What we should do (and do not do) to avoid dying before our time

Spain is one of the countries with the highest life expectancy in the world.

According to estimates by the World Health Organization (WHO), in 2019 it had a life expectancy of 83.2 years (83.68 years in women and 80.68 years in men).

Only surpassed by Japan, Switzerland and South Korea.

Chile is not very far either: 80.7 years of average life expectancy.

Above the 79.9 years of Peru and the 76.6 of Mexico and Argentina.

But, understandably, we always want to live longer.

Life expectancy is an indicator of the average health of the reference population.

But there are people who live much fewer years and people who live much longer.

What do we die

?

Causes of death and early death

According to data from the National Institute of Statistics, the main causes of death in Spain in 2020 were diseases of the circulatory system (24.3% of all deaths) and tumor diseases (22.8% of all people who died ).

If we look at early deaths – defined as the years a person stops living if they die at an age that is not the usual age of death for that group – the causes change.

Specifically, the main causes of premature death are those related to early childhood (malformations, birth problems) or to young age (accidents).

This leaves us with a first lesson in terms of prevention: actions to increase the years of life lost prematurely (for example, traffic accidents) are not the same as actions to prevent the main causes of death (heart diseases). circulatory system and tumors, as we have seen before).

Not everything is dying: healthy life expectancy

Although, obviously, people worry about when we are going to die, not everything is a question of whether we live or die: it is also important to live with the highest possible quality of life.

To quantify it, there are indicators of how many years we live with greater health.

This is the case of healthy life expectancy, which is defined as the average number of expected years that a person lives enjoying good health, that is, in the absence of functional limitations or disability.

In Spain, this healthy life expectancy in 2019 was 69.4 years in men and 70.4 years in women.

Another different measure is healthy life expectancy at age 60.

It is an indicator of quality of life once you reach retirement, and in 2019 it was slightly higher in men (12.4) than in women (12.3).

In order to know what are the causes that make us lose more years of healthy life, there is a project called Global Burden of

(or

in English).

Its purpose is to calculate, for different types of cause, how many years of healthy life are lost.

This project is coordinated by the Institute of Health Metrics and Evaluation and more than 3,000 researchers in 146 countries collaborate on it.

For Spain, it is estimated that the main causes of loss of years of healthy life are smoking, diabetes, obesity and hypertension.

Ignore medical advice

Statistics, epidemiological descriptions of what happens in our societies, are one of the key tools we have to guide our actions to improve health.

Based on the statistics we have seen of healthy life expectancy, we should avoid smoking, eat better, exercise or control hypertension.

To an adult, any doctor would make these five recommendations for a long and healthy life:

• No Smoking.

• Do not consume alcohol, and, if you do, keep it to the least amount possible.

• Practice physical exercise daily.

• Consume fruits and vegetables.

• Don't eat fast food.

Unfortunately, if everything were as easy as telling people what to do, the work of preventive medicine would surely be much simpler and the levels of health and quality of life would be extremely high.

The reality is that we have known for a long time that health decisions and behaviors are very complex and depend on many factors.

Epidemiology has studied how the probability of dying, of living in good or poor health, or of smoking, consuming alcohol or exercising are unequally distributed among the people who make up the same population.

Different epidemiological studies have systematically linked, for example, a disadvantaged socioeconomic position with an increased risk of poor health and premature death.

And this is not because lower class people do not know that smoking or consuming alcohol is harmful, far from it.

The reason is that these people are exposed to living conditions that make it more likely that they will have poor health.

This is what is known as the social gradient of disease.

The conditions of our neighborhood, our job, our social class, our gender, the education we receive or the family environment largely modulate how we behave.

Therefore, when making recommendations on how to live in better health, the social phenomena that influence our health must be taken into account, what we call social determinants of health.

Don't be poor, don't have poor parents

Replicating an exercise in humor that David Gordons did in 1999, an alternative lifestyle recommendation could be:

• Don't be poor.

• Don't have poor parents.

• Don't have a stressful job.

• Live in a good quality house.

• Don't live next to a polluting factory.

They may sound like absurd recommendations on an individual level.

However, under a framework of social determinants of health, they should be seen as collective efforts that we make as a society to protect, promote and promote the health of all the people who make up a society.

And that is precisely what public health is about: collective efforts that improve our global health and well-being, that prevent premature deaths and increase the healthy life expectancy of the population.

Article carried out with the advice of the Spanish Society of Epidemiology.

Pedro Gullón Tosio

Manuel Franco

This article was originally published on