THE FRAGILITY OF THE FUTURE AND THE TUG OF THE PAST: LONGEVITY IN LATIN AMERICA AND THE CARIBBEAN.

AbstractBACKGROUNDThe cohorts who will reach age 60 after 2010 in the Latin American and Caribbean region (LAC) are beneficiaries of a massive mortality decline that began as early as 1930. The bulk of this decline is due to the diffusion of low-cost medical technologies that improved recovery rates from infectious diseases. This decline has led to distinct changes in the composition of elderly cohorts, especially as those who could experience as adults the negative effects of adverse early conditions survive to old age.OBJECTIVEOur goal is to compute the bounds for the size of the effects on old-age mortality of changes in cohorts' composition by their exposure to adverse early conditions. We calculate estimates for countries in the LAC region that span the entire range of the post-1950 mortality decline.METHODSWe use counterfactual population projections to estimate the bounds of the changes in the composition of cohorts by their exposure to adverse early conditions. These are combined with the empirical effects of adverse early conditions on adult mortality to generate estimates of foregone gains in life expectancy at age 60.RESULTSAccording to somewhat conservative assumptions, life expectancy at age 60 will at best increase much more slowly than in the past, and will at worst reach a steady state or decline. The foregone gains may be as high as 20% of the projected values over a period of 30 to 50 years; i.e., the time it takes for cohorts who reaped the benefits of the secular mortality decline to become extinct.CONCLUSIONSThe changing composition of cohorts by early exposures represents a powerful force that could drag down or halt short-run progress in life expectancy at older ages.(ProQuest: ... denotes formulae omitted.)1. IntroductionThe rate of the decline in the force of mortality at older ages after 1950 in western Europe has been estimated to be close to 1% per year (Kannisto 1994; Kannisto et al. 1994). As the initial levels of life expectancy at age 60 are between 15 and 20 years, this rate of decline yields gains in life expectancy at age 60 of about 0.10 years per year. This type of progress is not unique. Recent evidence from countries in the Latin American and Caribbean regions (LAC) (CELADE 2007; Chackiel 2004; Palloni and Pinto 2011) confirms that the increase in life expectancy at age 60-from about 18 years in 1950 to about 23 in 1995-has unfolded in an almost linear fashion. In this case as well, the rate of progress is equivalent to yearly gains in life expectancy at age 60 of about 0.11 years per year, close to the rate of change seen in western Europe. This empiric fits nicely with the idea that human mortality is currently on a positive course (Oeppen and Vaupel 2002). But there are storm clouds ahead that deserve our attention.It has been pointed out that lifestyle changes embraced by newer cohorts of elderly people both in high- and low-income countries could prevent any further improvements in longevity (Olshansky et al. 2005; Preston 2005). The smoking epidemic (Ezzati and Lopez 2003; Palloni, Novak, and Pinto 2012) and increases in obesity and metabolic syndrome (Aschner 2002; Hossain, Kawar, and El Nahas 2007; Kain, Vio, and Albala 2003; Pena and Bacallao 2000; Barcelo et al. 2003) are powerful enough to call into question the more optimistic scenarios.A second hurdle to further survival gains that is especially relevant in the LAC countries is that the members of birth cohorts who will reach age 60 after the year 2000 are unlike prior cohorts, and their past health and mortality experiences could derail future progress. The size of these cohorts is boosted by the fastest mortality decline ever recorded. This decline is attributable in large part to the reduction in exposure and the increased resistance to common infectious diseases, which led to a decrease in fatality rates from these diseases. …