A research group in the sociology of medicine studies the development of health in the population and comes to surprising results.
In spite of their advanced age, they are in the middle of life, healthy, active and mentally alert – they are referred to as the “young old”. Statistically speaking, those who retire today have far more years of life ahead of them than their grandparents. The older generation benefits from improved living conditions after the Second World War:
Less heavy physical work, better nutrition, good health care and greater health awareness. “At the beginning of the 1980s, the American physician James Fries put forward the thesis that due to the overall improvement in living conditions, disease rates are decreasing and the occurrence of diseases and disabilities is postponed to later stages of life,” explains Professor Dr. Siegfried Geyer, Head of Medical Sociology at Hannover Medical School (MHH). From this positive perspective, Professor Geyer and his working group investigated how the health status of different age groups in the population developed.
Compression and expansion
Professor Geyer and his team have been working on the topic of “compression and expansion of morbidity” since 2014. This is also the title of their research focus. Morbidity refers to the impairment of an individual or a population by disease. Experts refer to morbidity compression when illnesses or disabilities occur less frequently or later in the course of life. If this is the case, a healthy life span is gained. On the other hand, when morbidity increases, the disease or disability appears more frequently or earlier in the course of life. If this is the case, healthy life time is lost. People then live more years of life with impairments and needing treatment.
Wide range of studies
For the review work, the researchers evaluated national and international studies and conducted their own research. In addition, they used data from AOK Niedersachsen, which depicts a broad social structure. “We looked at the period from 2005 to 2019 and compared cohorts of the same age at different times,” says Professor Geyer. The surprising result: the health status of the elderly, which used to improve over the years, does not continue in the generations born later. This is also the case for the USA, for example.
Older people: Better health and longer life
The state of health of today's older generation, i.e. people born in the 1950s and 1960s, has significantly improved: all types of cardiovascular disease have declined or moved into older age.
The same applies to strokes and lung cancer, primarily in men. Parallel to the decline in nicotine consumption, the rate of lung cancer among men fell by 31 percent between 2006 and 2017. Dementia also occur less often or later in the age group. For these diseases, a significant morbidity compression took place in this generation. “There are differences in education and income, but overall, the older generation has significantly improved in health,” says Professor Geyer.
Younger: Early Adiposity and Type 2 Diabetes
Among the diseases whose rate increased across all age groups was diabetes mellitus type 2. Here, the scientists observed an expansion in morbidity. It is worrying that the disease is becoming increasingly common in early adulthood.
“This is associated with a prolonged duration of the disease and an increased risk of co-morbidities, i.e. the additional occurrence of concomitant diseases,” says Professor Geyer. This is already evident in the age groups of 18 to 45 years old. The development of severe overweight, called obesity, in young years is also alarming. The proportion of obese people aged between 25 and 55 almost doubled between 2004 and 2020. It increased from 12.7 percent to 23.4 percent. Obesity in turn promotes diseases such as diabetes mellitus type 2, high blood pressure, heart attack, stroke and fatty liver.
Challenges for the social system, the health sector and the economy
“In our study, James Fries’s thesis of morbidity compression has only been confirmed for today’s older generation. It is much healthier than the generation of its parents and grandparents.
However, this positive development does not continue in the case of those born later,” Professor Geyer summarises the results of the review. Morbidity has increased among the younger generation. The poorer state of health was also accompanied by a demographic decline in the group of younger people. This could have a huge impact on social security systems and the economy. “The number of cases of illness will increase in the future and the cost of health care will rise,” fears the medical sociologist. In order to counteract this, the working conditions of individual occupational groups should be given greater attention. In the past, it was mainly physical stress and exposure to pollutants that were considered health risks. Today, however, risks arise from predominantly sedentary activity. Professor Geyer: “We move too little. Preventive measures are urgently needed in the workplace.” And there are also many things going wrong with nutrition.
Because while the necessary calorie requirement has decreased steadily over the years due to the changed lifestyle, the actual calorie consumption has steadily increased.
Text: Tina Götting