Steven Johnson How humanity doubled life expectancy in a century TED
Here’s a classic thought experiment
that’s designed to trick your brain
into thinking long-term
and getting out of the daily news cycle.
And it goes like this:
if a newspaper came out once a century,
what would the front page
banner headline be?
“We defeated the Nazis,”
or “landed on the moon,”
or “built the Internet”?
I would argue that it would be
the story of a single number,
maybe the most elemental measure
of progress that we have.
Life expectancy at birth.
The length of time
that the average person can expect to live
in a given place at a given time.
One hundred years ago,
as best as we can measure,
the average global life expectancy
stood somewhere in the mid 30s.
Today, it’s just over 70.
So in one century,
we doubled global life expectancy.
And to give a sense
of what this looks like geographically,
take a look at this image, these maps.
This is data courtesy
of the great organization,
Our World in Data.
This is the world in 1950.
And in blue are the countries
where life expectancy is more than 70.
You can see it’s just five countries
in northern Europe. That’s it.
And in red, these are the countries
where life expectancy is below 45.
It’s about a third of the planet.
So fast-forward to more recent history.
2015 – in blue the countries
where life expectancy is above 70.
Look at all that life.
And in red, the countries
where it’s below 45.
There’s no red on the map
because there are no countries
where life expectancy is below 45.
In fact, there are very few
where it’s below 60.
This is an extraordinary achievement.
And you’ll sometimes hear people say
that life expectancy
and this kind of progress
is actually just a statistical illusion.
That we got better
at reducing infant mortality,
but the rest of our lives
are actually not all that different.
And it is true that infant mortality
has been dramatically reduced
over the last hundred years.
But the story is much richer
and more intense than that.
If you take a look
at this early infographic
by the great Victorian statistician
William Farr,
which is attempting to show
mortality rates by age group
in London in the early 1840s.
I find something incredibly
heroic about this chart.
I mean, here’s a guy without computers,
without the Internet, without Excel,
trying to do something
that is incredibly hard
and incredibly important.
He’s trying to look at broad patterns
in life and death in a great city,
trying to make sense of what is going on.
And what the chart reveals
is that there is a tragic amount
of death among children,
not just infants,
but five-year-olds and 10-year-olds
are dying at an alarming rate.
But almost nobody makes it to 85 or 90.
And more than half of the population
is dead by the age of 45.
How many people in this room
are older than 45?
Right? And think about that:
half of you would not be here.
We talk about optimism.
That is the most fundamental form
of good news there is.
(Laughter)
You are not dead. Right?
(Laughter)
So I want to stress here
that this good news
is not uncomplicated.
100 years ago, there were
less than two billion people on earth.
Today there’s almost
eight billion and counting.
And we have that runaway population growth
not because people
started having more babies,
but rather because people stopped dying
and the generations stacked up.
And we have problems like climate change
because of these
underlying trends as well.
If we had kept mortality rates
where they were in 1920,
we wouldn’t have
anywhere near the magnitude
of the climate crisis we’re facing now
because there simply wouldn’t have been
enough people on the planet
to emit enough carbon into the atmosphere
to make a meaningful difference.
In a weird sense, climate change
is the unintended consequence
of industrialization
and increased longevity.
So all this extra life
is a mixed blessing,
like any change this momentous.
But I want to stress
not just that we did it,
but I think the more interesting
question is how we did it.
That’s what’s been obsessing me
over the last years,
that’s the investigation I’ve been on,
trying to figure out
what are the prime movers
when we see change this momentous.
What is really driving that change?
And I think we should say,
given everything
that’s happening in the world,
we should point out that, you know,
one of those prime movers,
which we should shout from the rooftops,
is vaccines.
Right? We doubled –
(Applause)
Yes, right?
Thank you.
I did invent vaccines,
so I appreciate that.
(Laughter)
I mean, for smallpox to polio,
influenza, TB and measles, and covid.
I mean, if we celebrated
the eradication of smallpox
the way we celebrate the moon landing,
we would have a lot less vaccine hesitancy
in the world right now.
But I also think it’s a mistake
to focus exclusively
on the march of science
and the kind of tangible objects,
like vaccines and antibiotics or X-rays.
And to explain what I mean by that,
I think it’s useful to look at the story
of how we conquered
one of the most terrifying threats
of the 19th century.
Milk.
Now, we think of milk as this kind of
emblem of health and vitality,
but in fact, in the middle
of the 19th century,
milk was a serious health threat,
particularly to children.
We had no mechanical refrigeration
and so there was
a lot of spoilage problems.
People could get tuberculosis from milk.
They figured out this thing
for urban cattle
where they couldn’t feed them grass
so they would feed them
slop from whiskey distilleries –
instead of grass, brilliant idea –
which produced
this kind of blue-tinted milk
that was very dangerous,
called swill milk.
In 1850,
more than half of all the deaths recorded
in New York City were young children,
many of them killed by contaminated milk.
And look, I know what you’re thinking.
You’re thinking, “I know
how we solved this problem.
We solved it with science.
We solved it with chemistry.”
Right? I mean, the solution is so famous.
It’s sitting there printed
on every carton of milk
in every grocery store
in the country, right?
Pasteurization.
But actually, the story of pasteurization
is a case study in the limits of science
because Louis Pasteur came up
with his technique for sterilizing milk
in 1865,
but we didn’t actually have
pasteurized milk as a standard
on American grocery stores’
shelves until 1915,
a full 50 years later.
And that’s because science and chemistry
on its own wasn’t enough
to make a meaningful change.
You also needed persuasion.
You had to convince people
to drink pasteurized milk,
you had to convince the dairy industry
to make pasteurized milk,
and that took a whole other
cast of characters.
It took muckraking journalists.
It took crusading lawmakers.
There was a whole subculture
of pasteurization activists back then.
Maybe the most unlikely one
was a department store magnate
named Nathan Straus,
who got obsessed
with the pasteurization cause
and he funded all these milk depots
all around New York City
where pasteurized milk was sold at cost
to low-income residents
so that they would develop a taste for it.
So in a sense, the way to think about it
is that Pasteur solved the problem
on the level of chemistry,
but Straus and his allies
solved it on the level of society.
And you need both fronts
to effect change on that scale.
And there’s another prime mover
that we don’t talk about enough,
which seems a little bit unlikely
in the context of disruptive innovation,
and that is large
bureaucratic institutions.
Now, if that seems contradictory to you,
I suggest that you flip through the pages
of any pharmaceutical drug catalog
from the early 20th century.
I mean, these things are just
a laundry list of deadly poisons,
one after another:
arsenic, mercury, belladonna,
not to mention all the heroin and cocaine.
A lot of medical historians believe
that all-in pharmaceutical drugs
were a net negative
in terms of human health
until the invention
of antibiotics in the 1940s.
That’s what life was like.
And in 1937, there was
this Tennessee pharma startup
that hit upon this idea
for a new cough syrup,
a cure for strep throat actually,
targeted at children.
At the time, there was a new drug
called sulfa drugs
that were kind of
a forerunner of antibiotics.
But they were generally packaged
in this bulky pill format,
very difficult for kids to swallow.
So a chemist at this startup
came up with the brilliant idea
of dissolving the sulfa drug
in diethylene glycol
and then adding some raspberry flavoring
to make it more palatable for the kids.
Seemed like a brilliant idea,
except that diethylene glycol
is toxic to human beings.
It’s basically antifreeze.
And so almost immediately, weeks after,
there were dozens of deaths
around the United States
from this terrible concoction,
and the crazy thing is that putting
diethylene glycol in your medicine
was not a problem,
given the existing regulations of the day.
The only thing that the FDA
was really interested in
was whether you were actually listing
the ingredients
of your potion on the label.
So if you wanted to put antifreeze
in your cough syrup,
go ahead, as long as you
list ingredients on the label.
That’s what life was like.
But because of this tragedy,
laws were changed.
And for the first time, the FDA mandated
the pharma companies show that their drugs
were not harmful to consumers,
which seems kind of obvious,
but somebody had to figure that out.
And so what we needed at that point
was not just kind of new miracle drugs.
We needed new institutions.
We needed new medi-innovations,
like three phase trials
and randomized controlled experiments,
and regulatory bodies, like the FDA,
to separate out the fake cures
from the real thing.
And that kind of institutional innovation
is going to be increasingly important
in the decades to come,
because all around the world right now,
there are well-funded scientists
and serious labs that are working
on tackling the problem of aging itself.
I mean, currently
the outer boundary of human life
is somewhere around 110 and 115.
It’s very hard to live past that.
But there is serious research out there
that suggests that we can just
blow past that boundary
and live for decades longer,
maybe even indefinitely.
I’m not saying this is going to happen,
but it is on the table.
And the thing about it is,
if we did do that,
it would be the most momentous change
in the history of our species, right?
Initially, it would intensely –
increase the health
inequalities in the world
because people could – only rich people
could afford these treatments originally.
It would greatly exacerbate
our runaway population growth problem
and it would fundamentally alter
the definition of the arc of a human life.
And when you ask people, do you think
we should mess around with immortality,
ordinary people, most of them say no.
But the problem is
we don’t have collectively
a decision-making body that can help us
wrestle with changes this immense.
We’re like the FDA back in 1930,
like, go ahead and make
your immortality pill.
Just make sure the ingredients
are right on the label.
That’s where we are.
So the kinds of innovations we need
are going to be on the level of oversight
and decision making,
and I think we can make these innovations
if we if we work at it.
Now, we all realize
that regulatory overreach is a problem.
So we’re going to have to design
decision-making bodies
that are both sensitive to the dangers
and the unintended consequences,
but also genuinely open
to the possibilities.
But to my mind, we should be focusing
less on extending life indefinitely
and more on reducing the gaps
that remain in health outcomes
here and around the world.
I mean, just look at what we’ve lived
through in the past year and a half.
On average, white Americans
lost one year of expected life in 2020,
thanks largely to covid.
African Americans lost three years.
And we should be focusing
on reducing the gap
between what we call
health span and lifespan.
The amount of time that we spend
that is fundamentally
healthy and full capacity.
I think we all agree
that these are problems
that are worth solving
and we have the tools at our disposal
right now to solve them.
If the first great revolution
in human health
was extending the overall
average human life,
the second should be
about closing the gaps.
Thank you very much.
(Applause)