a sobering emissions reckoning − but there are also signs of progress</a>
</strong>
</em>
</p>
<hr>
<p>Gradual decarbonization is not acceptable if it sacrifices such large numbers of human lives. And while each of these proposals may at first seem shocking, if we ask ourselves “would I accept this policy to save one billion human lives?” then I feel the answer becomes much clearer. </p>
<p>We must act to prevent the deaths of millions of our fellow human beings.</p>
<h2>Not so radical</h2>
<ol>
<li><p>We must mandate all new construction be net-zero buildings or <a href="https://doi.org/10.1016/j.solener.2010.09.001">positive energy buildings</a>. This would also have the bonus of providing building owners a positive return on investment and it is <a href="https://doi.org/10.1080/09613218.2014.960783">even possible to make them with no net cost</a>.</p></li>
<li><p>Mandate mass purchases of energy conservation or renewable energy technologies and make them freely available to everyone with zero-interest loans that are easily paid back with energy savings. For example, a government could construct new factories to provide free insulation or solar panels to everyone that will take them. As an added bonus <a href="https://doi.org/10.1016/j.rser.2020.110599">solar power will save homeowners money</a> on electric bills as well as making major savings on <a href="https://www.energystar.gov/buildings/save_energy_commercial_buildings/ways_save">energy conservation measures</a> over their lifetimes.</p></li>
<li><p>Immediately <a href="https://doi.org/10.1007/s10098-020-01917-9">end the sale of fossil fuel vehicles</a> which will save considerable carbon and money as <a href="https://www.nrdc.org/stories/electric-vs-gas-cars-it-cheaper-drive-ev">electric vehicles already have a lower lifetime cost than gas vehicles</a>).</p></li>
<li><p>Revoke the charters of fossil fuel companies and disperse their assets if a company or industry is responsible for killing more people from emissions than they employ. It is a sobering fact that <a href="https://doi.org/10.3390/socsci8020062">The United States coal industry already kills more people from air pollution per year than it employs, and that does not include climate change-related deaths</a>.</p></li>
<li><p>Immediately stop investing in more fossil fuels and heavily tax all fossil fuel-related investments, and/or hold <a href="https://doi.org/10.1016/j.rser.2015.11.025">climate emitters as well as investors economically liable</a> for harm caused by carbon emissions in the future.</p></li>
<li><p>Retrain fossil fuel workers en masse for renewable energy jobs which would help both society and workers who could expect an on average <a href="https://doi.org/10.1016/j.eneco.2016.05.016">seven per cent pay rise moving to the solar industry</a>.</p></li>
<li><p>Immediately ban the extraction of fossil fuels with enforced <a href="https://doi.org/10.1007/s10584-017-2135-5">moratoriums</a>.</p></li>
</ol>
<p>Each of these seven policies will prevent an escalating amount of carbon from entering the atmosphere, preventing the concomitant climate change and billion premature deaths that would be caused by the status quo. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-secretive-legal-system-lets-fossil-fuel-investors-sue-countries-over-policies-to-keep-oil-and-gas-in-the-ground-podcast-191804">A secretive legal system lets fossil fuel investors sue countries over policies to keep oil and gas in the ground – podcast</a>
</strong>
</em>
</p>
<hr>
<h2>Moving forward</h2>
<p>These policies can be achieved by targeting those first three actions that also directly align with economic savings. As economic replacements for fossil fuel technologies scale, the need for fossil fuel investment will continue its existing decline and pushing that decline further will become more politically palatable. As this is happening it will make sense to protect fossil fuel workers by <a href="https://doi.org/10.1007/s43979-023-00067-3">retraining them</a> so they can help accelerate the transition until all carbon-emitting fossil fuel use is ended to enable a stable climate. </p>
<p>This obviously is not going to be easy, but I believe that the vast majority of human beings are good people who will accept temporary inconveniences to transition to an energy system that will prevent one billion premature deaths. </p>
<p>Protecting these lives instead of sacrificing them would be an outcome from COP28 that demonstrates real leadership.</p><img src="https://counter.theconversation.com/content/212953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua M. Pearce has received funding for research from the Natural Sciences and Engineering Research Council of Canada, the Canada Foundation for Innovation, Mitacs, the U.S. Department of Energy (DOE) and the Advanced Research Projects Agency-Energy (ARPA-E), U.S. Department of Defense, The Defense Advanced Research Projects Agency (DARPA), and the National Science Foundation (NSF). In addition, his past and present consulting work and research is funded by the United Nations, the National Academies of Science, Engineering and Medicine, many non-profits and for-profit companies in the energy and solar photovoltaic fields. He is a founding member of Agrivoltaics Canada. He does not directly work for any solar manufacturer and has no direct conflicts of interests.</span></em></p>A recent study found one billion people are likely to die prematurely by the end of the century from climate change. Here are seven energy policies that could save their lives.Joshua M. Pearce, John M. Thompson Chair in Information Technology and Innovation and Professor, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2155602023-10-13T12:17:30Z2023-10-13T12:17:30ZSouth Africa’s 2022 census missed 31% of people - big data could help in future<p>No census is ever exact: as academics Tom Moultrie and Rob Dorrington at the University of Cape Town have <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Oct/undesa_pd_tp_2020_tp_population_estimates.pdf#page=8">noted previously</a>:</p>
<blockquote>
<p>a census is not, in reality, a full and accurate count of the number of people in a country; rather, it is itself an estimate of the size of the population at a moment in time. </p>
</blockquote>
<p>South Africa has announced the results of its fourth census as a democracy – <a href="https://www.statssa.gov.za/?p=16711">Census 2022</a>. I have been involved in the process for the last four years as chair of South Africa’s National Statistics Council. As outgoing chair, my last task was to <a href="https://www.statssa.gov.za/?p=15192">take part</a> in the release of Census 2022.</p>
<p>The census found that the national population has grown to <a href="https://www.statssa.gov.za/?p=16711">62 million</a>, up 10.3 million from the last census <a href="https://www.statssa.gov.za/publications/P03014/P030142011.pdf">in 2011</a>. Gauteng is now clearly the most populous province in the country, with 15.1 million people, overtaking KwaZulu-Natal (12.4 million). The Western Cape jumped from fifth to being the third largest province, with 7.4 million people. These figures are important because they inform resource allocation by government.</p>
<p>What is perhaps most striking about Census 2022 is the very high <a href="https://www.statssa.gov.za/publications/P03015/P030152022.pdf#page=11">undercount</a> – 31% of people and 30% of households were missed (or chose not to self-enumerate, either online or via zero-rated telephone methods). This is the highest undercount of any post-apartheid census; sadly, it may set a new international record. </p>
<p>A census is immediately followed by a <a href="https://www.statssa.gov.za/publications/P03015/P030152022.pdf">Post Enumeration Survey</a>, which identifies where the census missed people. This allows Statistics SA to develop adjustment factors, or weights, so that the final data represents an adjusted final tally. The Post Enumeration Survey is used to manage the undercount. Census undercounts are the norm, <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Oct/undesa_pd_tp_2020_tp_population_estimates.pdf#page=8">not the exception</a>. But it is safe to assume that with weighting on this scale – adjusting for an undercount of 31.06% – analysts may identify some confounding results. </p>
<p>At aggregate level, <a href="https://census.statssa.gov.za/#/">Census 2022</a> is robust. At sub-national – and especially sub-provincial – levels, however, it may be less so. Only time and data analysis will tell.</p>
<p>The census confirmed the global trend of <a href="https://www.icf.com/insights/health/declining-survey-response-rate-problem">declining survey response rates</a>. People are less and less inclined to be involved in the process. This raises the question: does a fieldwork-based census have a future? Given the challenges that faced Census 2022, I believe the census may need to be re-imagined as a very different exercise. This requires <a href="https://www.statssa.gov.za/">Statistics South Africa</a>, which conducts the census, to fully engage with big data to bring the process into the 21st century.</p>
<h2>The process</h2>
<p>South Africa’s National Statistics Council, an independent body of experts that advises the statistician-general and the minister in the presidency regarding statistics, had secured a number of local and international experts – as had Stats SA – to stress test the census and the Post Enumeration Survey. Council never has prior sight of the data: its job is to focus on methods and process.</p>
<p>The experts do engage with the data and flagged only a few variables (mortality data, and some service and asset questions which had too many non-responses to be reliable) as requiring a cautionary note. Council engaged vigorously with the experts and Stats SA, and with no red flag raised by any, we declared the census <a href="https://census.statssa.gov.za/#/">“fit for purpose”</a>.</p>
<p>It is notable that Stats SA routinely conducts a post enumeration survey. Many countries do not, even when there is systematic undercounting of particular groups (often young men, children and minorities). Moreover, Stats SA will make available both the weighted and the raw data for analysts to examine in detail. This transparency should be welcomed, given that (as previously noted by the <a href="https://unstats.un.org/unsd/demographic/sources/census/wphc/QA.htm">United Nations Statistics Division</a>) issues of undercounting affect all countries, and estimating the undercount and whether to adjust the data is a political issue “throughout the world”. The undercount was high, but not as a result of any lack of effort or commitment from Stats SA.</p>
<h2>Why the undercount</h2>
<p>The undercount is the result of many factors. </p>
<p>First, the context matters. This time round it was as bad as it could be, with the COVID-19 pandemic affecting training and supply chains for equipment. The pandemic also generated anxiety in a populace that had been avoiding contact with strangers as part of social distancing. Census planning usually starts three or four years prior to fieldwork. Training about 100,000 enumerators is a major effort in its own right, combined with the shift to digital platforms for the first time. All were affected by the pandemic.</p>
<p>The fieldwork took place after the devastating <a href="https://theconversation.com/south-africas-deadly-july-2021-riots-may-recur-if-theres-no-change-186397">July 2021 insurrection</a>, and after the hard-fought <a href="https://www.elections.org.za/pw/Elections-and-results/Municipal-Elections-2021">local elections</a>. The process also coincided with xenophobic violence meted out by the anti-migrant pressure group-<a href="https://www.theguardian.com/global-development/2023/sep/26/south-africa-anti-migrant-vigilante-operation-dudula-registers-as-party-2024-elections">turned-political party</a> <a href="https://theconversation.com/rising-vigilantism-south-africa-is-reaping-the-fruits-of-misrule-179891">Operation Dudula</a> in Johannesburg. Taken together, the effect was a deep-seated reluctance to open doors to strangers, particularly those asking lots of questions.</p>
<p>A second factor that affected the gathering of data was the fact that there is <a href="https://www.afrobarometer.org/wp-content/uploads/migrated/files/publications/Dispatches/ad474-south_africans_trust_in_institutions_reaches_new_low-afrobarometer-20aug21.pdf">very low trust in the government</a>. Although the census is conducted by Stats SA, which is an independent entity, it is seen as “government”. This label didn’t make it easy to persuade people to allow an enumerator into their dwellings and answer questions. </p>
<p>People in the Western Cape, the only province not run by the African National Congress, were particularly resistant to being enumerated or self-enumerating. This was true even after the provincial premier and Cape Town mayor made public calls for people to comply. The undercount in the Western Cape stands at 35.58% of people and 36.3% of households. In the Free State, by comparison, the undercount is 20.95% of people and 17.93% of households.</p>
<p>A third factor was that response rates have been getting consistently lower over at least the last decade. This has been true for Stats SA and other entities undertaking primary research. The decision to go digital was an attempt to open different avenues for people to complete the questionnaire online, or by phone, to improve response rates.</p>
<p>People appear to be sick and tired of being polled by everyone, from their local supermarket to endless tele-marketers and others. They also appear much more wary of sharing their data. What, then, is the future for the census?</p>
<h2>Enter big data</h2>
<p>Countries around the world are facing the same challenge of low response rates. </p>
<p>The advent of big data opens intriguing possibilities. </p>
<p>A first step would be to harvest data from the records kept by government departments (assuming they are run well). In addition, data could be unlocked if a working relationship was developed with private sector entities, such as suppliers and banks. </p>
<p>Becoming far more tech-savvy, and encouraging people to engage with Stats SA digitally, could be combined with other options to compile a national population dataset. It would also represent a significant cost-saving. This approach – harvesting data rather than gathering it directly – is being considered by many countries, but has not yet been attempted, and Stats SA needs to carefully consider this option.</p>
<p>Stats SA needs to fully engage with the world of big data, and the key players in that data ecosystem. It has convening authority, and should be engaging all key players, whether they are academic, private sector or others. </p>
<p>At the very least, an alternative way of conducting the next census in 2032 must be rigorously examined and tested. </p>
<p>Big data is not the answer to all the challenges that faced Census 2022, but it may be a key enabler for gathering reliable national data in the future.</p><img src="https://counter.theconversation.com/content/215560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Everatt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Big data is not the answer to all the challenges that faced Census 2022, but it may be a key enabler for gathering reliable national data in the future.David Everatt, Professor of Urban Governance, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2108782023-08-09T20:06:22Z2023-08-09T20:06:22ZPoor, middle-aged Australians are more likely to die from cancer – and the gap is widening<figure><img src="https://images.theconversation.com/files/541387/original/file-20230807-21-68n6bz.jpg?ixlib=rb-1.1.0&rect=26%2C44%2C5846%2C3865&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ararat-vic-australia-june-16-2023-2319355771">Shutterstock</a></span></figcaption></figure><p>A cancer diagnosis is frightening news for anyone. But our fresh analysis shows what happens next can depend on how much money you have and where you live.</p>
<p>Among middle-aged Australians cancer is the leading cause of death, accounting for 45% of all deaths among those aged 45 to 64 years. </p>
<p>In an article just published in <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4746">Health Economics</a>, we examine the inequality in mortality (or death rates) across Australia. As has been found elsewhere, death rates in Australia are highest among those with the lowest socioeconomic status (SES).</p>
<p>This measure of income, employment and education has long been recognised as related to <a href="https://doi.org/10.1257/jep.13.2.145">both</a> a person’s health status and their ability to “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388137/">buffer</a>” against the negative impacts of a health condition.</p>
<p>What’s new from our study is our finding middle-aged men living in the poorest local areas of Australia in 2016-18 were twice as likely to die from cancer than those living in the richest areas. Women in the same areas were 1.6 times more likely. </p>
<p>This disparity between rich and the poor is growing over time, widening by 34% from 2001 to 2018. And while deaths from cancer have fallen everywhere over time, they have fallen by more in our richest locations compared to our poorest.</p>
<h2>Measuring death and status</h2>
<p>For our new analysis, we examined all deaths and those from specific causes for men and women across all age groups. We used death registry data provided by the Australian Institute of Health and Wellbeing and Census data on SES. </p>
<p>We ranked local areas across the country by two measures of SES: the Australian Bureau of Statistics’ <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001%7E2016%7EMain%20Features%7EIRSD%7E19">Index of Relative Socio-economic Disadvantage</a> and the share of households in a local area living in poverty (sourced from a customised Census report). Our findings remained consistent using either of these measures. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graph looking at cancer deaths over time" src="https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541329/original/file-20230805-84679-ipgwsj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">3-year cancer mortality rate per 1,000 people, Ages 45–64 years, by sex. The blue line plots the 3-year mortality rate due to cancer in the poorest 10% of local areas ranked by the IRSD. Red plots the richest.</span>
</figcaption>
</figure>
<p>The new findings for middle-aged Australians stand out because inequality in mortality has been relatively stable over time and death rates are falling for most other age groups.</p>
<p>Among young Australians aged 15–24 years we can see death rates falling and the SES gap in mortality shrinking due to greater declines in road deaths in poor areas. </p>
<p>Nevertheless, if we could eliminate death inequality, and all Australians under the age of 75 enjoyed the lower mortality rates of those living in our most socioeconomically advantaged areas, 28% of the all deaths across Australia could have been avoided.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-actually-is-palliative-care-and-how-is-it-different-to-end-of-life-care-205488">What actually is palliative care? And how is it different to end-of-life care?</a>
</strong>
</em>
</p>
<hr>
<h2>Why the gap?</h2>
<p>We also looked at what could be driving this rising inequality in mortality for middle-aged Australians. Our research suggests different access to health care may have a role to play. Two findings support this. </p>
<p>First, when we compare city areas to more regional and remote areas, we find the increase in inequality (between low and high SES) is not as strong for women and is not present for men. This suggests the widening gap is because of smaller declines in deaths over time in our poorest regional and remote areas. In other words, improvements have been slower there. </p>
<p>Second, over the period from 2001 to 2018, the number of doctors per person is consistently greater in richer regions than poorer regions of Australia. </p>
<p>Over the past 20 years there have been substantial technological advances in medicine. However, access to new medications and treatments is often only available following consultations with primary physicians (such as GPs) or specialists. </p>
<p>Inequality in access to health care – as we can see exists between wealthier cities and poorer regional and remote areas – is likely to lead to a different level of benefit from medical advancements between the rich and the poor. </p>
<p>For <a href="https://www.cancer.org.au/assets/pdf/inequalities-in-cancer-outcomes">cancer</a> in particular, one of the <a href="https://doi.org/10.1634/theoncologist.2010-0404">contributing factors</a> to disparities in cancer deaths by SES is the limited availability of screening and treatment options.</p>
<p>We can’t say for certain poverty and access to doctors are linked with poor health outcomes and higher death rates, but it certainly warrants attention from policymakers. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1685151546588442624"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climb-the-stairs-lug-the-shopping-chase-the-kids-incidental-vigorous-activity-linked-to-lower-cancer-risks-210288">Climb the stairs, lug the shopping, chase the kids. Incidental vigorous activity linked to lower cancer risks</a>
</strong>
</em>
</p>
<hr>
<h2>More analysis needed</h2>
<p>Accessibility to health care significantly influences disparities in cancer death rates. But we need more comprehensive analysis of how various social determinants of health contribute to these inequalities. </p>
<p>These could include social and environmental characteristics of local areas, health behaviours and cancer awareness, income or income inequality. Future research should examine whether the socioeconomic disparities in cancer death rates are also evident in cancer diagnoses. </p>
<p>It’s also important to explore how population screening programs (such as BreastScreen Australia and the National Bowel Cancer Screening Program for over 50s) and subsidised early detection initiatives (including Medicare-subsidised breast cancer imaging and prostate-specific antigen tests) can mitigate these <a href="https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary">disparities</a>.</p>
<p>Lastly, policymakers should be alert to the possibility delays in screening and changes in health-care accessibility related to the COVID pandemic may have exacerbated these health inequalities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-your-status-where-you-live-and-your-family-background-affect-your-risk-of-dementia-183922">How your status, where you live and your family background affect your risk of dementia</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/210878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Research for this article was supported by a grant from the ARC Centre of Excellence for Children and Families over the Life Course and a 2020 SOAR fellowship from the University of Sydney. Kadir Atalay does not work for, consult, own shares in or receive funding from any other company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p><p class="fine-print"><em><span>Research for this article was supported by a grant from the ARC Centre of Excellence for Children and Families over the Life Course and a 2020 SOAR fellowship from the University of Sydney.
Rebecca Edwards does not work for, consult, own shares in or receive funding from any other company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
</span></em></p>A gap between rich and the poor in cancer deaths for middle-aged people is growing. Deaths from cancer have fallen over time, but less so in our poorest regions where there is less health care access.Kadir Atalay, Associate Professor in Economics, University of SydneyRebecca Edwards, Senior Lecturer in Economics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2102882023-07-27T20:11:19Z2023-07-27T20:11:19ZClimb the stairs, lug the shopping, chase the kids. Incidental vigorous activity linked to lower cancer risks<figure><img src="https://images.theconversation.com/files/539428/original/file-20230726-15-g6qffv.jpg?ixlib=rb-1.1.0&rect=9%2C9%2C3058%2C2037&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rear-view-woman-hand-grocery-trolley-2262929743">Shutterstock</a></span></figcaption></figure><p>Many people know exercise reduces the risk of <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2521826">cancers</a>, including liver, lung, breast and kidney. But structured exercise is time-consuming, requires significant commitment and often financial outlay or travel to a gym. These practicalities can make it infeasible for <a href="https://bjsm.bmj.com/content/42/11/901">most adults</a>. </p>
<p>There is <a href="https://www.nature.com/articles/s41591-022-02100-x">very little research</a> on the potential of incidental physical activity for reducing the risk of cancer. Incidental activities can include doing errands on foot, work-related activity or housework as part of daily routines. As such they do not require an extra time commitment, special equipment or any particular practical arrangements. </p>
<p>In our <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2807734">study</a> out today, we explored the health potential of brief bursts of vigorous physical activities embedded into daily life. These could be short power walks to get to the bus or tram stop, stair climbing, carrying heavy shopping, active housework or energetic play with children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-afford-a-gym-membership-or-fitness-class-3-things-to-include-in-a-diy-exercise-program-206204">Can't afford a gym membership or fitness class? 3 things to include in a DIY exercise program</a>
</strong>
</em>
</p>
<hr>
<h2>How was the study done?</h2>
<p>Our <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2807734">new study</a> included 22,398 <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a> participants who had never been diagnosed with cancer before and did not do any structured exercise in their leisure time. Around 55% of participants were female, with an average age of 62. Participants wore wrist activity trackers for a week. Such trackers monitor activity levels continuously and with a high level of detail throughout the day, allowing us to calculate how hard and exactly for how long people in the study were moving. </p>
<p>Participants’ activity and other information was then linked to future cancer registrations and other cancer-related health records for the next 6.7 years. This meant we could estimate the overall risk of cancer by different levels of what we call “<a href="https://pubmed.ncbi.nlm.nih.gov/33108651/">vigorous intermittent lifestyle physical activity</a>”, the incidental bursts of activity in everyday life. We also analysed separately a group of <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2521826">13 cancer sites in the body</a> with more established links to exercise, such such as breast, lung, liver, and bowel cancers. </p>
<p>Our analyses took into account other factors that influence cancer risk, such as age, smoking, diet, and alcohol habits.</p>
<h2>What we found out</h2>
<p>Even though study participants were not doing any structured exercise, about 94% recorded short bursts of <a href="https://pubmed.ncbi.nlm.nih.gov/33108651/">vigorous activity</a>. Some 92% of all bouts were done in very short bursts lasting up to one minute. </p>
<p>A minimum of around 3.5 minutes each day was associated with a 17–18% reduction in total cancer risk compared with not doing any such activity. </p>
<p>Half the participants did at least 4.5 minutes a day, associated with a 20–21% reduction in total cancer risk. </p>
<p>For cancers such as breast, lung and bowel cancers, which we know are impacted by the amount of exercise people do, the results were stronger and the risk reduction sharper. For example, a minimum of 3.5 minutes per a day of vigorous incidental activity reduced the risk of these cancers by 28–29%. At 4.5 minutes a day, these risks were reduced by 31–32%. </p>
<p>For both total cancer and those known to be linked to exercise, the results clearly show the benefits of doing day-to-day activities with gusto that makes you huff and puff.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&rect=8%2C13%2C2936%2C2035&q=45&auto=format&w=1000&fit=clip"><img alt="adult man helps child with bike" src="https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&rect=8%2C13%2C2936%2C2035&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539427/original/file-20230726-29-3o8y49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lots of people find it tough to make time for structured exercise.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-learn-his-little-son-ride-555030952">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/short-bursts-of-physical-activity-during-daily-life-may-lower-risk-of-premature-death-new-research-196304">Short bursts of physical activity during daily life may lower risk of premature death – new research</a>
</strong>
</em>
</p>
<hr>
<h2>Our study had its limits</h2>
<p>The study is observational, meaning we looked at a group of people and their outcomes retrospectively and did not test new interventions. That means it cannot directly explore cause and effect with certainty. </p>
<p>However, we took several statistical measures to minimise the possibility those with the lowest levels of activity were not the unhealthiest, and hence the most likely to get cancer – a phenomenon called “<a href="https://www.sciencedirect.com/topics/computer-science/reverse-causation">reverse causation</a>”. </p>
<p>Our study can’t explain the biological mechanisms of how vigorous intensity activity may reduce cancer risk. Previous <a href="https://journals.lww.com/acsm-msse/Fulltext/2017/02000/Brief_Intense_Stair_Climbing_Improves.10.aspx">early-stage trials</a> show this type of activity leads to rapid improvements in heart and lung fitness. </p>
<p>And higher fitness is linked to lower <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002934320300097">insulin resistance</a> and lower <a href="https://www.sciencedirect.com/science/article/pii/S0735109704017036">chronic inflammation</a>. High levels of these are risk <a href="https://www.sciencedirect.com/science/article/pii/S0735109704017036">factors for cancer</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/poor-sleep-is-really-bad-for-your-health-but-we-found-exercise-can-offset-some-of-these-harms-163270">Poor sleep is really bad for your health. But we found exercise can offset some of these harms</a>
</strong>
</em>
</p>
<hr>
<p>There is very little research on incidental physical activity and cancer in general, because most of the scientific evidence on lifestyle health behaviours and cancer is based on questionnaires. This method doesn’t capture short bursts of activity and is very inaccurate for measuring the incidental activities of daily life. </p>
<p>So the field of vigorous intensity activity and cancer risk is at its infancy, despite some <a href="https://academic.oup.com/eurheartj/article/43/46/4801/6771381">very promising</a> recent findings that vigorous activity in short bouts across the week could cut health risks. In another recent study of ours, we found benefits from daily <a href="https://www.nature.com/articles/s41591-022-02100-x%22%22">vigorous intermittent lifestyle activity</a> on the risk of death overall and death from cancer or cardiovascular causes.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1682344906017185792"}"></div></p>
<h2>In a nutshell: get moving in your daily routine</h2>
<p>Our study found 3 to 4 minutes of vigorous incidental activity each day is linked with decreased cancer risk. This is a very small amount of activity compared to <a href="https://bjsm.bmj.com/content/54/24/1451">current recommendations</a> of 150–300 minutes of moderate intensity or 75–150 minutes of vigorous intensity activity a week. </p>
<p>Vigorous incidental physical activity is a promising avenue for cancer prevention among people unable or unmotivated to exercise in their leisure time. </p>
<p>Our study also highlights the potential of technology. These results are just a glimpse how wearables combined with machine learning – which our study used to identify brief bursts of vigorous activity – can reveal health benefits of unexplored aspects of our lives. The future potential impact of such technologies to prevent cancer and possibly a <a href="https://www.nature.com/articles/s41591-022-02100-x">host of other</a> conditions could be very large.</p><img src="https://counter.theconversation.com/content/210288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research explores the health potential of brief bursts of activity – and how wearables combined with machine learning can reveal health benefits of unexplored aspects of our everyday lives.Emmanuel Stamatakis, Professor of Physical Activity, Lifestyle, and Population Health, University of SydneyMatthew Ahmadi, Postdoctoral Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2000362023-07-19T12:22:54Z2023-07-19T12:22:54ZHip-hop and health – why so many rap artists die young<figure><img src="https://images.theconversation.com/files/537895/original/file-20230717-17-u3sao8.png?ixlib=rb-1.1.0&rect=30%2C38%2C2502%2C2483&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hip hop artists, from top left, clockwise, DMX, Lexii Alijai, Prince Markie Dee and Trugoy the Dove have all passed away within the past decade. </span> <span class="attribution"><span class="source">Getty Images </span></span></figcaption></figure><p>The song “Be Healthy” from the 2000 album by hip-hop duo dead prez, “<a href="https://pitchfork.com/reviews/albums/dead-prez-lets-get-free/">Let’s Get Free</a>,” is a rare rap anthem dedicated to diet, exercise and temperance:</p>
<p><em>“They say you are what you eat, so I strive to eat healthy / My goal in life is not to be rich or wealthy / ‘Cause true wealth come from good health and wise ways / We got to start taking better care of ourselves”</em> </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/47757IZRc5c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">“Be Healthy,” from the 2000 album “Let’s Get Free”</span></figcaption>
</figure>
<p>In what’s widely recognized as <a href="https://www.grammy.com/news/2023-grammys-celebrate-50-years-hip-hop-star-performance-segment">hip-hop’s 50th anniversary</a>, an unfortunate reality is that several of its pioneering artists aren’t here to celebrate. The number of rappers who never live to see much more than 50 years themselves is astounding.</p>
<p>Rappers and rap fans can’t help but take notice that their peers and favorite rappers are dying young. Trugoy the Dove of De La Soul, 53, <a href="https://www.vulture.com/2023/02/de-la-soul-trugoy-the-dove-dead-at-54.html">passed away in February 2023</a> after a <a href="https://www.thedailybeast.com/trugoy-the-dove-member-of-hip-hop-trio-de-la-soul-dies-at-54">battle with congestive heart failure</a>. Gangsta Boo, hailed as the “<a href="https://www.commercialappeal.com/story/entertainment/music/2023/01/14/gangsta-boo-celebration-of-life-memphis-rap-railgarten/69804248007/">Queen of Memphis</a>” and known for her work with Three 6 Mafia, <a href="https://www.billboard.com/music/music-news/gangsta-boo-dead-former-three-6-mafia-rapper-dies-obituary-1235192876/">died at the age of 43</a> of a drug overdose in January 2023. Takeoff, a member of the Atlanta trio Migos, was <a href="https://www.nytimes.com/2022/11/01/arts/music/takeoff-migos-dead.html">killed in November 2022</a>. He was 28 years old. </p>
<p>Rapper <a href="https://www.vibe.com/news/entertainment/jim-jones-stands-on-rappers-have-the-most-dangerous-job-comment-1234672569/">Jim Jones has claimed</a> that rap is the most dangerous profession due to rappers <a href="https://www.theatlantic.com/ideas/archive/2022/11/takeoff-death-hip-hop-rap-violence/672117/">being violently killed so frequently</a>. Similarly, <a href="https://www.complex.com/music/a/backwoodsaltar/fat-joe-rappers-endangeed-species-pnb-rock-death">rapper Fat Joe believes</a> rappers are an endangered species. In the 2022 song “On Faux Nem,” Lupe Fiasco put it more succinctly: “Rappers die too much.”</p>
<p>As a rapper, a fan of hip-hop’s art and artists, and a <a href="https://news.virginia.edu/content/meet-ad-carson-uvas-professor-hip-hop">professor of hip-hop</a>, I agree with Lupe Fiasco: Rappers die too much. Whether it’s from gun violence, heart disease, cancer, self-harm or drugs, the number of rappers whose lives have ended prematurely is alarming.</p>
<figure class="align-center ">
<img alt="Rap star Nipsey Hussle looks out." src="https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=505&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=505&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=505&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=635&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=635&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537537/original/file-20230714-17-t3lnuk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=635&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rap star Nipsey Hussle was shot and killed in Los Angeles in 2019.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/rapper-nipsey-hussle-attends-a-craft-syndicate-music-news-photo/1080924940?adppopup=true">Prince Williams/WireImage via Getty Images</a></span>
</figcaption>
</figure>
<h2>The (un)exceptional spectacle of American gun violence</h2>
<p>Stories of rappers who die violently are well known. News media are quick to report on <a href="https://www.mercurynews.com/2022/11/01/gun-violence-has-killed-at-least-1-rapper-every-year-since-2018-2/">violence in hip-hop</a> to <a href="https://theconversation.com/scapegoating-rap-hits-new-low-after-july-fourth-mass-shooting-186443">support their view</a> that the music and the people who make it are exceptionally violent. Violence, death and conflict attract attention. Pair any of those with racial stereotyping and scapegoating and it’s easy to see why the murders of hip-hop stars such as Nipsey Hussle, the Notorious B.I.G., Tupac Shakur and countless other artists garner so much attention.</p>
<p>Though they were all taken by the <a href="https://theconversation.com/rappers-are-victims-of-an-epidemic-of-gun-violence-just-like-all-of-america-194429">very American plague of gun violence</a>, news and historical accounts often amplify the spectacle of violent Black death, even when they claim to honor those who are killed. </p>
<p>I’ve <a href="https://www.npr.org/sections/codeswitch/2021/05/24/173838383/a-letter-to-my-mother-just-in-case">written extensively</a> about the trend of scapegoating rappers. It is also the topic addressed in the song “<a href="https://aydeethegreat.bandcamp.com/track/ankh-featuring-nathaniel-star">ANKH</a>” from my forthcoming mixtap/e/ssay, “<a href="https://aydeethegreat.com/wp-content/uploads/2023/06/Illicit-Press-Release-6-23-pdf-232x300.jpg">V: ILLICIT</a>”:</p>
<p><em>“He died by the gun but they blamed the music. / They said, ‘What he said was evidence.’ And used it. …/ No compassion for the life torn apart when the bullets hit him, / cause he talked about the block in his art, so he’s not a victim. / Cameraman said, ‘They don’t value life too much.’ / He reported here before. Even twice some months. / Somewhere in his mid-twenties was his deadline (dying). / ‘Another N— Killed Here’ was the headline (crying).”</em></p>
<iframe style="border: 0; width: 350px; height: 442px;" src="https://bandcamp.com/EmbeddedPlayer/track=594009146/size=large/bgcol=ffffff/linkcol=de270f/tracklist=false/transparent=true/" seamless="" width="100%" height="400"><a href="https://aydeethegreat.bandcamp.com/track/ankh-featuring-nathaniel-star">ANKH (featuring Nathaniel Star) by A.D. Carson</a></iframe>
<p>An awful byproduct of this culture of consuming carnage is that the kinds of violent gun tragedies people are experiencing <a href="https://www.washingtonpost.com/nation/interactive/2022/gun-deaths-per-year-usa/">all across the U.S.</a> are being spotlighted in hip-hop and used as <a href="https://theconversation.com/scapegoating-rap-hits-new-low-after-july-fourth-mass-shooting-186443">excuses to criminalize and pathologize</a> certain people and the music they enjoy, the art they create, the neighborhoods they live in or the places they grew up.</p>
<p>Another heartbreaking consequence is that some rappers only gain wide popularity and realize financial success <a href="https://www.economist.com/graphic-detail/2020/07/23/posthumous-albums-by-young-rappers-are-topping-the-charts">after they’ve died</a>. Deceased rappers are an unfortunately abundant commodity. Juice WRLD and Pop Smoke are prime examples: They both sold four to five times as much music after their deaths than when they were alive.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=354&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=354&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=354&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=445&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=445&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538103/original/file-20230718-21-dohcve.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=445&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Before and after death sales.</span>
<span class="attribution"><span class="source">The Economist</span></span>
</figcaption>
</figure>
<p>Along with being alarmed by these tragedies, it’s important to examine the conditions that affect mortality and attempt to get to the actual causes rather than scapegoating a musical form.</p>
<h2>Deadly diseases</h2>
<p>While violence brings about headlines, guns are not the only cause for concern. Diseases – many of them preventable – are also a factor.</p>
<p>Heart disease, lung disease, cancer, diabetes, strokes and renal disease are among the top 10 causes of death <a href="https://www.cdc.gov/minorityhealth/lcod/men/2017/nonhispanic-black/index.htm">among Black men</a> and <a href="https://www.cdc.gov/minorityhealth/lcod/men/2018/byrace-hispanic/index.htm">Hispanic men</a>, according to the Centers for Disease Control and Prevention. It makes sense that these causes also prominently figure in the deaths of hip-hop artists. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Rapper Big Pun performs on stage." src="https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537899/original/file-20230717-210016-dd9z7i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rapper Big Pun, who sold a million albums, died at 28.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/big-pun-and-fat-joe-performing-at-les-poulets-on-may-13-news-photo/547402373?adppopup=true">Hiroyuki Ito/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<h2>Gone before retirement</h2>
<p><a href="https://www.nytimes.com/2006/02/14/arts/music/james-yancey-producer-known-for-soulful-hiphop-dies-at-32.html">Rapper and producer J-Dilla</a> (32), rappers <a href="https://www.chron.com/entertainment/music/article/houston-rappers-remember-big-moe-dead-at-33-1797262.php">Big Moe (33)</a>, <a href="https://www.complex.com/music/a/complex/black-the-ripper-dead-at-32">Black the Ripper (32)</a> from the U.K., <a href="https://www.vibe.com/news/entertainment/founding-three-6-mafia-member-lord-infamous-dead-40-199175/">Lord Infamous (40)</a>, <a href="https://hiphopdx.com/news/id.20369/title.big-hutch-releases-statement-on-passing-of-above-the-law-member-kmg?utm_source=twitterfeed&utm_medium=twitter#">KMG the Illustrator (43</a> from Above the Law, <a href="https://www.usatoday.com/story/entertainment/celebrities/2021/04/09/dmx-hip-hop-legend-dies-50-after-heart-attack/7074550002/">DMX (50)</a>, <a href="https://www.independent.co.uk/arts-entertainment/music/news/big-t-death-cause-texas-rapper-age-52-wanna-be-a-baller-a8343506.html">Big T (52)</a>, <a href="https://onthisdateinhiphop.com/news/april-3-tweedy-bird-loc-passes-away-2020/">Tweedy Bird Loc (52)</a>, <a href="https://www.rollingstone.com/music/music-news/black-rob-dead-1157364/">Black Rob (52)</a> and <a href="https://www.nytimes.com/2000/02/09/arts/christopher-rios-28-rapper-recorded-under-name-big-pun.html">Big Pun (28)</a> all died from heart attacks. <a href="https://www.hollywoodreporter.com/news/music-news/heavy-d-cause-death-pulmonary-embolism-276405/">Heavy D (44) experienced a pulmonary embolism</a> that led to his death. <a href="https://www.nytimes.com/2021/02/19/arts/music/prince-markie-dee-fat-boys-dead.html">Prince Markie Dee (52) of the Fat Boys</a> passed away from congestive heart failure. <a href="https://www.rollingstone.com/music/music-news/craig-mack-flava-in-ya-ear-rapper-dead-at-47-127656/">Craig Mack (47)</a> died from heart failure. And Brax (21) <a href="https://variety.com/2020/music/news/brax-dead-influencer-rapper-1234823912/#">died from cardiac arrhythmia</a>. </p>
<p><a href="https://ew.com/article/2016/03/23/phife-dawg-dead-dies/#">Phife Dawg (45)</a> of A Tribe Called Quest, <a href="https://www.rollingstone.com/music/music-news/tim-dog-f-k-compton-rapper-dead-at-46-98451/">Tim Dog (46)</a> and <a href="https://www.rollingstone.com/music/music-news/biz-markie-dead-1191772/">Biz Markie (57)</a> all passed away from complications related to diabetes. </p>
<figure class="align-center ">
<img alt="Phife Dawg of A Tribe Called Quest performs at a music festival." src="https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537822/original/file-20230717-210447-vwdxnq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In 2016, Phife Dawg of A Tribe Called Quest died at 45 after a long battle with Type-1 diabetes.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/phife-dawg-of-a-tribe-called-quest-performs-at-2013-h2o-news-photo/176730972?adppopup=true">Rodrigo Vaz/FilmMagic via Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://www.nytimes.com/2010/04/21/arts/music/21guru.html">Guru (48) of Gangstarr</a>, <a href="https://www.rollingstone.com/music/music-news/bushwick-bill-geto-boys-rapper-dead-obituary-846047/">Bushwick Bill (52) of the Geto Boys</a>, <a href="https://www.latimes.com/entertainment-arts/story/2022-11-07/hurricane-g-death-rapper-lung-cancer">Hurricane G (52)</a> and <a href="https://www.nytimes.com/2021/12/18/arts/music/kangol-kid-dead.html#">Kangol Kid (55)</a> died from cancer. <a href="https://www.billboard.com/music/rb-hip-hop/dj-kay-slay-55-dead-covid-19-battle-obituary-1235060195/">DJ K Slay passed away at 55</a> from what was described as COVID-19 complications.</p>
<p>Eazy-E <a href="https://deadline.com/2021/07/the-mysterious-death-of-eazy-e-docuseries-wetv-1234793623/">died of AIDS at 30</a>.</p>
<p><a href="https://www.nytimes.com/2011/03/17/arts/music/nate-dogg-hip-hop-collaborator-dies-at-41.html#:%7E:text=He%20was%2041.,on%20the%20songs%20of%20rappers.">Nate Dogg’s death at 41</a> was attributed to a stroke. </p>
<p><a href="https://www.latimes.com/local/la-me-pimpc5feb05-story.html">Pimp C’s death at 33</a> was attributed to sleep apnea and an <a href="https://www.nytimes.com/2008/02/06/arts/06arts-DRUGSKILLEDP_BRF.html">overdose of cough syrup</a>. <a href="https://www.mprnews.org/story/2020/01/28/autopsy-st-paul-rapper-lexii-alijai-died-of-accidental-overdose">Lexii Alijai (21)</a>, <a href="https://www.nbcnews.com/pop-culture/pop-culture-news/philadelphia-rapper-chynna-rogers-dies-25-n1180051">Chynna (25)</a>, and <a href="https://www.billboard.com/music/rb-hip-hop/digital-underground-shock-g-cause-of-death-9585758/">Shock G (57)</a> all reportedly died of accidental drug overdose.</p>
<p><a href="https://ew.com/article/2012/07/19/ms-melodie-rapperdead-at-43/">Ms. Melodie passed away</a> in her sleep at the age of 43. <a href="https://www.latimes.com/entertainment-arts/music/story/2023-06-18/big-pokey-death-houston-rapper-texas#">Big Pokey collapsed onstage</a> and passed away at 48. <a href="https://www.rollingstone.com/music/music-news/whodini-john-fletcher-dead-1107571/">Ecstasy of Whodini died at 56</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Artist Ms. Melodie performs on stage." src="https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=890&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=890&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=890&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1119&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1119&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537824/original/file-20230717-243941-wecfnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1119&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ms. Melodie of Boogie Down Productions passed away in 2012.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/late-rapper-ms-melodie-of-boogie-down-productions-performs-news-photo/465938029?adppopup=true">Raymond Boyd/Michael Ochs Archives via Getty Images</a></span>
</figcaption>
</figure>
<h2>A renewed focus on health</h2>
<p>Unfortunately, this list of tragic lives halted from ages 21 to 57 is not a comprehensive account of all the rappers who have passed away well before the age of retirement.</p>
<p>The occasion of celebrating 50 years of hip-hop provides a moment to reflect and honor some of the artists who contributed to the culture and are not here to celebrate this golden anniversary. It’s also, perhaps, an opportunity to consider some of the outcomes of systemic barriers to health and wellness, such as <a href="https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services">access to affordable health care</a>, varied dietary options and mental wellness resources.</p>
<p>Given the number of rappers and other prominent hip-hop artists who have died young, ultimately it may come down to seriously taking heed to dead prez’s instructions from “Be Healthy”: “We got to start taking better care of ourselves.”</p><img src="https://counter.theconversation.com/content/200036/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>A.D. Carson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As hip-hop turns 50, an unfortunate reality is that so many of its pioneering artists never live to see much more than 50 years themselves, a professor of hip-hop writes.A.D. Carson, Associate Professor of Hip-Hop, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2087402023-07-13T12:38:15Z2023-07-13T12:38:15ZWeather forecast accuracy is crucial in a heat wave – 1 degree can mean the difference between life and death<figure><img src="https://images.theconversation.com/files/536937/original/file-20230711-26-jekcvf.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C6000%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Extreme heat can put lives at risk, making accurate forecasts essential for people working outdoors.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/exhausted-construction-worker-at-construction-site-royalty-free-image/1334826526">FG Trade/E+ via Getty Images</a></span></figcaption></figure><p>Weather forecasts have gotten quite good over the years, but their temperatures aren’t always spot on – and the result when they underplay extremes can be lethal. <a href="https://doi.org/10.3386/w31361">Even a 1-degree difference</a> in a forecast’s accuracy can be the difference between life and death, our research shows. </p>
<p>As <a href="https://scholar.google.com/citations?user=614D6AEAAAAJ&hl=en">economists</a>, <a href="https://scholar.google.com/citations?user=9VrtHcIAAAAJ&hl=en">we have</a> <a href="https://scholar.google.com/citations?user=o7NswrkAAAAJ&hl=en">studied</a> how people use forecasts to manage weather risks. In a new working paper for the National Bureau of Economic Research, we looked at how human survival <a href="https://doi.org/10.3386/w31361">depends on the accuracy of temperature forecasts</a>, particularly during heat waves like <a href="https://abcnews.go.com/US/37-million-americans-alert-dangerous-heat/story?id=100959311">large parts of the U.S.</a> have been experiencing in recent days.</p>
<p>We found that when the forecasts underplayed the risk, even small forecast errors led to more deaths.</p>
<p>Our results also show that improving forecasts pays off. They suggest that making forecasts 50% more accurate would save 2,200 lives per year across the country and would have a net value that’s nearly <a href="https://www.everycrsreport.com/files/2022-06-17_IF11914_d3e26afb6fbd9006c54580150fc833d6f1614231.pdf">twice the annual budget</a> of the National Weather Service.</p>
<h2>Forecasts that are too mild lead to more deaths</h2>
<p>In the U.S. alone, the National Oceanic and Atmospheric Administration issues <a href="https://www.noaa.gov/sites/default/files/2021-06/NOAABlueBook2022_final.pdf">1.5 million forecasts per year</a> and collects around 76 billion weather observations that help it and private companies make better forecasts.</p>
<p>We examined data on <a href="https://www.cdc.gov/">every day’s deaths</a>, weather and National Weather Service forecast in every U.S county from 2005 to 2017 to analyze the impact of those forecasts on human survival. </p>
<p>We then compared deaths in each county over the week following a day with accurate forecasts to deaths in the same county over the week following a day with inaccurate forecasts but the same weather. Because weather conditions were the same, any differences in mortality could be attributed to how people’s reactions to forecasts affected their chance of dying in that weather.</p>
<figure class="align-center ">
<img alt="Cars drive under a sign reading: Extreme heat. Save Power 4-9PM. Stay Cool" src="https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536939/original/file-20230711-29-ur6l4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vehicles on the 110 Freeway pass warning signs on Sept. 2, 2022, during a heat wave with temperatures as high as 112 degrees Fahrenheit (44 Celsius) in the Los Angeles suburbs.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/vehicles-drive-past-a-sign-on-the-110-freeway-warning-of-news-photo/1242895722?adppopup=true">Patrick T. Fallon/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>We found similar results when the forecast was wrong on hot days with temperatures above 86 degrees Fahrenheit (30 Celsius) and on cold days with temperatures below freezing. Both summer days that were hotter than forecast and winter days that were colder <a href="https://www.nber.org/papers/w31361">had more deaths</a>. Forecasts that went the other way and overestimated the summer heat or winter cold had little impact. </p>
<p>That doesn’t mean forecasters should exaggerate their forecasts, however. If people find that their forecasts are consistently off by a degree or two, they might change how they use forecasts or come to trust them less, leaving people at even higher risk.</p>
<h2>People are paying attention</h2>
<p>People do pay attention to forecasts and adjust their activities.</p>
<p>The <a href="https://www.bls.gov/tus/overview.htm">American Time Use Survey</a>, conducted continuously for the U.S. Bureau of Labor Statistics, shows what Americans across the country are doing on any given day. We found that on days when the forecast called for temperatures to be milder than they turned out to be – either cooler on a hot day or warmer on a cold day – people in the survey spent more time on leisure and less in home or work settings.</p>
<p><a href="https://www.eia.gov/">Electricity use</a> also varies in sync with forecasts, suggesting that people’s use of air conditioning does not just respond to the weather outside but also depends on how they planned for the weather outside.</p>
<figure class="align-center ">
<img alt="A man holds something over his head to shield the sun from his forehead. Other people walking across the bridge on a bright, sunny day have umbrellas and hats." src="https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536940/original/file-20230711-23-mdhw2x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A man shields his head from the Sun as he walks across New York’s Brooklyn Bridge on a hot summer day in 2018.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-shields-his-head-from-the-sun-as-he-walks-across-the-news-photo/987271692">Drew Angerer/Getty Images</a></span>
</figcaption>
</figure>
<p>However, forecasts are not used equally across society. Deaths among racial minorities are less sensitive to forecast errors, we found. That could be due in part to having less flexibility to act on forecasts, or not having access to forecasts. We will dig into this difference in future work, as the answer determines how the National Weather Service can best reach everyone.</p>
<h2>The value of better forecasts</h2>
<p>It’s clear that people use forecasts to make decisions that can matter for life and death – <a href="https://www.texasmonthly.com/travel/texas-hiking-heat-deaths-big-bend-palo-duro/">when to go hiking</a>, for example, or whether to encourage an elderly neighbor to <a href="https://theconversation.com/saving-lives-from-extreme-heat-lessons-from-the-deadly-2021-pacific-northwest-heat-wave-206737">go to a cooling center</a>.</p>
<p>So, what is the value of accurate forecasts?</p>
<p>We combined our theoretical model with <a href="https://www.epa.gov/environmental-economics/mortality-risk-valuation">federal cost-benefit estimates</a> of how people value improvements in their chances of survival. From those, we estimated people’s willingness to pay for better forecasts. That calculation accounts for the risk of dying from extreme weather and for the costs of using forecasts to reduce their risk of dying, such as the costs of altering work and play schedules or using electricity.</p>
<p>The result shows that 50% more accurate forecasts are <a href="https://doi.org/10.3386/w31361">worth at least US$2.1 billion per year</a> based on the mortality benefits alone. In comparison, the 2022 <a href="https://www.everycrsreport.com/files/2022-06-17_IF11914_d3e26afb6fbd9006c54580150fc833d6f1614231.pdf">budget of the National Weather Service</a> was less than $1.3 billion.</p>
<p>Weather forecasts have gotten steadily better over the past decades. About 68% of the next-day temperature forecasts now have an error of less than 1.8 degrees. Our results suggest investing in improved forecast accuracy would probably be worth the cost. </p>
<p>Past improvements have come from better models, better observations and better computers. Future improvements could come from similar channels or from applying recent innovations in <a href="https://theconversation.com/ai-and-machine-learning-are-improving-weather-forecasts-but-they-wont-replace-human-experts-182498">machine learning</a> and <a href="https://www.nature.com/articles/d41586-023-02084-9">artificial intelligence</a> to weather prediction and communication.</p>
<p>Climate change will <a href="https://nca2018.globalchange.gov/">increase the frequency of extremely hot days</a>, which are <a href="https://climate.nasa.gov/explore/ask-nasa-climate/3151/too-hot-to-handle-how-climate-change-may-make-some-places-too-hot-to-live/">especially important for human health</a> and survival to forecast accurately. Climate change will make the weather weirder, but weird weather can do less harm when we can see it coming.</p><img src="https://counter.theconversation.com/content/208740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Derek Lemoine receives funding from Global Research Institute, is a Research Associate at the National Bureau of Economic Research, and is an Associate Fellow at the Centre for Economic Policy Research.</span></em></p><p class="fine-print"><em><span>Jeff Shrader receives funding from the National Science Foundation. </span></em></p><p class="fine-print"><em><span>Laura Bakkensen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Three economists looked at years of temperature and death data and calculated the costs when forecasts miss the mark.Derek Lemoine, Associate Professor of Economics, University of ArizonaJeffrey Shrader, Assistant Professor of International and Public Affairs, Columbia UniversityLaura Bakkensen, Associate Professor of Economics and Policy, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2046222023-06-13T12:29:56Z2023-06-13T12:29:56ZAnnual numbers of excess deaths in the US relative to other developed countries are growing at an alarming rate<figure><img src="https://images.theconversation.com/files/527599/original/file-20230522-14385-h3se2w.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5100%2C3802&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Homicides and the opioid epidemic both contribute to the rising U.S. death rates.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/people-at-a-funeral-royalty-free-image/104302939?phrase=U.S.+cemetery&adppopup=true">Rubber Ball Productions/Brand X Pictures via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>People in the U.S. are dying at higher rates than in other similar high-income countries, and that difference is only growing. That’s the key finding of a <a href="https://doi.org/10.1371/journal.pone.0283153">new study that I published</a> in the journal PLOS One.</p>
<p>In 2021, more than 892,000 of the 3,456,000 deaths the U.S. experienced, or about 1 in 4, were “<a href="https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm#">excess deaths</a>.” In 2019, that number was 483,000 deaths, or nearly 1 in 6. That represents an 84.9% increase in excess deaths in the U.S. between 2019 and 2021. </p>
<p>Excess deaths refer to the actual number of deaths that occur in a given year compared with expected deaths over that same time period based on prior years or, as in this study, in other countries.</p>
<p>In my study, I compared the number of U.S. deaths with those in the five largest countries in Western Europe: England and Wales, France, Germany, Italy and Spain. Those five countries make for a good comparison because they are nearly, if not quite, as wealthy as the U.S. and their combined population is similar in size and diversity to the U.S. population.</p>
<p>I also chose those countries because they were used in an earlier study from another research team that documented a <a href="https://doi.org/10.1073/pnas.2024850118">34.5% increase in excess deaths</a> in the U.S. between 2000 and 2017. </p>
<p>The acceleration of this already alarming long-term trend in excess deaths in the U.S. was exacerbated by the fact that the U.S. experienced higher death rates from COVID-19 <a href="https://doi.org/10.1136/bmj.n1343">compared with similar countries</a>. However, <a href="https://theconversation.com/279-700-extra-deaths-in-the-us-so-far-in-this-pandemic-year-147887">COVID-19 alone does not account</a> for the recent increase in the number of excess deaths in the U.S. relative to comparison countries.</p>
<h2>Why it matters</h2>
<p>Rising living standards and medical advances through the 20th century have made it possible for people in wealthy countries to live longer and <a href="https://doi.org/10.1257/jep.20.3.97">with a better quality of life</a>. Given that the U.S. is the largest economic power in the world, with cutting-edge medical technology, Americans should have an advantage over other countries in terms of life span and death rates.</p>
<p>But in the last 50 years, many countries around the world have outpaced the U.S. in how fast death rates are declining, as revealed by <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm#">trends in life expectancy</a>.</p>
<p>Life expectancy is an average age at death, and it represents how long an average person is expected to live if current death rates remain unchanged throughout that person’s lifetime. Life expectancy is based on a complex combination of death rates at different ages, but in short, when death rates decline, life expectancy increases. </p>
<p><iframe id="6Jigb" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/6Jigb/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Compared to about 20 other high-income countries, since around the mid-1970s <a href="https://www.npr.org/sections/health-shots/2023/03/25/1164819944/live-free-and-die-the-sad-state-of-u-s-life-expectancy#">the U.S. life expectancy</a> has been <a href="https://doi.org/10.17226/13497">slipping from about the middle, or median, to the lowest rungs</a> of life expectancy. So the relative stagnation in life expectancy in the U.S. compared with other countries is directly related to the fact that death rates have also declined more slowly in the U.S.</p>
<p>The U.S. has higher death rates than its peer countries due to a variety of causes.
Cardiovascular disease prevalence has been an <a href="https://doi.org/10.1161/CIRCRESAHA.116.309115">important driver of life expectancy changes across the globe</a> in recent decades. But while death rates from cardiovascular disease have continued to decline in other parts of the world, those <a href="https://doi.org/10.1073/pnas.1920391117">rates have stagnated in the U.S.</a>. </p>
<p>A key reason for this trend is the <a href="https://doi.org/10.1073/pnas.1716802115">rise in obesity</a>, as research shows that <a href="https://doi.org/10.1161/CIR.0000000000000973">obesity increases the risk of death from cardiovascular disease</a>. High prevalence of obesity in the U.S. also likely contributed to the <a href="https://doi.org/10.1136/bmj.n1343">relatively high death rates from COVID-19</a>. </p>
<p>Another cause is that the U.S. has disproportionately high death rates from intentional injuries in the form of homicides, <a href="https://doi.org/10.1097/TA.0b013e3181dbaddf">in particular those caused by firearms</a>. Moreover, it also has high death rates from unintentional injuries, <a href="https://doi.org/10.1111/padr.12228">in particular drug overdoses</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lmxF2owm3Gg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">People are being exposed to fentanyl without knowing it, and because the synthetic opioid is so highly potent, people are dying in unprecedented numbers.</span></figcaption>
</figure>
<h2>What other research is being done</h2>
<p>While these specific causes of deaths should clearly be health policy priorities today, there might be more fundamental causes to the elevated U.S. death rates. </p>
<p>In the early 1990s, young people in the U.S. between the ages of 15 and 34 were already dying at <a href="https://doi.org/10.1016/S1054-139X(01)00329-9">higher rates than their peers in other countries</a> from a combination of homicides, unintentional injuries – in large part from motor vehicle accidents – and <a href="https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline/">deaths from HIV/AIDS</a>. </p>
<p>Research is underway to understand the more <a href="https://doi.org/10.1097/PHH.0000000000001626">fundamental societal causes</a> that may explain the vulnerability of the U.S. population to successive epidemics, from HIV/AIDS and COVID-19 to gun violence and opioid overdoses. </p>
<p>These <a href="https://doi.org/10.1073/pnas.2014750117">include racial</a> and <a href="https://doi.org/10.2105/AJPH.2008.139469">economic inequalities</a>, which combined with a weaker social security net and lack of health care access for all may help explain larger health and death disparities compared to European countries.</p><img src="https://counter.theconversation.com/content/204622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Heuveline does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research shows that preventable deaths are increasing in the US at the same time that life expectancy keeps dropping.Patrick Heuveline, Professor of Sociology, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016302023-04-02T11:46:49Z2023-04-02T11:46:49ZAgeism and the pandemic: How Canada continues to let older adults suffer and die from COVID-19<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/ageism-and-the-pandemic--how-canada-continues-to-let-older-adults-suffer-and-die-from-covid-19" width="100%" height="400"></iframe>
<p>Three years into this pandemic, most Canadians have taken off their masks and many have stopped getting booster shots. However, COVID-19 is rising among the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401">leading causes of death</a> in Canada, <a href="https://www.finder.com/ca/what-are-the-top-10-causes-of-death-in-canada">reaching the No. 3 spot</a>.</p>
<p>This is the first time an infectious disease has pushed its way into the top five causes of death during the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causesofdeathover100years/2017-09-18">last 80 years or so of the antibiotic era</a>.</p>
<p>Older adults account for most of those deaths, and we are letting it happen.</p>
<h2>COVID-19, aging and ageism</h2>
<p>COVID is a <a href="https://www.cdc.gov/globalhealth/immunization/diseases/index.html">vaccine-preventable disease</a>, but we are not using vaccines as well as we could. Most Canadians don’t understand the importance of booster shots in <a href="https://www.bmj.com/content/380/bmj-2022-072529">protecting them from long-term health issues that may follow infection</a>, such as long COVID. Even fewer recognize that getting vaccinated <a href="https://immunize.ca/">helps protect their entire community</a>, including older adults. </p>
<figure class="align-center ">
<img alt="A man and his grandson wearing face masks touching elbows greeting social" src="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Healthy seniors are assets to their communities. They are caregivers, volunteers and keepers of cultural knowledge.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Most COVID deaths are in older people. That’s not just a problem for them. It’s a problem for everyone. When older adults are healthy they are an incredible asset to our communities — they are <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00007-eng.htm">caregivers</a>, <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2021001/article/00002-eng.htm">volunteers</a> and <a href="https://www.bayshore.ca/resources/respect-your-elders-how-seniors-contribute-to-a-better-world/">repositories of knowledge and culture</a>. When they are unwell it is a <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/economic-burden-illness-canada-2010.html">tremendous strain</a> on them, their caregivers and <a href="https://www.cambridge.org/core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement/article/abs/chronic-health-conditions-changing-prevalence-in-an-aging-population-and-some-implications-for-the-delivery-of-health-care-services/0FFB314D39504F95027340EBD7534DCB">our health-care system</a>.</p>
<p><a href="https://www.cihi.ca/en/hospital-stays-in-canada">COVID has become the second-leading cause of hospitalization in Canada</a>, after childbirth. Among those over 50, it is the single leading cause of hospitalization. </p>
<p>We had <a href="https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance/covid-19-data-tool?tab=outbreaks">more outbreaks in long-term care facilities in 2022</a> than we had in <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">2020 and 2021 combined, and more deaths and more hospitalizations than the first two years of the pandemic combined</a>. </p>
<p>COVID is not over, but we are acting like it is. Many COVID research programs are <a href="https://www.covid19immunitytaskforce.ca/citf-leadership/">winding down</a>. Can you imagine winding down research into any other condition on the top five mortality list? </p>
<p>The reason for not doing more to prevent COVID-19 appears to be ageism, plain and simple. There is no logical explanation for accepting an unnatural degree of hospitalization and premature deaths in elders except that we value the lives of younger people more. </p>
<h2>The toll of COVID-19 in older people</h2>
<p>Unfortunately, dying isn’t even necessarily the worst of it. </p>
<p>It’s just the part that’s easier to count and that makes the most headlines. There is still a sea of suffering out there, as older people — who are more likely to have other health issues — get sick with COVID and take a long time to recover, if they do recover. </p>
<figure class="align-center ">
<img alt="Rows of small white crosses on a lawn with a building in the background" src="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Canada had the highest proportion of COVID deaths in long-term care of any country in the Organisation for Economic Co-operation.
and Development. Crosses outside a Mississauga, Ont. long-term care centre during the first wave of the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>For older adults, respiratory illness is often a <a href="https://doi.org/10.1007/978-3-030-22009-9_550">catalyst for other health problems</a>, triggering a spiral that ends in premature death. Illness also causes many people to <a href="https://www.nber.org/books-and-chapters/women-working-longer-increased-employment-older-ages/women-working-longer-labor-market-implications-providing-family-care">retire early because they or the people they care for are chronically ill</a>.</p>
<p>Canada had the <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">highest proportion of COVID deaths in long-term care</a> of any country in the Organisation for Economic Co-operation and Development, because we did not prioritize preventing infectious disease. Now, because of the demographic bulge of the Baby Boom, the <a href="https://toronto.ctvnews.ca/wait-list-for-long-term-care-beds-in-ontario-nearly-doubled-in-10-years-oltca-says-1.6229216">demand for long-term care for older adults is rising</a>, even as COVID outbreaks continue in such facilities.</p>
<p>It’s hard to believe that after the <a href="https://www.cbc.ca/news/canada/montreal/quebec-herron-inquest-day-3-1.6170046">horror show</a> in so many Canadian long-term care homes during early months of COVID that we have slipped back into complacency, allowing Canadians’ parents, grandparents, neighbours and friends to become infected because the rest of us won’t take simple actions.</p>
<p>It doesn’t have to be this way, and it shouldn’t. </p>
<h2>Excess COVID-19 deaths in older adults are not inevitable</h2>
<p>Typically, people under 50 are likely to have much more social contact through school, social events and work, making them the most likely to be exposed to the virus. However, they are also the least likely to protect themselves — and others — by keeping up with their <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/#a5">booster shots</a> and <a href="https://angusreid.org/covid-unmasked-unwilling/">wearing masks</a>. </p>
<figure class="align-center ">
<img alt="An older woman walking outdoors with a younger woman who has her arm through the older woman's. Both are wearing face masks." src="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It may be easier for them to believe and behave as if the threat of COVID has passed, because they are far <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">more likely to make a quick and complete recovery</a> from COVID. But they are also the ones <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">most likely to spread it to those who have far less immune protection</a> and far less choice. </p>
<p>We shouldn’t treat COVID-19 in older adults as inevitable. With better testing, policy makers could have better information to make decisions about how to reduce the number of infections. If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</p>
<p>Older adults have inherent value and dignity, and are an asset to their communities. They are people who have already contributed to society in family, professional and social capacities, and who continue to do so. They deserve to live as long and as well as possible.</p><img src="https://counter.theconversation.com/content/201630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force (Public Health Agency of Canada) for her research on COVID-19 infections and vaccinations in older adults. She is on the Board of Directors of the Lung Health Foundation. </span></em></p>COVID-19 is the third-leading cause of death in Canada, but it’s older people who are dying. That we accept this and carry on as if the pandemic is over reveals our ageism: We don’t value older people.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957182022-12-16T13:13:54Z2022-12-16T13:13:54Z1918 flu pandemic upended long-standing social inequalities – at least for a time, new study finds<figure><img src="https://images.theconversation.com/files/499388/original/file-20221206-16-lo9q7q.jpg?ixlib=rb-1.1.0&rect=0%2C220%2C3000%2C1742&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In this November 1918 photo, a nurse tends to a patient in the influenza ward of the Walter Reed hospital in Bethesda, Md. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreak1918InfluenzaCOVID19/97d84472fcad44449444ae3b7cc5f539/photo?Query=1918%20flu&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=91&currentItemNo=29">AP Photo/Harris & Ewing via Library of Congress</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Racial disparities in <a href="https://doi.org/10.1215/00703370-10235825">influenza deaths shrunk by 74% in U.S. cities</a> during the <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">1918 flu pandemic</a> due to an odd coincidence of virus and history. That’s the key finding of our recently published study in the journal Demography. </p>
<p>This conclusion contradicts the <a href="https://tidsskriftet.no/2017/05/global-helse/social-inequality-forgotten-factor-pandemic-influenza-preparedness">common claim</a> that crises like pandemics <a href="https://doi.org/10.1073/pnas.2020685118">make social inequalities worse</a>. The 1918 influenza pandemic was a surprising exception. </p>
<p>Prior to the 1918 pandemic, Black people in the U.S. died of respiratory diseases <a href="https://doi.org/10.1007/s13524-019-00789-z">at vastly higher rates</a> than white people. But our study found that urban white people in their 20s and 30s were especially vulnerable to the 1918 virus, dying at rates that were up to 20 times higher than normal. While the death rates of Black people in urban settings also spiked during the 1918 pandemic, they did so by a much smaller rate than in white populations. On average, across all age groups, white mortality increased fivefold, while Black mortality increased threefold.</p>
<p>Overall, Black people <a href="https://doi.org/10.7326/M20-2223">still died at higher rates</a> than white people during the 1918 pandemic, but the ratio of Black-to-white mortality – a measure of racial inequality – <a href="https://doi.org/10.3390/ijerph16142487">shrank dramatically</a> compared with other time periods. So while 1918 was wildly deadly across the world, the death rate among urban white young adults in the U.S. was truly unprecedented.</p>
<p><iframe id="i69Ni" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/i69Ni/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why it matters</h2>
<p>One anomalous feature of the pandemic is well known: It <a href="https://doi.org/10.1371/journal.pone.0069586">killed many young adults</a> alongside children and elderly people, who are traditionally at risk from flu viruses.</p>
<p>But the unusually small racial inequality in flu deaths in the U.S. in 1918 is a little-known puzzle that contrasts with modern pandemics <a href="https://doi.org/10.1073/pnas.2205813119">like COVID-19</a> <a href="https://doi.org/10.2105/AJPH.2009.170241">and HIV</a>, which have hit Black communities especially hard. It also contrasts with a global tendency for <a href="https://doi.org/10.1186/s13643-018-0931-2">poorer populations to be more likely</a> to die from the flu.</p>
<p>Our study considered several hypotheses to explain the surprising patterns in the U.S. during the 1918 pandemic. One such potential explanation was that policies like school closures especially benefited Black populations because of their higher risk of dying from the flu in nonpandemic years when such measures were absent.</p>
<p>But only one explanation fits our evidence: Urban white young adults in the U.S. were deeply vulnerable in 1918 because of the way their immune systems had been programmed during childhood in the late 19th century. This is because the first flu people encounter as children is special: <a href="https://doi.org/10.1126/science.aag1322">It teaches the immune system</a> how to respond to future flu infections. However, research shows that this so-called immunological imprinting <a href="https://doi.org/10.1016/j.jaut.2017.04.008">can be harmful</a> when the virus someone later encounters is very different from the virus their immune system has been trained against.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/U6Ccdk5wPvk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The 1918 flu pandemic killed at least 50 million people worldwide.</span></figcaption>
</figure>
<p>The last flu pandemic to hit U.S. cities before 1918 was a <a href="https://doi.org/10.1073/pnas.1000886107">devastating global pandemic</a> that began in 1889. Exposure to that virus would have taught children’s immune systems to expect <a href="https://doi.org/10.1073/pnas.1324197111">what was probably an H3N8 flu</a>. But the devastation in 1918 was caused by the world’s first H1N1 pandemic. The two strains belong to two different groups of influenza viruses, and immune protection from H3N8 would not have conferred protection against H1N1. </p>
<p>To the contrary: People whose first flu exposure occurred in the 1890s would have likely had a compromised immune response to the 1918 pandemic because their immune system produced the wrong kind of antibodies that <a href="https://doi.org/10.1038/s41467-021-23977-1">crowded out more effective ones</a>.</p>
<p>In <a href="https://doi.org/10.1371/journal.pone.0069586">2013</a> and <a href="https://doi.org/10.1073/pnas.1324197111">2014</a> studies, two groups of virologists and demographers proposed and tested the hypothesis that 1890s imprinting explains the unusually high mortality of young adults during the 1918 pandemic. We adapted their argument to explain unusually small racial disparities as well. </p>
<p>This hypothesis suggests that the pattern of Black and white deaths in 1918 revolves around a historical coincidence. Black young adults were more often spared this fateful imprinting because they spent their childhoods in rural areas. As a result, though they often lived in deep poverty, they did not encounter some of the respiratory diseases that were rampant in cities. So while they were vulnerable to 1918’s novel flu, they were less so than people whose immune systems were primed to meet a virus like the one that circulated in the 1890s. </p>
<h2>What still isn’t known</h2>
<p>Immunologists are only beginning to understand the exact mechanisms through which imprinting affects long-term immune responses. Recent studies about the <a href="https://doi.org/10.3390/v11020122">early 20th century</a> and the <a href="https://doi.org/10.1038/s41467-021-23977-1">COVID-19 pandemic</a> support the idea that imprinting can significantly affect immune responses later in life. We all carry in our bodies the memories of our past disease exposures. </p>
<p>Those exposures <a href="https://doi.org/10.1007/s13524-019-00789-z">changed radically</a> during the 20th century, and the full consequences for population immunity in the COVID-19 era remain to be unraveled.</p><img src="https://counter.theconversation.com/content/195718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Wrigley-Field receives funding from the Minnesota Population Center, which is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number P2C HD041023).</span></em></p><p class="fine-print"><em><span>Martin Eiermann does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During the 1918 flu pandemic, white people died at similar rates to Black Americans, according to a new study – a very different pattern than what occurred during the COVID-19 pandemic.Elizabeth Wrigley-Field, Assistant Professor of Sociology, University of MinnesotaMartin Eiermann, Postdoctoral Fellow in Sociology, Duke UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962812022-12-12T04:15:39Z2022-12-12T04:15:39ZThousands more Australians died in 2022 than expected. COVID was behind the majority of them<figure><img src="https://images.theconversation.com/files/500267/original/file-20221212-94530-9fo5k3.jpg?ixlib=rb-1.1.0&rect=43%2C34%2C5699%2C3794&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-australia-july-29-2022-600w-2184218879.jpg">Shutterstock/David L Young</a></span></figcaption></figure><p>Last month, the Australian Bureau of Statistics (ABS) released a <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/jan-jul-2022">report</a> of mortality statistics. It showed that from January to July 2022, there were 17% more deaths (16,375) than the average expected for these months. </p>
<p>This historical average is based on an average of the deaths for 2017, 2018, 2019 and 2021. They did not include 2020 in the baseline for 2022 data because it included periods where numbers of deaths were significantly lower than expected. The difference between the expected number of deaths based on historical data, and the actual number, is called “excess deaths”. </p>
<p>However, as the ABS points out in its report, using previous years as the predictor for the expected number of deaths does not take into account changes in population age structure over time, or potential improvements in mortality rates. </p>
<p>As we will see, the excess deaths this year were likely lower than the ABS estimate – but still overwhelmingly related to COVID and its effects on health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/there-are-still-good-reasons-to-avoid-catching-covid-again-for-one-your-risk-of-long-covid-goes-up-each-time-196041">There are still good reasons to avoid catching COVID again – for one, your risk of long COVID goes up each time</a>
</strong>
</em>
</p>
<hr>
<h2>A different approach</h2>
<p>Last week, the Australian Actuaries Institute released its <a href="https://www.actuaries.digital/2022/12/07/covid-19-mortality-working-group-excess-mortality-continues-in-august-2022/">report</a> looking at excess deaths. Actuaries are statisticians who specialise in assessing risk, and most often work for insurance companies, superannuation funds, banks or government departments. </p>
<p>Unlike the ABS, the actuaries’ report adjusts the expected deaths for differences in age distributions over time using a <a href="https://www.aihw.gov.au/getmedia/95237794-4b77-4683-9f00-77c4d33e0e7c/13406.pdf.aspx?inline=true#:%7E:text=Direct%20age%2Dstandardisation%20accounts%20for,distribution%20of%20a%20standard%20population.">method</a> called “direct age-standardisation”. </p>
<p>The report also uses a <a href="https://en.wikipedia.org/wiki/Counterfactual_thinking">counterfactual</a> approach which basically asks, what would the number of deaths have been in the absence of the pandemic? Their comparison between recorded and expected deaths is likely to be more accurate than the ABS comparison. </p>
<h2>What the actuaries saw</h2>
<p>Both the Actuaries Institute report and the ABS separate COVID deaths into two categories:</p>
<ul>
<li><p>deaths from COVID, where COVID is listed as the primary or underlying cause of death</p></li>
<li><p>deaths with COVID, where the underlying cause of death has been determined as something other than COVID, but the virus was a contributing factor.</p></li>
</ul>
<p>The Actuaries Institute report shows 13% excess mortality for the first eight months of 2022 (approximately 15,400 deaths), substantially lower than the ABS estimate for the first seven months. </p>
<p>Just over half of the excess mortality – 8,200 deaths, are deaths <em>from</em> COVID. Another 2,100 deaths are deaths <em>with</em> COVID. The remaining excess of 5,100 deaths makes no mention of COVID on the death certificate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="black hearse at cemetery" src="https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID was not listed on thousands of death certificates, but was still likely a factor in many.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-nsw-australia-february-25-600w-1936556404.jpg">Shutterstock/Rose Makin</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-mild-covid-raises-the-chance-of-heart-attack-and-stroke-what-to-know-about-the-risks-ahead-190552">Even mild COVID raises the chance of heart attack and stroke. What to know about the risks ahead</a>
</strong>
</em>
</p>
<hr>
<h2>So what is the likely cause of those non-COVID excess deaths?</h2>
<p>The actuaries’ report gives the following possible explanations for excess deaths not listed as from or with COVID:</p>
<p><strong>Long COVID and interactions with other serious health conditions</strong></p>
<p>A previous COVID infection can cause later illness or death. We know COVID is associated with higher <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00087-4/fulltext">risk</a> of death from heart disease, cancer and other causes. </p>
<p>But a doctor tasked with completing a death certificate may not identify a link between the death and a COVID infection months earlier. Therefore, it seems likely some deaths were due to late COVID effects.</p>
<p><strong>Delayed deaths from other causes</strong></p>
<p>Deaths from respiratory disease in 2020 and 2021 were <a href="https://medicalrepublic.com.au/respiratory-deaths-fell-during-second-covid-19-wave/38109">lower</a> than expected. This is presumably due to public health measures like mask wearing. While those measures were in place, people caught fewer respiratory diseases. Some people may have died earlier had their systems been stressed by respiratory disease during this time. So, some of the reported non-COVID excess deaths may be due to the catch-up effect of those people succumbing to underlying illnesses. </p>
<p><strong>Delays in emergency care</strong></p>
<p>Around Australia, our health systems are under pressure, with staff absences due to COVID, ambulance ramping, and bed blocks in our acute hospitals. </p>
<p>Unfortunately, there have been <a href="https://www.abc.net.au/news/2022-09-13/report-released-into-south-australia-ambulance-delays/101434904">cases</a> of people dying while waiting for an ambulance. It could be that people with conditions such as heart disease, cancer or diabetes may not be getting lifesaving emergency care due to these factors. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-death-data-can-be-shared-to-make-it-look-like-vaccines-dont-work-or-worse-but-thats-not-the-whole-picture-172411">COVID death data can be shared to make it look like vaccines don't work, or worse – but that's not the whole picture</a>
</strong>
</em>
</p>
<hr>
<p><strong>Delays in routine care</strong></p>
<p>Over the pandemic period we have seen <a href="https://ahpa.com.au/advocacy/australians-are-delaying-healthcare-appointments-and-tests-during-covid-19/#:%7E:text=Of%20those%20surveyed%2C%2059%25%20were,services%20would%20be%20too%20busy.">delays</a> in people <a href="https://www.pwc.com.au/media/2021/pwc-global-health-industry-issues-survey.html">seeking</a> routine health care or attending <a href="https://www.aihw.gov.au/reports/australias-health/cancer-screening-and-treatment#How%20has%20the%20COVID-19%20pandemic%20impacted%20the%20cancer%20screening%20programs?">screening tests</a> for breast and cervical cancer. </p>
<p>There have also been <a href="https://9now.nine.com.au/a-current-affair/coronavirus-elective-surgery-covid19-holds-become-ticking-time-bombs-for-aussie-patients/630d03bc-87e9-4ba9-b6b4-791d2690bda2">delays</a> in elective surgery. And people may have been <a href="https://janesthanalgcritcare.biomedcentral.com/articles/10.1186/s44158-021-00032-5">avoiding</a> health-care settings due to fear of catching COVID. These delays in routine care may have led to deaths that would have been prevented in previous years. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person getting blood pressure checked" src="https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many people have delayed routine health checks since the start of the pandemic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-patient-undergoing-routine-600w-2099534764.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>Pandemic lifestyle changes</strong></p>
<p>There is evidence in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11971-7">Australia</a> and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540284/">United Kingdom</a> a higher proportion of people made less healthy lifestyle choices during lockdowns, such as drinking more alcohol and exercising less. Higher risks for childhood obesity were also <a href="https://www.bmj.com/content/374/bmj.n1716">noted</a>. We could be starting to see the impact of these changes.</p>
<p><strong>Undiagnosed COVID</strong></p>
<p>It is almost certain some of the excess deaths are from unidentified COVID. Unfortunately in Australia, we have no firm data on the percentage of undiagnosed COVID cases, and even less on how that percentage might have changed over time. </p>
<p>So, the good news is the ABS excess death estimate of 17% more deaths in the first eight months of this year is likely an over-estimate, with the true rate closer to 13%. Of this 13%, some 7% are deaths from COVID, 2% are deaths with COVID, and much of the remaining 4% is likely to still be COVID-related in some way. </p>
<p>Last week, there were <a href="https://www.covid19data.com.au/deaths">219</a> COVID-related deaths reported. If the actuaries’ analysis is accurate, then the true number of COVID-related deaths last week was closer to 250 – a sobering thought as we approach the festive season. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-were-on-a-global-panel-looking-at-the-staggering-costs-of-covid-17-7m-deaths-and-counting-here-are-11-ways-to-stop-history-repeating-itself-190658">We were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself</a>
</strong>
</em>
</p>
<hr>
<p><em>Editor’s note: After publication, the ABS contacted The Conversation to clarify its Provisional Mortality Statistics should not be used or reported as official excess mortality estimates.</em></p><img src="https://counter.theconversation.com/content/196281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Esterman receives funding from the MRFF, the NHMRC and the ARC.</span></em></p>There were deaths from COVID and deaths with COVID – but other deaths are also likely linked to the virus’s impact on our health and our medical care.Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1936282022-12-12T02:04:46Z2022-12-12T02:04:46Z‘We are only passing through’: stories about memory, mortality and the effort of being alive<figure><img src="https://images.theconversation.com/files/496684/original/file-20221122-11-lwjunf.jpg?ixlib=rb-1.1.0&rect=8%2C17%2C5857%2C3887&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Roger Ce/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Chris Flynn’s <a href="https://www.uqp.com.au/books/here-be-leviathans">Here Be Leviathans</a> is a collection of short stories that seems quirky and light-hearted, propelled by its creative use of perspective. Each story is established from a surprising vantage point and so the world as Flynn imagines it becomes topsy-turvy – anything at all might be alive and sentient. Animals, chairs, boats, you name it. </p>
<hr>
<p><em>Review: Here Be Leviathans – Chris Flynn (UQP) and The Tower – Carol Lefevre (Spinifex)</em></p>
<hr>
<p>A bear eats a teenager, and thus inherits the boy’s memories. An airplane seat describes its last day at work. A hotel room observes its favourite couple, who return over the years. A monkey details a trip into outer space. But these stories are driven by more than quirky inspiration. </p>
<p>The point-of-view might offer an interesting hook, and Flynn’s tone may be jaunty at times, but the stories are propelled by deeper themes of mortality, death and existential pointlessness. Flynn uses perspective to reflect and question the way we think about things. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-and-girls-at-risk-at-the-end-of-the-world-these-subversive-short-stories-reflect-our-anxieties-186823">Women and girls at risk, at the end of the world: these subversive short stories reflect our anxieties</a>
</strong>
</em>
</p>
<hr>
<h2>Memory and mortality</h2>
<p>Many of the characters in this collection die, have died or are about to die – but there’s also a counter-theme of connection. The bear may eat the teenager, and so the ranger is hunting him down; we enter a hide-and-seek game for survival. But it’s the connection the bear and ranger have, the mutual respect they share, that becomes the message of the first story, Inheritance. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=896&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=896&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=896&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1126&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1126&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497560/original/file-20221128-26-5t8y8o.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1126&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Flynn also explores ideas of memory transference, and this imbues the story with lingering, thoughtful hope: something that pervades the whole collection. In Flynn’s world, death can be a means to existence – as long as our memories keep living, our experiences and perspectives continue to exist. </p>
<p>Flynn’s use of unexpected points of view allows him to avoid the sentimental. In 22F, he tells the story of an airplane seat abandoned in the jungle and we’re left with the superb image of moss growing up and over the upholstery, claiming the seat for the natural domain. We learn about the seat’s history, the work-politics of neighbouring seats, and observations of the passengers who have sat in them. We see glimpses of these human cargoes that simultaneously show the banality and profundity of life.</p>
<p>The collection took Flynn ten years to write, and he includes notes at the end about his process and the stories’ origins. For instance, he describes how 22F was inspired by the Werner Herzog documentary <a href="https://letterboxd.com/film/wings-of-hope/">Wings of Hope</a>, which interviewed Juliane Koepcke, the sole survivor of a 1971 airplane crash. Together, Herzog and Koepcke journey to the site of the crash and find parts of the airplane in the jungle. Flynn says the story is about:</p>
<blockquote>
<p>Memory and place. A reminder that we are only passing through and that everything is part of something larger.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497575/original/file-20221128-21-v71muf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One of Chris Flynn’s stories is told from the perspective of an airplane seat abandoned in the jungle.</span>
<span class="attribution"><span class="source">Leslie Cross/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The importance of memory and place is further explored in the story A Beautiful and Unexpected Turn, where we follow the perspective of a hotel room that takes a special interest in its guests, Diane and Hector. We see the waxing and waning and waxing of their relationship. At the end, the room says: </p>
<blockquote>
<p>We are places of passage, of transience […] Eventually, I would be demolished, perhaps to make way for another hotel or an apartment block, or nothing […] I would become rubble, and then dust. </p>
</blockquote>
<p>This could be the larger message of the book – our lives are transient and then we become dust. The connections we experience and inspire are what give us meaning in the moment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-will-i-be-able-to-upload-my-brain-to-a-computer-184130">When will I be able to upload my brain to a computer?</a>
</strong>
</em>
</p>
<hr>
<h2>Complications of care</h2>
<p>Carol Lefevre’s <a href="https://www.spinifexpress.com.au/shop/p/9781925950625">The Tower</a> also emphasises place. This thoughtful collection of short stories is very different from Flynn’s in tone and focus, but it too grounds storytelling in the themes of place and mortality. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=928&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=928&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=928&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1166&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1166&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497573/original/file-20221128-14-p18sux.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1166&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>The Tower is structured around a series of interlocking narratives about Dorelia MacCraith – in the very first story, after losing her husband Geordie, she sells her house and buys a new one, with a tower. Her children, who she does not consult, are suspicious of this defiant act. </p>
<p>Straight away, the reader is thrust into the negotiations and complications of care. People who Dorelia once cared for are now asserting (or trying to assert) forms of reverse care. And many stories in the collection reverberate with related themes – women caring for children and partners and parents, or making decisions about their positions as carers, especially in the context of trying (or deciding not) to have children.</p>
<p>The interconnected stories about Dorelia and her tower are the centrepiece of the collection. Yet Dorelia finds this house of her own by accident, when driving her dear friend and fellow artist Elizabeth Bunting to an appointment:</p>
<blockquote>
<p>they took a wrong turn, and then another, until at the end of the a quiet cul-de-sac, set among sheltering trees, stood the most adorable house […] and above the porch rose a small tower.</p>
</blockquote>
<p>I appreciate that it is the women’s friendship – their spark of connection and humour are immediate and inviting – that enables Dorelia to find her tower oasis. I also appreciate that this critical act occurs during a moment of generosity and care: Dorelia is driving Elizabeth to an appointment. </p>
<p>While Dorelia may find her tower by accident, we never feel Lefevre is accidental in rendering the lives of these women on the page. The prose is carefully controlled, as is the detail and world-building – and the deeper reflections of the stories kaleidoscope through one another, building in nuanced ways. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-grey-haired-and-radiant-reimagining-ageing-for-women-182336">Friday essay: grey-haired and radiant – reimagining ageing for women</a>
</strong>
</em>
</p>
<hr>
<h2>Reimagining the crone</h2>
<p>Of course, symbolic permutations resonate throughout this text – a tower of one’s own harks to <a href="https://theconversation.com/skin-and-sinew-and-breath-and-longing-reimagining-the-lives-of-queer-artists-and-activists-from-sappho-to-virginia-woolf-184459">Virginia Woolf</a> and Rapunzel. Dorelia reimagines the crone from the Rapunzel <a href="https://theconversation.com/reader-beware-the-nasty-new-edition-of-the-brothers-grimm-34537">fairy tale</a> as central and heroic. </p>
<p>This rewriting and revision of the crone – and her motives and backstory – seems key to recognising women’s narratives more generally, and prioritising a multiplicity of stories and experiences within the Australian literary canon. In this sense, it feels like Lefevre is in conversation with authors such as Drusilla Modjeska, <a href="https://theconversation.com/intellectual-fearlessness-politics-and-the-spiritual-impulse-the-remarkable-career-of-amanda-lohrey-187354">Amanda Lohrey</a> and Charlotte Wood. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496662/original/file-20221122-23-obj24f.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The main, recurring narrator of The Tower reimagines the crone from the Rapunzel fairytale as central and heroic.</span>
</figcaption>
</figure>
<p>In <a href="https://theconversation.com/tarot-resurgence-is-less-about-occult-than-fun-and-self-help-just-like-throughout-history-139448">tarot</a> mythology, the card of The Tower considers the collapse of old structures. We get a sense of this in the reflexivity of the text, as well as in its story-world – as Dorelia faces life without her husband Geordie. Indeed, old age itself collapses life as she’s known it. The interplay between the textual and the intertextual resonates in this collection, making this book as enjoyable to later ponder as it was to actually read. </p>
<p>Here Be Leviathans and The Tower are two very different short-story collections to consider in tandem. They vary in voice, tone and style. Yet both engage with the precariousness and effort that is at the foundation of being alive, and making meaning from our short time on the planet.</p><img src="https://counter.theconversation.com/content/193628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shady Cosgrove does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A bear eats a teenager, and inherits his memories. An ageing woman writer buys a tower of her own – where she reimagines the crone from Rapunzel. Two inventive new books resonate with our reviewer.Shady Cosgrove, Associate Professor, Creative Writing, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1890322022-10-31T12:33:02Z2022-10-31T12:33:02ZFuture Air Force officers get a 30,000-foot view of death in this course<figure><img src="https://images.theconversation.com/files/485428/original/file-20220919-12904-4s04q1.jpg?ixlib=rb-1.1.0&rect=0%2C47%2C6300%2C4442&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The subject of death can be a difficult one to broach.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/air-force-honor-guardsman-carrying-folded-american-royalty-free-image/1331974845?adppopup=true">pamelasphotopoetry via Getty Images</a></span></figcaption></figure><figure class="align-right ">
<img alt="Text saying: Uncommon Courses, from The Conversation" src="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><a href="https://theconversation.com/topics/uncommon-courses-130908">Uncommon Courses</a> is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.</em> </p>
<h2>Course Title:</h2>
<p>“Death, Dying, and Finding Meaning”</p>
<h2>What does the course explore?</h2>
<p>Our course explores not only how people die in the physical, biological sense but also personal and societal beliefs about dying, death, and the afterlife. We do this in various ways.</p>
<p>First, students write about and share their own experiences with death. Some stories involve friends and relatives who died, took their own lives, or are in the process of dying. Students also share their ideas about death.</p>
<p>Second, students read bestselling memoirs that deal with death and dying, such as Paul Kalanithi’s “<a href="http://www.randomhousebooks.com/books/258507/">When Breath Becomes Air</a>” and Atul Gawande’s “<a href="http://atulgawande.com/book/being-mortal/">Being Mortal: Medicine and What Matters in the End</a>.”</p>
<p>Third, we participate in informal discussions with what we refer to as “death professionals,” such as physicians who care for patients not expected to recover, funeral directors and morticians. We also extend invitations to religious personnel such as Buddhist monks to share religious perspectives that many of us may not be not familiar with.</p>
<h2>Why is this course relevant now?</h2>
<p>According to Barbara Karnes, a nurse, hospice pioneer, and educator who deals with end-of-life issues, most of what Americans know about death and dying comes from movies and TV, which do not provide accurate depictions of <a href="https://bkbooks.com/collections/booklets/products/gone-from-my-sight-the-dying-experience?variant=36961181171868">how real people die</a>. We as a society need to become familiar with what dying entails. And that means talking about it.</p>
<h2>What’s a critical lesson from the course?</h2>
<p>The inevitable final part of life, death causes a variety of feelings and elicits all kinds of questions. People’s reactions to it vary widely, as do their answers to these questions. This course not only gives students the opportunity to share their experiences and beliefs but also challenges them to find a way to express as clearly as possible what they think, feel and believe.</p>
<p>For example, the cadets noticed that because of the stigma often attached to suicide, cadet deaths by suicide were treated as cautionary lessons. On the other hand, a cadet who was killed in a flying accident was labeled a hero. With our help, the cadets drafted a letter to the dean, who then attended the final lesson to listen to them. The cadets expressed the need to remember fellow members of the Cadet Wing and grieve with one another regardless of how a cadet died.</p>
<h2>What materials does the course feature?</h2>
<p>• Allan Kellehear’s “<a href="http://cup.columbia.edu/book/the-inner-life-of-the-dying-person/9780231167857">The Inner Life of the Dying Person</a>”</p>
<p>• Paul Kalanithi’s “<a href="http://www.randomhousebooks.com/books/258507/">When Breath Becomes Air</a>”</p>
<p>• Atul Gawande’s “<a href="http://atulgawande.com/book/being-mortal/">Being Mortal: Medicine and What Matters in the End</a>”</p>
<h2>What will the course prepare students to do?</h2>
<p>At graduation, our students are commissioned second lieutenants in the U.S. Air Force. They may be placed in harm’s way. Before they deploy, they will be advised to draft their wills, something that most college graduates probably do not think about. As officers within the profession of arms, they may have to take the lives of others or die in defense of their country. Some of their comrades and friends may die in training accidents or in action. If a death occurs, some of these officers may assume the difficult duty of notifying the next of kin.</p>
<p>Death is inevitable, but ignoring it is not helpful. Our students learn that many questions go unanswered, it is all right to cry, and sometimes the best response involves touch, silence and the willingness to listen.</p>
<h2>What prompted the idea for the course?</h2>
<p>The course was originally designed at Emory University as part of <a href="https://www.palliativeundergrad.org/partners/">a program</a> meant to provide undergraduates the opportunity to have difficult discussions about death. For people unfamiliar with death, talking about it can be uncomfortable. Dealing with it can be traumatic.</p>
<p>The course we offered for the first time at the United States Air Force Academy was a joint venture between the departments of biology and philosophy. We knew it would appeal to biology majors. To make it appealing to students across multiple disciplines, the biologist who designed the course at Emory and was a visiting professor at the academy decided to co-teach the course with a philosopher assigned to the academy.</p><img src="https://counter.theconversation.com/content/189032/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L. William Uhl is affiliated with the United States Air Force Academy. </span></em></p><p class="fine-print"><em><span>Arri Eisen received funding from the Arthur Vining Davis Foundations for the initial work that led to the teaching of this course. </span></em></p>Views on death and the afterlife vary from person to person and culture to culture. This course gives US Air Force cadets a broad perspective on mortality and its effects on people and society.L. William Uhl, Assistant Professor of Philosophy, United States Air Force AcademyArri Eisen, Professor of Pedagogy in Biology, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1874222022-08-29T12:39:49Z2022-08-29T12:39:49ZExtreme heat and air pollution can be deadly, with the health risk together worse than either alone<figure><img src="https://images.theconversation.com/files/481425/original/file-20220828-7442-4j6f2d.jpg?ixlib=rb-1.1.0&rect=37%2C37%2C3551%2C2355&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bad air pollution and extreme heat each raise health risks, but they're worse combined.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/los-angeles-resident-carmen-green-jumps-rope-at-a-closed-news-photo/1228565250">Brian van der Brug/Los Angeles Times via Getty Images</a></span></figcaption></figure><p>Heat waves and air pollution from wildfire smoke and other sources are <a href="https://doi.org/10.1001/jama.2017.17923">each problematic</a> for <a href="https://doi.org/10.1016/S0140-6736(21)01208-3">human health</a>, particularly for vulnerable populations such as older adults. But what happens when they hit at the same time?</p>
<p>We examined over 1.5 million deaths from 2014 to 2020 registered in California – a state prone to summer heat waves and air pollution from wildfires – to find out.</p>
<h2>Deaths spike when both risks are high</h2>
<p>The number of deaths rose both on hot days and on days with high levels of fine particulate air pollution, <a href="https://www.health.ny.gov/environmental/indoors/air/pmq_a.htm">known as PM2.5</a>. But on days when an area was hit with a double whammy of both high heat and high air pollution, the effects were much higher than for each condition alone.</p>
<p>The risk of death on those extra-hot and polluted days was about <a href="https://doi.org/10.1164/rccm.202204-0657OC">three times greater</a> than the effect of either high heat or high air pollution alone.</p>
<p>The more extreme the temperatures and pollution, the <a href="https://doi.org/10.1164/rccm.202204-0657OC">higher the risk</a>. During the top 10% of hottest and most polluted days, the risk of death increased by 4% compared to days without extremes. During the top 1%, it increased by 21%; and among older adults over age 75, the risk of death increased by more than a third on those days.</p>
<p><iframe id="2f0eY" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/2f0eY/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why risks are higher when both hit at once</h2>
<p>There are several ways the combined exposure to extreme heat and particulate air pollution can harm human health.</p>
<p>Oxidative stress is the most common biological pathway linked with particulate air pollution and heat exposure. <a href="https://doi.org/10.1038/s41573-021-00233-1">Oxidative stress</a> is an imbalance between production of highly reactive molecules known as reactive oxygen species, or ROS, and the body’s ability to remove them. It’s been linked with <a href="https://link.springer.com/chapter/10.1007/978-981-32-9366-3_5">lung diseases</a>, among other illnesses. </p>
<p>Antioxidants help clean up these molecules, but particulate air pollution and heat disrupt this balance through excessive metabolic ROS production and lowered antioxidant activity.</p>
<p>Our research also showed that the effects of particulate air pollution and heat extremes were <a href="https://doi.org/10.1164/rccm.202204-0657OC">larger when high nighttime temperature and pollution occurred together</a>. High nighttime temperatures can <a href="https://doi.org/10.1016/S2542-5196(22)00139-5">interfere with normal sleep</a> and potentially contribute to chronic health conditions such as <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215006">heart disease</a> and <a href="https://www.pnas.org/doi/full/10.1073/pnas.1216951110">obesity</a>, and disrupt how the body regulates temperature.</p>
<p>Older adults may be more susceptible to effects of extreme heat and air pollution exposure, in part because this stress comes on top of age-related chronic health conditions like heart disease, high blood pressure, diabetes or chronic lung disease. <a href="https://www.ncbi.nlm.nih.gov/books/NBK507838/">Impaired body temperature regulation</a> in response to heat can also occur with aging. And older adults may be less mobile and therefore less able to get to cooling centers or to medical care and be less able to afford air conditioning. </p>
<h2>A future of high temperatures and air pollution</h2>
<p>This isn’t just a California problem. Climate change will increase exposure to high heat and air pollution in many parts of the country. </p>
<p>Yearly average temperatures in the U.S. are already more than 1.8 degrees Fahrenheit (1 degree Celsius) warmer than at the beginning of the 1900s. By the end of this century, global temperatures are on pace to be <a href="https://www.unep.org/resources/emissions-gap-report-2021">nearly 5 F (2.7 C) warmer</a>. Dangerous extreme heat waves, currently rare, will <a href="https://science2017.globalchange.gov/chapter/6/">become more common</a>. </p>
<p>Changing climate is also <a href="http://doi.org/10.1016/j.amepre.2008.08.025">affecting levels</a> of outdoor fine particulate pollution – for example, through weather changes such as air stagnation events, wind and dust storms, and drier and warmer conditions that <a href="https://nca2018.globalchange.gov/chapter/13/">contribute to increasingly frequent and intense wildfires</a>.</p>
<h2>What to do to stay safe</h2>
<p>Further research is needed to better understand these effects, such as the full impact of wildfire smoke exposure. However, enough is known that people should take measures to reduce their risk of harm during periods of extreme heat or air pollution.</p>
<p>That means staying <a href="https://www.cdc.gov/disasters/extremeheat/heattips.html">well hydrated and keeping cool</a>. Shopping malls and other air-conditioned public spaces can provide a refuge from heat. Home air conditioning, especially during nighttime, can reduce mortality. A portable air filter in the bedroom can <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ina.12753">markedly reduce particle pollution levels</a>.</p>
<p>People with <a href="https://www.cdc.gov/disasters/extremeheat/warning.html">symptoms of heat stress</a>, such as headache, nausea, dizziness or confusion, especially the elderly, should seek medical care. </p>
<p>Many county and state health departments already provide alerts about extreme heat and extreme air pollution. Developing a special category of alert during co-occurring extremes may be beneficial to public health.</p>
<p>Governments also need to take steps now to avoid the worst future climate change scenarios. Some best practices for cities include creating cooling shade cover and green space that will also reduce particle pollution.</p><img src="https://counter.theconversation.com/content/187422/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erika Garcia receives support from Southern California Environmental Health Sciences Center, National Institute of Environmental Health Sciences grant P30ES007048, and the University of Southern California Office of Research Strategic Development of Research Award.</span></em></p><p class="fine-print"><em><span>Rob Scot McConnell receives funding from the National Institute of Environmental Health Sciences</span></em></p><p class="fine-print"><em><span>Md Mostafijur Rahman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The worst effects are during high nighttime temperatures, something happening more often with climate change. Wildfire smoke adds to the risk.Erika Garcia, Assistant Professor of Population and Public Health Sciences, University of Southern CaliforniaMd Mostafijur Rahman, Postdoctoral Scholar and Research Associate in Environmental Health, University of Southern CaliforniaRob Scot McConnell, Professor of Population and Public Health Sciences, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1861062022-07-20T12:21:43Z2022-07-20T12:21:43ZLosing a grandmother can have long-lasting mental health effects for kids and adolescents, a new study finds<figure><img src="https://images.theconversation.com/files/473719/original/file-20220712-17569-azpdr2.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows that grandparents' involvement in their grandchildren's lives plays a critically important role in a child's overall health and development. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-girl-helping-her-grandmother-while-working-in-royalty-free-image/1124704742?adppopup=true">Mayur Kakade/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>The death of a grandmother can have severe and lasting mental health consequences for both her adult children and grandchildren, according to <a href="https://doi.org/10.1016/j.ssmmh.2022.100100">our recently published study</a>. </p>
<p>This finding may be surprising, because the death of a grandparent is a normal, even anticipated, part of life. Yet the effects are profound. Losing a grandparent can <a href="https://doi.org/10.1016/j.ssmmh.2022.100100">increase adolescents’ risk</a> of having a depressed parent and of having higher depressive symptoms themselves. </p>
<p><a href="https://doi.org/10.1111/cdep.12016">Decades of research</a> show that grandparents’ involvement and support is beneficial to their grandchildren. This is especially true for kids growing up with <a href="https://doi.org/10.1111/j.1540-4560.2007.00537.x">single mothers</a>. Maternal grandparents often act as a safety net, providing benefits like housing stability, child care and financial and emotional support, all of which benefit their <a href="https://doi.org/10.1111/cdep.12016">grandchildren’s health and development</a>. </p>
<p>But what happens when a grandparent dies? In our study, we used a <a href="https://fragilefamilies.princeton.edu/documentation">national dataset</a> on a sample of mother and adolescent pairs whom researchers have interviewed multiple times since the child’s birth. We analyzed whether a maternal grandparent’s death during later childhood or early adolescence affected adolescents’, or their mothers’, depressive symptoms, net of depressive symptoms before the loss. </p>
<p>Following a grandmother’s death, adult daughters were more likely to become depressed relative to other women. Adult daughters experienced this increase in depression for up to seven years following the death. Adolescent boys who lost their grandmother in the prior seven years also had higher depressive symptoms than their peers. We found no statistically significant increase in depression following a grandfather’s death. </p>
<h2>Why it matters</h2>
<p><a href="https://doi.org/10.1177/0004867414533834">Adolescent mental health has worsened</a> in recent decades. Experts stress the potential for the <a href="https://doi.org/10.1007/s10964-020-01332-9">COVID-19 pandemic to accelerate</a> this concerning trend, pointing to the financial hardships, school disruptions and social isolation as prime reasons young people’s mental health could decline further. </p>
<p>The mental health effects of losing a loved one to COVID-19 have been curiously overlooked. Although young people experience low COVID-19 mortality rates, COVID-19 mortality has intimately affected millions of young people. Tens if not hundreds of thousands of youths in the U.S. have <a href="https://doi.org/10.1001/jamapediatrics.2021.0161">lost parents to COVID-19</a>. And as of June 2022, our statistical models suggest that approximately <a href="https://doi.org/10.1073/pnas.2007476117">4 million people</a> in the U.S. have lost a grandparent to COVID-19 in a mere two years – representing a significant increase in the burden of grandparental death experienced <a href="https://doi.org/10.1016/j.ssmmh.2022.100100">prior to the pandemic</a>. </p>
<p>Our study suggests that this dramatic increase in the number of grieving adolescents will increase rates of depression in the U.S.</p>
<h2>What still isn’t known</h2>
<p>A troubling possibility is that having a grandparent die of COVID-19 is even harder for adolescents than the pre-pandemic losses that we studied. COVID-19 deaths epitomize “<a href="https://doi.org/10.1080/08959420.2020.1764320">bad deaths</a>” – painful, frequently sudden deaths that happen alone and often strip families of the chance to say goodbye. </p>
<p>In other recent research, we found that adults who lost a spouse to COVID-19 <a href="https://doi.org/10.1093/geronb/gbac085">face higher rates of depression and loneliness</a> than those whose spouse died right before the pandemic. Future research can assess whether losing a grandparent to COVID-19 has more severe or far-reaching consequences for adolescents than our analysis of pre-pandemic data shows. </p>
<p>We are also still examining the gendered nature of our study’s findings. Why does the loss of a grandmother seem to have deeper and longer-lasting effects than that of a grandfather? Why are boys uniquely vulnerable after losing a grandmother? </p>
<p>Gender socialization could explain boys’ higher depressive symptoms after a grandmother’s death. Adolescent boys may feel pressure to internalize their emotions. Additionally, a grandfather’s death could affect adolescents in other ways, such as their school performance and grades, maintenance of healthy relationships or risk behaviors. </p>
<p>Even as this study offers a small window into the distress of losing a grandparent, our findings underline the pressing need for adolescents and their parents to have access to support services as they navigate the cascading consequences that such a loss can set in motion – an all-too-common experience in the COVID-19 era.</p><img src="https://counter.theconversation.com/content/186106/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Smith-Greenaway receives funding from the National Science Foundation and the National Institute of Child Health and Human Development. She is a member of the Evermore Foundation's scientific advisory board. </span></em></p><p class="fine-print"><em><span>Ashton Verdery receives funding from the National Institute on Aging, which is a part of the National Institutes of Health. He is affiliated with Evermore Foundation as a member of its scientific advisory board.</span></em></p><p class="fine-print"><em><span>Rachel Margolis receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Michelle Livings does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Models shows that some 4 million people in the US have lost a grandparent to COVID-19. But until now, there has been a dearth of research into the mental health effects of losing a grandparent.Emily Smith-Greenaway, Associate Professor of Sociology, USC Dornsife College of Letters, Arts and SciencesAshton Verdery, Professor of Sociology, Demography and Social Data Analytics, Penn StateMichelle Livings, PhD Student in Population, Health and Place, USC Dornsife College of Letters, Arts and SciencesRachel Margolis, Associate Professor of Sociology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1858212022-07-05T10:16:59Z2022-07-05T10:16:59ZPoliticians live longer than the populations they represent: new research<figure><img src="https://images.theconversation.com/files/471857/original/file-20220630-22-izd6m9.jpg?ixlib=rb-1.1.0&rect=149%2C7%2C4842%2C3255&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Joe Biden is the oldest person to be sworn in as US president. New research shows politicians are likely to live longer than the populations they represent.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/washington-dc-usa-january-20-2021-1936930486">BiksuTong / Shutterstock</a></span></figcaption></figure><p>In many countries, inequalities in income and wealth have been rising since the 1980s. It has been estimated that the top 1% of income earners globally earn <a href="https://equalitytrust.org.uk/scale-economic-inequality-uk">20% of total income</a>. But inequality isn’t just about wealth – elite groups also have advantages over the rest of society in areas such as <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/811045/Elitist_Britain_2019.pdf">education</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJM199307083290210">health</a>. They also tend to live longer. Life expectancy of the top 1% of income earners in the US is <a href="https://jamanetwork.com/journals/jama/article-abstract/2513561">almost 15 years longer</a> than the bottom 1%. </p>
<p>Typically highly educated, and with salaries well above average population levels, politicians are one important elite group. They are often accused of being too unlike those they represent, and slow to make policies that would improve the welfare of everyday people. In a <a href="https://link.springer.com/article/10.1007/s10654-022-00885-2">recent study</a> we investigated differences in mortality between politicians and the public and found that politicians generally live longer than the populations they represent.</p>
<p>Our analysis is the most comprehensive so far, based on data from 11 high-income countries: Australia, Austria, Canada, France, Germany, Italy, the Netherlands, New Zealand, Switzerland, the UK and the US. Previously, similar studies tracking long-term trends in health inequalities have focused on just a few countries, such as <a href="https://link.springer.com/article/10.1007/s10654-020-00685-6">Sweden</a> and the <a href="https://www.sciencedirect.com/science/article/pii/S0014498311000246">Netherlands</a>. </p>
<p>Our study was based on more than 57,000 politicians, using historical data that in some cases dated back two centuries. To measure the inequalities, we matched each politician according to their country, age and gender to mortality data for the general public. Then, we compared the number of politicians who died each year with the number expected based on population mortality rates. We also calculated the difference in remaining life expectancy at the age of 45 (which is when, on average, politicians first get elected to office) between politicians and the public.</p>
<p>For nearly all countries, politicians had similar mortality to the general population in the late 19th and early 20th centuries. But throughout the second half of the 20th century, lifespans of politicians grew more rapidly, meaning that in all countries we studied they lived longer than the general population. </p>
<figure class="align-center ">
<img alt="Chart showing that remaining life expectancy at age 45 is longer for politicians than general populations in 11 countries." src="https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=280&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=280&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=280&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=352&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=352&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472268/original/file-20220704-20-jd8a24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=352&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Remaining life expectancy of 45-year-old politicians and the general populations in 11 countries.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The graph above shows the most recent estimates of life expectancy for politicians and the public. While life expectancy varies across countries, there is much less variation in the life expectancy of politicians. In most countries, politicians’ remaining life expectancy at the age of 45 is around 40 years. The general public’s life expectancy across countries is lower and more varied (ranging from 34.5 years in the US to 37.8 years in Australia). Currently, politicians can expect to live between three and seven years longer than the public.</p>
<p>Over much of the 20th century, the remaining life expectancy of 45-year-old politicians across all countries with available data increased by an average of 14.6 years. For the general population across the same countries, the average increase was 10.2 years.</p>
<h2>Why politicians might be living longer</h2>
<p>While gaps in income and wealth may partly explain these trends, they do not appear to be the only factor. Income inequality (measured by the share of overall income belonging to the richest in society) began to rise in the 1980s. In contrast, differences in life expectancy between politicians and the public began to widen as early as the 1940s.</p>
<p>Politicians’ survival advantage may be due to a variety of factors, including differences in standards of healthcare and lifestyle factors such as smoking and diet. Cigarettes were widely popular in the <a href="https://www.britannica.com/topic/smoking-tobacco/A-social-and-cultural-history-of-smoking">first half of the 20th century</a> and smoking was prevalent across <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2085438/pdf/brmedj03396-0011.pdf">all sections of society</a> by the 1950s. This is no longer the case. Public health measures, starting with bans on tobacco advertising, mean smoking rates have fallen, especially among more advantaged professional groups, such as politicians.</p>
<figure class="align-center ">
<img alt="Black and white photo of Winston Churchill in an open-top car, wearing a top hat and with a cigar in his mouth, giving the v for victory sign" src="https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=585&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=585&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=585&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=736&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=736&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472049/original/file-20220701-18-s342fa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=736&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the past, it was far more common to see politicians smoking.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/a/a1/Winston_Churchill%2C_cigar_in_mouth%2C_gives_his_famous_%27V%27_for_victory_sign_during_a_visit_to_Bradford%2C_4_December_1942._H25966.jpg">War Office official photographer, Horton (Capt), via Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>It is also possible that the introduction of new campaigning methods (including television broadcasting and social media) changed the type of person who became a politician. </p>
<p>Women tend to live longer than men generally, but in most countries, data on female politicians were available only after 1960. We found that trends in life expectancy gaps between politicians and the general public were similar for women and men.</p>
<p>In many countries, the public expects transparency and disclosure about politicians’ earnings. The other advantages they have, such as longer life expectancy, have been much less appreciated. Our study focused only on politicians in high-income, democratic countries where data were readily available. Conducting more analysis, particularly of low and middle-income countries, could improve our understanding of global health inequality trends and help find solutions.</p><img src="https://counter.theconversation.com/content/185821/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Clarke receives funding from NIHR, MRC, NHMRC and NIH. </span></em></p><p class="fine-print"><em><span>An Tran-Duy receives funding from the National Health and Medical Research Council and Medical Research Future Fund.</span></em></p><p class="fine-print"><em><span>Laurence Roope receives funding from the Economic and Social Research Council, the Medical Research Council and the NIHR Oxford Biomedical Research Centre.</span></em></p>The public expects transparency about politicians’ earnings, but it’s not the only area where elite groups have an advantage.Philip Clarke, Professor of Health Economics, University of OxfordAn Tran-Duy, Senior Research Fellow, Centre for Health Policy, The University of MelbourneLaurence Roope, Senior Researcher, Health Economics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821812022-05-05T19:00:12Z2022-05-05T19:00:12ZExcessive mortality of young adults: a natural trait?<figure><img src="https://images.theconversation.com/files/460322/original/file-20220428-18-up9sna.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1920%2C1238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mortality rate among young adults is higher than it should be, statistically.</span> <span class="attribution"><span class="source">Sammie Chaffin/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The risk of death is high at birth and during the first years of life, but it decreases through childhood until approximately the age of 10. It then begins a steady, exponential increase that continues throughout adult life. This U-shaped curve of age-specific death rates suggests that the risk of dying for young adults should be relatively low.</p>
<h2>Mortality can be high between ages 15 and 30</h2>
<p>It is not rare, however, to observe relatively high levels of mortality during a period in early adulthood between the ages of 15 and 30. This is called “excess mortality” because it exceeds the levels that would be expected due to biological factors and epidemiological circumstances.</p>
<p>The relative scale of this excess mortality appears to be independent of the general level of mortality, as illustrated by the age-specific mortality curves based on data from the <a href="https://www.cairn-int.info/article-E_POPSOC_590_0001--is-young-adult-excess-mortality-a.htm">Human Mortality Database</a> (Figure 1). They show situations for different periods between 1900 and 2018 in 45 countries with exhaustive vital statistics, mainly in Europe or other continents with populations of European origin, as well as a few Asian countries such as Japan.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Age-specific mortality rates in 45 countries between 1900 and 2018" src="https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The absolute level of young adult mortality can be surprising. For example, <a href="https://www.google.fr/books/edition/Journal_of_the_Institute_of_Actuaries_an/v0UDAAAAYAAJ?hl=en&gbpv=1&dq=Thiele+T.+N.,+1871,+On+a+mathematical+formula+to+express+the+rate+of+mortality+throughout+the+whole+of+life,+tested+by+a+series+of+observations+made+use+of+by+the+Danish+Life+Insurance+Company+of+1871,+_Journal+of+the+Institute+of+Actuaries+and+Assurance+Magazine_&pg=PP12">in 1900–1904</a>, the mortality of Danish men was generally similar to or even lower than that of Norwegian men, but with practically none of the excess mortality between ages 15 and 40 observed in Norway. Starting from a much lower level of overall mortality, the curve of American men in 1990–1994 displays pronounced excess mortality, placing them above the absolute level in Australia in 1940–1944, despite a much higher level of overall mortality in the latter country.</p>
<p>Similar observations can be made for women, although they are generally less affected by this excess mortality than men. For example, in the immediate post-war period, while the overall mortality of Japanese and Portuguese women is identical up to age 15, their excess mortality is much higher in Japan above that age. Forty years later, while the absolute mortality rate of French and Ukrainian women was similar between ages 15 and 25, its level reflected high excess mortality in France but not in Ukraine, which has a strong female mortality disadvantage at all other ages. So, it is logical to conclude that for each country pair considered here, young adults are intrinsically more vulnerable in Denmark than in Norway, in the United States than in Australia, in Japan than in Portugal, and in France than in Ukraine, whatever the absolute mortality levels between ages 15 and 30.</p>
<p>Young adult excess mortality seems to be a distinct component of human mortality that stands alongside the other processes governing overall mortality. While called the “excess-mortality hump” because of the bulge it creates in the mortality curve, like that observed for Norwegian males in 1900, it may also resemble a plateau, as observed for American males in 1990 and for French females in 1980. Let us examine the possible causes of this phenomenon.</p>
<h2>Historically universal excess mortality?</h2>
<p>Young adult excess mortality is considered a <a href="https://www.cairn-int.info/article-E_POPSOC_590_0001--is-young-adult-excess-mortality-a.htm">worldwide phenomenon</a> particularly prevalent <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014826">among men</a>. This is because we tend to view adolescence as a naturally tumultuous period, marked by the psychological upheavals associated with puberty*<em>, such as the production of sex hormones or the asynchronous development of different parts of the brain</em>*. It is believed these hallmarks of the “adolescent brain”, as it is sometimes called in the neuropsychological literature, are reflected in a lack of inhibition, excessive risk-taking, impulsiveness, and a general struggle to foresee the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892678/">consequences of one’s behaviour</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Age-specific mortality rates in selected male populations showing little or no evidence of young adult excess mortality" src="https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=593&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=593&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=593&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=745&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=745&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=745&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>These assumptions are only partially borne out by fact, however. Analysis of several thousand curves similar to those presented in Figure 1 shows that while excess mortality is a frequent reality for men, it is <a href="https://archive-ouverte.unige.ch/unige:73525">very limited or non-existent in certain cases</a> (Figure 2). Exceptions of this kind were especially common in the 1950s and 1960s, in both Southern Europe (Spain and Portugal) and Northern Europe (Ireland and Finland).</p>
<p>Excess mortality among young women is systematically lower than that of young men, if not non-existent. It is nonetheless widely observed in different contexts, not only in the past, when maternal mortality was still high, but also more recently (Figure 3).</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Age-specific mortality rates in selected female populations showing clear evidence of young adult excess mortality" src="https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=692&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=692&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=692&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=869&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=869&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=869&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>It was especially high in the interwar period, both in Northern Europe (Finland and Norway) and in Southern Europe (Italy), perhaps due to the high incidence of tuberculosis (see below), a common disease after the Second World War in countries such as Japan and Bulgaria. More recently, pronounced excess female mortality among young adults has been observed in several industrialized countries including France, the United States, and New Zealand; only the 1950s and 1960s were free of this phenomenon. The excess mortality hump is thus not universal, and neither is it specific to males.</p>
<h2>Live fast, die young?</h2>
<p>Another common belief is that youths tend to die in higher numbers because of a greater inclination to take risks in the years after puberty. In the literature, the term “accident hump” is often used, with some authors seeing an explicit link between excess mortality and adolescent risk-taking resulting in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014826">more frequent accidental or violent deaths</a>. Here again, this explanation is only partially borne out by fact.</p>
<p>First, regarding the age range concerned, while the hump starts to form in early adolescence, it continues up to age 30 at least – well beyond the end of puberty. In the United States, young adult excess mortality in the 1960s disappeared at around <a href="https://pubmed.ncbi.nlm.nih.gov/29869068/">age 35 for men and age 25 for women</a>. This limit then shifted to later ages for both sexes, reaching 45–50 years in the early 1990s, partly because of the HIV epidemic which causes deaths at later ages, on average, than accidents do. Since then, the age limit of the US accident hump has fluctuated between 30 and 40 years, partly because of the current epidemic of <a href="https://pubmed.ncbi.nlm.nih.gov/29869068/">opioid overdose deaths</a>. Given the extensive age range covered by the hump, it cannot be attributed to a purely biological factor that leads to high-risk behaviour in adolescence.</p>
<p>Secondly, the breakdown of causes of death linked to the excess mortality hump is more complex than it appears, and while accidents have played an important role in recent decades, they are not always the leading cause of excess mortality at young ages. For example, in the United States, road traffic accidents, which accounted for around 60% of excess mortality in the 1960s, now only explain a quarter of young men’s deaths, on a par with <a href="https://pubmed.ncbi.nlm.nih.gov/29869068/">suicides and homicides</a>. For both sexes, the contribution of overdoses to excess mortality has risen from practically 0% to 20% in the last decade.</p>
<h2>The role of tuberculosis</h2>
<p>Historically, deaths from external causes have not always reached the levels seen in recent years. In the 22 countries, pulmonary tuberculosis was the main cause of excess mortality among youths <a href="https://books.google.fr/books/about/Causes_of_Death_Life_Tables_for_National.html?id=4nRqAAAAMAAJ&redir_esc=y">until the mid-19th century</a>. In the interwar period, the disease still accounted for around 50% of male excess mortality on average, with proportions of up to 90% in Portugal, and ranging from 70% to 90% in Sweden, Spain, France, England, Greece, Italy, the Netherlands, and Norway.</p>
<p>In the same period, maternal mortality accounted for less than 10% of female young adult excess mortality, excepting certain non-European countries (United States, Chile, New Zealand, and Taiwan), where it still represented 30% to 40% before the 1940s. Deaths from external causes (suicides, homicides, accidents including road traffic accidents) overtook tuberculosis deaths between 1940 and 1960, with varying patterns across countries. This turnaround coincides with the development of antibiotics (streptomycin, effective against tuberculosis, was discovered in 1944) and the boom in car ownership. In historical terms, the major role of violent and accidental deaths in young adult excess mortality is a relatively recent phenomenon.</p>
<hr>
<p>While the young adult excess mortality hump was <a href="https://www.google.fr/books/edition/Journal_of_the_Institute_of_Actuaries_an/v0UDAAAAYAAJ?hl=en&gbpv=1&dq=Thiele+T.+N.,+1871,+On+a+mathematical+formula+to+express+the+rate+of+mortality+throughout+the+whole+of+life,+tested+by+a+series+of+observations+made+use+of+by+the+Danish+Life+Insurance+Company+of+1871,+_Journal+of+the+Institute+of+Actuaries+and+Assurance+Magazine_&pg=PP12">first spotted 150 years ago</a>, it remains imperfectly understood. It is sometimes the object of misconceptions based on a purely biological conception of adolescence as a universal, gendered phenomenon linked to high-risk behaviour of young adults.</p>
<p>In reality, the hump evolves independently of overall mortality levels, is more pronounced for men than women, and is not universal. It often extends beyond puberty and fluctuates with changes in causes of death not necessarily linked to accidents or violence. While biological factors cannot be excluded, the historical context of the transition to adulthood plays a key role by placing young adults at heightened risk.</p>
<hr>
<p><em>This text is adapted from an article by the authors published in Population & Societies, no. 590, <a href="https://www.cairn-int.info/article-E_POPSOC_590_0001--is-young-adult-excess-mortality-a.htm">“Is young adult excess mortality a natural phenomenon?”</a></em></p><img src="https://counter.theconversation.com/content/182181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrien Remund received an Early Postdoc.Mobility Fellowship from the Swiss National Science Foundation and a Eugène Choisy and Charles Borgeaud Postdoctoral Fellowship from the Société Académique de Genève.</span></em></p><p class="fine-print"><em><span>Timothy Riffe has received funding from the Basque Foundation for Science.</span></em></p><p class="fine-print"><em><span>Carlo Giovanni Camarda ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The risk of dying changes over the course of a lifetime. Very high at birth, it falls and then gradually rises again… except for a peak after adolescence. Why such a statistical anomaly?Carlo Giovanni Camarda, Docteur, spécialiste des méthodes de prévision (mortalité, longévité, etc.), Institut National d'Études Démographiques (INED)Adrien Remund, Docteur, spécialiste des migrations et en démographie historique, University of GroningenTimothy Riffe, Docteur, spécialiste en santé des populations, Universidad del País Vasco / Euskal Herriko UnibertsitateaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1690542021-10-05T10:28:33Z2021-10-05T10:28:33ZHow COVID deaths compare with other deaths in the UK – latest numbers<p>COVID restrictions in England were lifted on July 19, and although COVID cases are currently soaring in schoolchildren and their parents’ age group, many feel that the worst of the pandemic is now over. Thanks to the tremendous effectiveness of COVID vaccines, further lockdowns seem unlikely. However, a look at recent mortality data reveals that everything is not yet back to normal.</p>
<p>Since the start of July, almost 13,000 more deaths have been registered in England and Wales than the average for the same period in 2015-19. The week ending September 24 saw 1,420 excess deaths. These numbers are small compared with the darkest days of the first wave when excess deaths in the two nations exceeded 11,000 a week, but they are still substantial. It is surprising that more attention hasn’t been paid to them. </p>
<p>Perhaps the most striking thing about recent mortality data is that only around half of these excess deaths have been directly from COVID. So what else are people dying from in 2021 that they weren’t in pre-pandemic times?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Since the start of July we have seen excess mortality in England and Wales compared to the 2015-19 average, with around half of these excess deaths being due to COVID and half due to other causes" src="https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424696/original/file-20211005-21-ntv5a.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Analysis from <a href="https://www.gov.uk/government/statistics/excess-mortality-in-england-weekly-reports">Public Health England</a> shows that recent months have seen more deaths from cardiovascular conditions, liver disease and diabetes than the same months in the five years before the pandemic. </p>
<p>But are these deaths really unexpected? The population of the UK is growing and ageing – both factors mean that we would expect the number of deaths to increase gradually over time. </p>
<p>An independent research body that specialises in analysing mortality and sickness rates in the UK, called Continuous Mortality Investigation (CMI), accounted for these changes by calculating age-standardised mortality rates. Their <a href="https://www.actuaries.org.uk/system/files/field/document/Mortality%20summary%20pandemic%20monitor%20Week%2037%202021%20v01%202021-09-28.pdf">analysis</a> finds that adjusting for these factors eliminates the non-COVID excess deaths. So it is true that more people are dying from non-COVID causes than in previous years, but this is due to the population getting older, rather than rising mortality rates.</p>
<p>Of course, 888 deaths from COVID in the most recent week of data is still a tragic loss. However, there are other reasons why we might still be concerned about mortality from other causes.</p>
<p>The first of these lies in what demographers call “mortality displacement”. This effect arises from the fact that the people who have died during the pandemic were, on average, in poorer health than their peers. As a result, some of them would have sadly passed away in subsequent months, even if COVID had never happened. This means that we might expect mortality rates from other causes to fall, as the people who would have died had already been taken early by COVID. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="There were 33,015 more deaths in January to February 2021 than the 2015-19 average, but 9,748 fewer deaths in March to June" src="https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424697/original/file-20211005-25-tslb2e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>We can see evidence of this effect if we look at the cumulative number of excess deaths in 2021 compared with the 2015-19 average. The Christmas wave resulted in over 33,000 more deaths than would usually occur in January and February. But we then saw almost 10,000 <em>fewer</em> deaths between March and June before the delta wave struck. This means that if COVID disappeared tomorrow, we would expect to see fewer deaths than in pre-pandemic years. The fact that we are currently seeing roughly the same number, <a href="https://twitter.com/COVID19actuary/status/1442885393842642945">according to the CMI</a>, suggests that the current picture is less rosy than it appears and that more people really are dying of non-COVID causes than we would expect. Why might this be?</p>
<h2>Knock-on effects</h2>
<p>The effects of the pandemic on society have been huge, particularly on healthcare services. Hospitals have been overwhelmed with COVID patients, with a huge knock-on effect on treatments for everything else. In 2020, the number of patients completing elective treatment in England <a href="https://www.health.org.uk/news-and-comment/charts-and-infographics/how-is-elective-care-coping-with-the-continuing-impact-of-covid-19">fell by 4 million</a> compared with 2019. </p>
<p>At the same time, the number of new early cancer diagnoses <a href="https://www.cancerresearchuk.org/sites/default/files/covid_and_cancer_key_stats_august_2021.pdf">fell by more than a quarter</a> compared with pre-pandemic levels. Consequently, fewer people have been identified as needing treatment and those who were referred are waiting longer to receive the care they need.</p>
<p>There have also been major changes to people’s willingness or ability to seek medical help during the pandemic, meaning fewer people have attended GP surgeries and hospitals for non-COVID health problems. This has led to a big shift in the places people have been dying over the past 18 months. Outside of the major COVID waves, deaths in hospitals have been considerably lower than previous years, while deaths at home have been consistently higher.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Between major COVID waves, deaths have been lower than usual in hospitals, but higher than usual in private homes" src="https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424698/original/file-20211005-25-1l1dm39.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>There have also been big changes in people’s health-related behaviour. Rates of smoking in younger adults and heavy drinking across all age groups <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.15656">increased during the first lockdown</a>, and deaths due to alcohol <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/quarterlyalcoholspecificdeathsinenglandandwales/2001to2019registrationsandquarter1jantomartoquarter4octtodec2020provisionalregistrations">rose by 20% in 2020 compared with 2019</a>. Whether these changes in people’s behaviour persist as things return to normal remains to be seen. But the effects they have on people’s health are likely to continue for some time.</p>
<p>The effects of the pandemic on health and healthcare in England will be deep and long lasting. People are still dying from COVID, and although we may not be seeing more deaths from other causes than we might expect, after accounting for population growth, the scars that the pandemic leaves on mortality data will be seen for decades to come.</p><img src="https://counter.theconversation.com/content/169054/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Angus does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around half of recent excess deaths in England have been directly from COVID.Colin Angus, Research Fellow in the Sheffield Alcohol Research Group, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1679202021-09-17T13:19:42Z2021-09-17T13:19:42ZUnpacking South Africa’s excess deaths. What is known and where the gaps are<figure><img src="https://images.theconversation.com/files/421578/original/file-20210916-15-pg9an2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A pop-up site in Johannesburg aimed at encouraging mini-bus taxi operators and commuters to vaccinate on site. </span> <span class="attribution"><span class="source">Luba Lesolle/Gallo Images via Getty Images</span></span></figcaption></figure><p><em>In the 2000s experts from the University of Cape Town and the South African Medical Research Council built a system to track AIDS mortality on a monthly and a yearly basis, using data from the Department of Home Affairs. In 2020 researchers built on this system to track COVID-19 deaths in South Africa. Now, South Africa is one of few countries in the developing world that have managed to build a near-real time mortality tracking system. The South African Medical Research Council publishes a <a href="https://www.samrc.ac.za/reports/report-weekly-deaths-south-africa">weekly report</a> on deaths in the country. The Conversation’s Ina Skosana spoke to demographer Tom Moultrie about what the data shows.</em></p>
<hr>
<p><strong>Who, according to your figures, is dying, and where are they?</strong></p>
<p>The weekly mortality <a href="https://www.samrc.ac.za/reports/report-weekly-deaths-south-africa">report</a> provides information on deaths registered in almost real-time on the National Population Register. These are used to determine the actual number of deaths that have occurred in the country and calculate the number of excess deaths over and above the numbers that would be expected had the historical mortality trends before the COVID-19 pandemic continued. </p>
<p>In South Africa between May 2020 and early September 2021, over a quarter of a million more people have died from natural causes than was predicted for that time period. </p>
<p>The vast majority – three quarters – are over the age of 60. </p>
<p>The burden of this has been very heavily felt by those at older ages. But it is not completely unaffecting those aged under 60. And that is because of the high <a href="https://www.samrc.ac.za/media-release/silent-killer-why-south-africa%E2%80%99s-health-could-crumble-under-pressure-non-communicable#:%7E:text=The%20four%20major%20NCDs%20share,NCD%20epidemic%20in%20South%20Africa.">prevalence</a> of noncommunicable diseases. South Africa has a high <a href="https://www.samrc.ac.za/media-release/silent-killer-why-south-africa%E2%80%99s-health-could-crumble-under-pressure-non-communicable#:%7E:text=The%20four%20major%20NCDs%20share,NCD%20epidemic%20in%20South%20Africa.">incidence</a> of diseases and conditions such as diabetes, hypertension and obesity. These are all <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html">known</a> cofactors for COVID-19 related mortality </p>
<p>The geography of where people are dying is largely a reflection of where people are living. The actual count of excess deaths is lower in the sparsely populated Northern Cape than more densely-populated provinces such as the Western Cape or Gauteng. Allowing for population size and age-distribution, the three most-affected provinces are the Northern Cape, KwaZulu-Natal, and the Eastern Cape; while the three least-affected provinces are the Western Cape, North West, and Gauteng.</p>
<p><strong>What are the leading causes of death?</strong></p>
<p>This is the real problem we have with trying to understand COVID-19 deaths in the country. We get the data we use from the Department of Home Affairs, which only classifies deaths by natural or unnatural causes.</p>
<p>Unnatural causes of death would be homicides, suicides and accidents. Natural causes refers to medical causes of death. </p>
<p>At the time of death, a doctor or medical attendant records the chain of causes leading to death on an official death notification form. But that information is not captured in real time by the Department of Home Affairs. This data is only released by Statistics South Africa many years after the fact. For example, the mortality and causes of death <a href="http://www.statssa.gov.za/publications/P03093/P030932018.pdf">report release in 2021</a> reflects deaths recorded through to 2018. However, the actual data are still only available through to 2017. </p>
<p>The numbers reported by the national Department of Health every night reflect those known to have died from COVID-19 and who were known to have been infected with the virus. But those reports miss many deaths, especially of those who do not die in a health facility. </p>
<p>In the meantime, however, we can look at the proportions of people testing positive, the excess deaths (above what was expected) as well as the officially reported COVID-19 deaths to get a sense of how these relate to each other. The estimates of excess deaths produced every week show that the peaks of the excess deaths follow almost exactly the peaks of reported COVID-19 deaths, as well as the cases reported a week or so earlier. </p>
<p>The South African Medical Research Council and University of Cape Town collaboration, who produce the estimates of excess deaths every week, has come to the view that between 85% and 95% of the excess natural deaths in the country are related to COVID-19. </p>
<p>But we do not know for certain. That’s one of the great tragedies of vital registration systems in sub-Saharan Africa and the developing world generally.</p>
<p><strong>How can this information be used in the COVID-19 response?</strong></p>
<p>The excess deaths shows that the effects of COVID-19 are far more severe than that reflected in the national data. We can see that even at a more granular level by looking at the provincial data. The number of COVID-19 deaths reported in the Western Cape – which has the best-functioning health data system in the country – is about 70% of the number of excess deaths estimated for the province. Based on this information we can be fairly certain that other provinces are missing COVID-19 deaths.</p>
<p>But even if we can’t attribute all of those excess deaths to COVID-19, we can say with a high degree of certainty that a lot more people have died from COVID-19 than has been reported by the National Department of Health.</p>
<p>Another thing that we’ve managed to do during this period of <a href="https://www.gov.za/covid-19/resources/regulations-and-guidelines-coronavirus-covid-19">repeated lockdowns and changes in regulations </a> has been to try and tease out the effects of the various alcohol bans and curfews on the number of unnatural deaths. Unnatural deaths – as a consequence of homicide, suicide, and accidents – tend to be strongly associated with alcohol. And one of the things which we have managed to show in the <a href="http://www.samj.org.za/index.php/samj/article/view/13345">paper</a>, which we published in the South African Medical Journal, was exactly how extreme the effects of banning alcohol are in terms of their impacts on the number of unnatural deaths. We also showed that the partial restrictions on the sale of alcohol are largely ineffective. </p>
<p>So this data contributes to the evidence base which government can draw on to determine what their COVID-19 response should be.</p><img src="https://counter.theconversation.com/content/167920/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Moultrie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Between May 2020 and early September 2021, over a quarter of a million more people have died from natural causes than was predicted for that time period.Tom Moultrie, Professor of Demography, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674472021-09-10T03:29:12Z2021-09-10T03:29:12ZAiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death<p>Many Australians are walking for their permitted fitness activity during lockdown. Some, emerging from winter hibernation, are taking part in <a href="https://www.steptember.org.au/the-challenge">STEPtember</a> — a global initiative to raise money for cerebral palsy services and research. </p>
<p>The goal for participants is to reach 10,000 steps each day during the month of September. Indeed, 10,000 steps is the de-facto target around the world that many people associate with being fit, healthy and ageing well. </p>
<p>Now, a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783711">new study</a> says a lower — and more achievable — daily goal of 7,000 steps will still yield substantial health benefits. </p>
<h2>From marketing to medical advice</h2>
<p>The 10,000 step benchmark originated from a marketing campaign rather than a specific health objective. A Japanese company (<a href="http://www.yamax-yamasa.com/aboutus/">Yamasa Corporation</a>) built a campaign for their new step-tracker off the momentum of the <a href="https://link.springer.com/article/10.2165/00007256-200434010-00001">1964 Tokyo Olympics</a>. The pedometer’s brand name — <em>Manpo-Kei</em> means 10,000 step meter in English — and a new phenomenon was born.</p>
<p>The new study from the US in 2,100 adults aged over 40 found that while 10,000 steps may well be an optimal health goal, adults can still achieve significant health benefits from only 7,000 steps per day. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman checks smart watch" src="https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420400/original/file-20210910-21-v1012k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Technology including smart watches help walkers and researchers keep track of steps.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/girl-checks-information-on-screen-600w-478885666.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>The researchers in the new study collected data using wearable sensors (triaxial accelerometers similar to those used in smartwatches and phones) and followed participants over a period of around ten years. Researchers looked at the average step counts and analysed the risk of death (after controlling for other factors that might influence the result, like poor health, smoking, and diet). </p>
<p>Compared to adults who walked less than 7,000 steps per day on average, those who reached between 7,000 and 9,999 steps per day had a 60% to 70% lower risk of early death from any cause. The effect was the same for both men and women. But there wasn’t significant further reduction in the risk of early death for those who walked more than 10,000 steps. </p>
<p>The effective step target might be even lower in <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709">older women</a>. A 2019 study of 16,741 women with a mean age of 72 years found those who averaged around 4,400 steps per day had significantly lower mortality rates when they were followed up more than four years later, compared with the least active women in the study.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765">Do we really need to walk 10,000 steps a day?</a>
</strong>
</em>
</p>
<hr>
<h2>Not such a need for speed</h2>
<p>The researchers found health benefits were not affected by walking pace (based on the peak steps per minute over a 30-minute period) or intensity (the total time with over 100 steps per minute). </p>
<p>These findings corroborate a <a href="https://jamanetwork.com/journals/jama/fullarticle/2763292">2020 publication</a> and further confirm the WHO’s 2020 physical activity report that tells us “<a href="https://www.who.int/news/item/25-11-2020-every-move-counts-towards-better-health-says-who">every move counts</a>”. Such messaging is echoed in Australia’s <a href="https://theconversation.com/will-the-governments-new-move-it-exercise-campaign-move-us-or-lose-us-100969">Move it</a> campaign. </p>
<p>Research has shown walking to increase our individual speed <a href="https://bjsm.bmj.com/content/52/12/761">could be more important than absolute speed</a> — emphasising the goal to challenge ourselves while out walking for exercise.</p>
<h2>What about during lockdown?</h2>
<p>A large UK study shows prolonged lockdown conditions may limit our movement to <a href="https://onlinelibrary.wiley.com/doi/10.1111/sms.14032">3,500 steps a day</a>. And we know less physical activity not only affects physical health, but also <a href="https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome">mental health</a>. </p>
<p>Exercise during lockdown is considered an essential activity by <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/ongoing-support-during-coronavirus-covid-19/exercising-and-staying-active-during-coronavirus-covid-19-restrictions">national</a> and <a href="https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/noncommunicable-diseases/stay-physically-active-during-self-quarantine">international</a> authorities — as important as obtaining food and medical care. </p>
<p>For the millions of Australians in lockdown right now, this new study brings positive news and a more achievable goal for protecting their <a href="https://www.sciencedirect.com/science/article/abs/pii/S088915912100180X?via%3Dihub">health</a>. </p>
<p>There is no one-size fits all when it comes to fitness. And there are many different <a href="https://theconversation.com/how-to-stay-fit-and-active-at-home-during-the-coronavirus-self-isolation-134044">innovative ways to stay active</a> while we’re at home. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/home-cooking-means-healthier-eating-theres-an-opportunity-to-change-food-habits-for-good-136881">Home cooking means healthier eating – there's an opportunity to change food habits for good</a>
</strong>
</em>
</p>
<hr>
<h2>Just keep walking</h2>
<p>For those people who don’t have mobility issues, walking provides therapeutic benefits and is an excellent activity for health. It is free of charge, expends energy at any pace, can be done all year round and is a <a href="https://link.springer.com/article/10.2165/00007256-199723050-00004">habit forming activity</a>.</p>
<p>While it is estimated more than a quarter of the world’s population is <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30357-7/fulltext">physically inactive</a>, an easy and achievable solution might be right on our doorstep. </p>
<p>Whether we walk or do other physical activities, it is important we do so at a speed and intensity appropriate to our personal abilities and physical capacity. </p>
<p>More research is needed to understand the potential long-term health benefits across the lifespan of <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-01042-2">light-intensity activities</a> such as household activities like gardening, watering the garden or vacuuming. But evidence continues to affirm that stepping to the beat of your own drum can ensure health benefits, prevent premature death and set attainable benchmarks to make us want to keep active and motivated to continue.</p>
<p>Public health messaging has emphasised the need to <a href="https://www.heartfoundation.org.au/heart-health-education/sit-less-move-more">sit less and move more</a>. Events like STEPtember add to heightened public awareness around the <a href="https://www.thelancet.com/series/physical-activity-2021">health benefits of physical activity</a> and present an opportunity to focus on efficient ways to be active.</p>
<p>Whether you take 7,000 or more steps a day, the most important message is every single step counts. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-some-people-find-it-easier-to-stick-to-new-habits-they-formed-during-lockdown-149438">Why some people find it easier to stick to new habits they formed during lockdown</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/167447/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Ahmadi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While the figure of 10,000 steps a day has become a popular benchmark, new research finds we might not need to take quite so many strides to cut our chances of an early death.Matthew Ahmadi, Postdoctoral Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645422021-08-10T12:28:08Z2021-08-10T12:28:08ZThe maximum human life span will likely increase this century, but not by more than a decade<figure><img src="https://images.theconversation.com/files/412474/original/file-20210721-19-1cw069.jpg?ixlib=rb-1.1.0&rect=16%2C25%2C5590%2C3707&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Biologists and demographers are actively debating whether there is a natural cap on the human life span, and how high that might be.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-and-old-hands-royalty-free-image/183297590?adppopup=true">eucyln/iStock via Getty Images Plus</a></span></figcaption></figure><p>When <a href="https://www.bbc.com/news/world-europe-49746060">Jeanne Calment of France died in 1997</a> at the age of 122 years and 164 days, she set a record for oldest human. That record still stands. </p>
<p><a href="https://scholar.google.com/citations?user=2nGjQFsAAAAJ&hl=en">As statisticians</a> who <a href="https://scholar.google.com/citations?user=QN9RQAYAAAAJ&hl=en&oi=ao">study demography</a>, we expect that record will be broken by 2100. </p>
<p>We study the maximum human life span using a data-driven approach. <a href="https://www.demographic-research.org/volumes/vol44/52/default.htm">Our peer-reviewed study</a>, published in June 2021, models and combines two key components: how the risk of dying flattens after age 110, and growth in the number of people to reach age 110 this century. </p>
<p>Our analysis of these two factors, which we did before the COVID-19 pandemic, suggests it’s nearly inevitable that someone will break Calment’s record during the 21st century, with an 89% chance that someone will live to at least 126, but only a 3% chance that someone will reach age 132. </p>
<h2>Debate around maximum human life span</h2>
<p>Scientists are actively debating whether there is <a href="https://theconversation.com/is-150-years-really-the-limit-of-human-lifespan-162209">a fixed limit to the human life span</a>.</p>
<p><a href="https://doi.org/10.1196/annals.1395.001">Some biologists</a> think the data shows that aging is not a disease that can be treated, but instead an inevitable process that cannot be fully stopped, whether through medical breakthroughs or other means. <a href="https://pubmed.ncbi.nlm.nih.gov/2237414/">Some demographers</a> have argued that there is a natural limit to life expectancy, implying that maximum ages will level off as well. </p>
<p>But others think there’s good evidence that life spans will continue to lengthen - at least for a lucky few. Several <a href="https://www.nature.com/articles/s41586-019-1365-2">prominent biologists</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/30545477/">medical experts</a> have recently published findings suggesting there is some hope for extending life spans dramatically via medical interventions. Ultrawealthy tech titans like Tesla’s Elon Musk and Google co-founder Sergey Brin <a href="https://futurism.com/live-forever-silicon-valley">are investing heavily</a> in such research.</p>
<p>In 2002, two demographers named <a href="https://doi.org/10.1126/science.1069675">Jim Oeppen and James Vaupel observed</a> that between 1928 and 1990, limits to life expectancy proposed by leading demographers were broken just five years after the prediction on average. They also noted that flattening gains to life expectancy should not determine our view of maximum life span, as they are quite different things – the maximum is not the average! </p>
<p>Even a pair of prominent demographers who come down on the side of a fixed limit to human life, S. Jay Olshansky and Bruce A. Carnes, <a href="https://doi.org/10.1007/978-1-4020-8356-3_33">acknowledged that</a> there is no age at which death is absolutely certain, leaving open the possibility of continually broken life span records.</p>
<h2>Challenges studying supercentenarians</h2>
<p>Data on “supercentenarians,” or those who reach age 110, are limited and often of poor quality. There is the <a href="https://link.springer.com/chapter/10.1007%2F978-3-642-11520-2_1">problem of “age-attainment bias”</a>, or the tendency of very old individuals to misstate or exaggerate their age. For this reason, we’ve used only data from the <a href="https://www.supercentenarians.org/">International Database on Longevity</a>, a collection of rigorously verified death records for supercentenarians.</p>
<p>Since these individuals died before 2020, they were all born no later than 1910. Because of record-keeping limitations throughout the world at that time, only records from 13 countries could be included in the database. For that reason, our study is limited to individuals from those 13 countries. </p>
<p><iframe id="r7G3r" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/r7G3r/9/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Basic demography of super-agers</h2>
<p>Yearly mortality rates generally increase as people age. For example, individuals are more likely to die at age 80 than age 20. </p>
<p>But this changes for those who make it to 110 years old. The <a href="https://www.supercentenarians.org/">best available data</a> suggests that mortality rates for these “supercentenarians,” while high, <a href="https://doi.org/10.1007/s10687-017-0305-5">do not increase</a> as they continue to age. In a sense, this means that supercentenarians stop aging. </p>
<p>Instead, supercentenarians as a group have a steady but very high mortality rate of about 50% per year. This means that for every 1,000 individuals who have reached age 110, we expect approximately 500 of them will have died before their 111th birthday, and 250 more by age 112. Taken to its logical end point, this pattern suggests only 1 of the 1,000 would reach age 120, and only 1 in a million supercentenarians would reach age 130. </p>
<p>Even more, such traditional demographic factors as <a href="https://doi.org/10.1007/s10687-017-0305-5">sex and nationality that affect mortality rates also appear to not affect supercentenarians</a>. But scientists have yet to figure out what factors lead supercentenarians to live as long as they do. Do they benefit from excellent genetics? Or healthy environments? Or some other factor as yet unidentified? They appear to be extraordinary individuals, but the exact reason is unclear.</p>
<p>That pattern led us to the second component of our study: projecting how many people will reach age 110 during the 21st century, which ends in the year 2100. Using <a href="https://doi.org/10.1073/pnas.1211452109">population forecasting methods developed by our research group</a> that are used by the United Nations, we found that large mid-20th-century population growth will likely lead to an orders-of-magnitude increase in the supercentenarian population by 2100. Our estimates suggest that about 300,000 people will reach age 110 by 2080, give or take about 100,000. Although this range is well below a million, it makes the one-in-a-million chance that at least one of them will reach age 130 a real possibility.</p>
<h2>Practical limit to human life span this century</h2>
<p>Predicting the extremes of humanity is a challenging task filled with unknowns. Just as it’s conceivable that a medical breakthrough could let humans live indefinitely, every individual to reach age 123 could simply die the next day. Instead, our study has taken a statistical, data-driven approach focused on what will be observed this century rather than on untestable hypotheses about absolute limits to life span. Our results indicate there’s only a 13% chance any individual will reach age 130, and a very tiny chance anyone lives to age 135 this century. </p>
<p>In other words, the data suggests that life span may not have a hard limit, but a practical one. Humans will almost certainly break Calment’s record of 122 this century, but probably not by more than a decade.</p>
<p>While we carried out our analysis using data collected before the beginning of the COVID-19 pandemic and its <a href="https://doi.org/10.1136/bmj.n1343">impact on life expectancy</a>, we believe our overall findings remain accurate. The pandemic may lead to a somewhat smaller total number of 21st-century supercentenarians. But that reduction is unlikely to be very large, and any big effect on their mortality past 110 is unlikely to last many years into the future. </p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p><img src="https://counter.theconversation.com/content/164542/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Raftery receives funding from NICHD. </span></em></p><p class="fine-print"><em><span>Michael Pearce does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Jeanne Calment of France died in 1997 at the age of 122 years and 164 days. That record will be broken this century, statistical models suggest.Michael Pearce, PhD Candidate in Statistics, University of WashingtonAdrian Raftery, Boeing International Professor of Statistics and Sociology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1636482021-07-01T19:52:25Z2021-07-01T19:52:25ZVital Signs: Australia’s anti-lockdown tribe battles on against the evidence<p>You might have thought the “lockdown wars” in Australia were over.</p>
<p>After all, Australia navigated the pandemic better than essentially any other country in 2020.</p>
<p>We closed our international border in March, used an early and relative light lockdown in NSW to get contact testing and tracing up and running, squelched costly hotel quarantine leaks in Victoria with more dramatic measures, and generally kept Australia as COVID-free as possible. </p>
<p>We adopted the wise principle, borne out by so much tragic international experience, that we could not have a functioning economy with a pandemic raging.</p>
<p>The overwhelming focus of public policy has now shifted to getting people vaccinated. But some of the anti-lockdown tribe are battling on, suggesting our border controls and lockdown didn’t save lives.</p>
<p>Are they right? No.</p>
<p>Their latest argument uses a US National Bureau of Economic Research <a href="https://www.nber.org/papers/w28930">working paper</a> by academics from the University of Southern California and the RAND Corporation that looks at “excess deaths”. That is, it compares total deaths from all causes in a particular jurisdiction with an estimate of “expected” deaths in that jurisdiction based on historical data. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-lockdowns-are-costly-but-the-alternatives-are-worse-163572">Yes, lockdowns are costly. But the alternatives are worse</a>
</strong>
</em>
</p>
<hr>
<p>Their data covers all 50 US states and 43 nations, including Australia. Their conclusion is that “shelter-in-place” policies were associated with an increase in excess mortality, with the exception of three countries: Australia, Malta and New Zealand.</p>
<p>So this isn’t a good argument against our approach. Nor did the authors find any statistical significant result covering more than the immediate weeks following shelter-in-place implementation in the more internally comparable US data. </p>
<p>Nonetheless it’s worth examining this paper, and also looking at what Australian data on excess deaths is showing. </p>
<h2>A brave empirical method</h2>
<p>The National Bureau of Economic Research is a distinguished organisation. It has published <a href="https://www.nber.org/people/richard_holden?page=1&perPage=50">nine of my working papers</a>. But this does not bestow some kind of magical status on them. It doesn’t mean they are peer-reviewed. Rather, it is an automatic privilege accompanying bureau affiliation. </p>
<p>Thus every paper comes with the disclaimer that “working papers are circulated for discussion and comment purposes” and “have not been peer-reviewed”.</p>
<p>The paper latched on to by the anti-lockdown tribe uses an empirical method known as an “event study”. Such studies were popularised in financial economics thanks to <a href="https://www.jstor.org/stable/2525569?seq=1#metadata_info_tab_contents">an influential 1969 paper</a> on stock prices by American economist Gene Fama and colleagues.</p>
<figure class="align-right ">
<img alt="Eugene Fama 1969 paper 'The Adjustment of Stock Prices to New Information'." src="https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=896&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=896&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=896&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409230/original/file-20210701-21243-onx46u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eugene Fama 1969 paper ‘The Adjustment of Stock Prices to New Information’.</span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Fama has been called the “<a href="https://www.chicagobooth.edu/faculty/directory/f/eugene-f-fama">father of modern finance</a>” for his work on the “efficient markets hypothesis” – the idea that asset prices reflect all available information, so it is impossible in the long run to “beat” the market. </p>
<p>The efficient markets hypothesis is a big and important idea in financial economics. It rightly led to the 2013 Nobel prize for economics, which Fama shared with University of Chicago colleague Lars Peter Hansen
and Yale University’s Robert Shiller, who built on Fama’s work and concluded that markets are often very far from efficient.</p>
<p>Whatever one’s view about the rationality of asset prices, it is important to understand the “event study” method relies crucially on rationality in financial markets and the efficiency of securities prices. As one <a href="https://www.jstor.org/stable/pdf/2729691.pdf?casa_token=Iy0Lrk3PXkwAAAAA:yuj63VkAdoJ3vkhzUfu9AEWcm3lu_8HjZdK9nEQAswfU8IYkyYXMwQ7qE7RPjO-YU5egA81uqt95RsZ74NYybnW83l1vUJte3efPyzWHfdefIdpDdD8k">survey article of event studies</a> notes:</p>
<blockquote>
<p>The usefulness of such a study comes from the fact that, given rationality in the marketplace, the effects of an event will be reflected immediately in security prices. Thus a measure of the event’s economic impact can be constructed using security prices observed over a relatively short time period.</p>
</blockquote>
<p>Using an event study to assess a noisy measure of mortality in decidedly inefficient political markets (if one can even call them that in this case) is a million miles away from the purpose and internal logic of event studies in securities markets. </p>
<p>The nice way to describe using an event study to assess pandemic policy is that it’s “brave”.</p>
<h2>Australian data on deaths</h2>
<p>The Australian Bureau of Statistic collates definitive statistics about deaths after reports from state coroners are finalised. It usually publishes these annually, in September.</p>
<p>Due to the interest in deaths due to the pandemic, however, the bureau has been publishing monthly “provisional mortality statistics” based on doctor-certified deaths. (About 80-85% of all deaths are certified by doctors, without a coroner determining the cause.)</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-cant-fix-it-if-you-cant-see-it-how-the-abs-became-our-secret-weapon-156637">You can't fix it if you can't see it: how the ABS became our secret weapon</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/jan-dec-2020">The provisional statistics</a> show Australia had slightly fewer non-COVID-related deaths in 2020 than normally the case (an average of 385.6 deaths per day, compared to the baseline average of 385.8.) </p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Doctor certified deaths, COVID-19 infections, Australia, 23 Feb 2020 - 28 Mar 2021 vs 2015-2019 benchmarks." src="https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=317&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=317&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=317&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409226/original/file-20210701-21056-1bltvo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">ABS</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<hr>
<p>In 2020 and <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">so far in 2021</a> Australians have been less likely than normal to die of heart disease and strokes, and dramatically less likely to die from flu. </p>
<h2>What about suicides?</h2>
<p>A common claim by the anti-lockdown tribe is that suicides have risen due to people being socially isolated and losing work.</p>
<p>But early <a href="https://thewest.com.au/business/limited-impact-from-covid-life-insurers-c-3221193">evidence from insurance companies</a> on suicides shows the opposite. </p>
<p>There’s a good reason for this. As Simon Swanson, the chief executive of ClearView Life Assurance, <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/commrep/8472be85-cc92-461d-83c6-5c0d844e5a5b/toc_pdf/Standing%20Committee%20on%20Economics_2021_06_25_8906_Official.pdf">told the House Standing Committee</a> on Economics on June 25:</p>
<blockquote>
<p>If you read our annual report last year you would have seen we increased assumptions for suicide. That did not actually happen — suicide actually went down —and in our research part of that was because people were participating in a global pandemic and everyone was in this together. The second impact was there was an incredible increase in telehealth, which was an interesting part of technology actually delivering to consumers.</p>
</blockquote>
<p>Everyone was in this together.</p>
<p>There may, of course, be other mental health impacts from lockdowns. But there are no perfect options. We will have a greater array of policy options when at least 80% of the population are vaccinated.</p>
<p>With apologies to John Keating (played by Robin Williams) in Dead Poets Society: “‘Twas always thus, and always thus will be.”</p><img src="https://counter.theconversation.com/content/163648/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Holden is president-elect of the Academy of the Social Sciences in Australia.</span></em></p>The nice way to describe a new study suggesting lockdowns haven’t saved lives is that it’s ‘brave’.Richard Holden, Professor of Economics, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.