Eric R. Kingson
Professor Eileen Crimmins' and Dominique Ingegneri's paper does an excellent job of summarizing perspectives and literature about whether current and projected declines in age-specific mortality rates are and will be accompanied by improvements or decrements in the health of middle-aged and older persons. It also presents informative findings from their research on this topic.
As a discussant for this paper I will first summarize some of what we learn from their interesting paper. Then I will identify several questions and issues that I believe need to be addressed.
First, from their analysis and review of the literature we learn that in spite of large increases in life expectancy at birth and at older ages from 1968 through 1988, the health of middle-aged and older Americans, on average, does not appear to have improved. We also learn that this trend is consistent with trends in Canada, Great Britain, Japan, and Australia. The discussion and analysis suggests that recent declines in mortality rates which have been driven primarily by reductions in death rates from chronic illnesses have "resulted in people with health limitation living longer" through these people may not "be very severely impaired" ( Crimmins and Ingegnen, 1991). Ironically, They point out, it is "the very factors which have produced the remarkable declines in mortality since the mid-1960's which call into question whether people in 1990 are healthier...as well as longer lived" ( Crimmins and Ingegneri, 1991).
Second, we learn of the complexity surrounding the relationship between morbidity and mortality trends. The authors note that to the extent that age- specific mortality rates decline as a result of decreases in infectious disease (as Was the case in the first half of the century), then the health of the population should also improve. However, potential health outcomes for the surviving population are more ambiguous when improvements in life expectancy result from reductions in death rates from chronic diseases (as has been the case since the mid-1960's). This is because mortality reductions could be associated with, for example, reductions in the prevalence of chronic diseases or with lengthened periods of survivorship after the onset of such diseases. Morever, the relationship between morbidity and mortality is more difficult to disentangle for two other reasons. As mortality declines, the surviving population tends "to be a frailer group" who is more susceptible to a whole host of diseases." Also, much of the health and disability problems of older persons are a function on non-lethal chronic diseases such as arthritis as opposed to "killer" chronic diseases such as cancer. Thus, reductions in case fatalities from prevention or treatment of killer