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  • 16th May 2019

How can more people live good, long lives?

Two new launches aim to tackle inequality and low life-expectancy in the UK

This week saw the announcement of two interesting policy beginnings, and one end of a beginning, around the theme of living a good, long life.

First, the launch of Nobel Prize-winning Sir Angus Deaton and the IFS’ ambitious and wide ranging review on inequalities, and whether the UK and other countries will follow the US pattern of rising ‘deaths of despair’, and the drivers that lie behind it. For those not familiar with Angus’s work, a good place to start is with this shocking graph:

This rise in deaths of despair, concentrated in US whites with below degree level education—detectable because US death certificates contain information on education—is largely driving the increase in all-cause mortality.

This rise in deaths of despair is being driven, in essence, by the destruction of working class life, and the everyday social fabric that it supported

US life expectancy has now fallen for three years in a row—a fall of this magnitude having not been seen for over a century, since the First World War and Spanish flu epidemic. Deaton’s argument is this rise in deaths of despair is being driven, in essence, by the destruction of working class life, and the everyday social fabric that it supported. White Americans without degree level education have seen falling wages and reduced job security, bringing in their wake broken marriages, families and communities (cf Putnam’s Our Kids), and in turn, a new kind of despair, opioid and alcohol use, and a surge in suicides.

By coincidence, as the Deaton review was announced, a more upbeat All Party Parliamentary Group on longevity was launched (appropriately enough for a group on longevity, the launch dinner event was hosted in the House of Lords).

Central to its objective is to encourage government, industry and society to adjust to a world where more than 1 in 4 people could soon expect to live to 100 years old. This ought to be widespread cause for celebration, but it does mean that we’d better get used to working longer, and/or figuring out how to adjust our tax and welfare systems. There’s also the curious puzzle of how slowly our economies seem to be adjusting to the aging profile of our citizens; even the demographic might of the aging baby-boomers seems not (yet) to have prompted a surge of products that interest them.

The Deaton review and longevity APPG agree about one thing: the answer to these challenges doesn’t lie in spending lots more money on expensive new drugs and medical treatment for end of life care. Tackling plummeting US longevity, and achieving the hoped-for continued rises in longevity in the UK/EU, means not just preventive public healthcare, but deeper social policy such as keeping people in meaningful work, satisfying relationships, and strong communities.

But before we get too smug on our side of the Atlantic, there are grounds for real concern. First, note that Deaton’s breakdown of US mortality by education is not easy to do in many other countries’ data—it’s possible that it is starting to happen elsewhere, and just hasn’t been noticed. Matt Hancock’s announcement that opioids are to carry addiction warnings is a welcome sign that policymakers are vigilant, but we will need to do more, particularly focusing on areas where prescription rates are markedly higher. Second, some of the underlying causes Deaton points to definitely are happening elsewhere, such as the weakening of collective bargaining, falling relative wages in unskilled groups, and gaps in the longevity of personal relationships.

Perhaps less widely noticed this week, was the end of an important beginning. Back in 2011, the Education Endowment Foundation was launched to find out what works in education, and in particular to systematically identify how to most effectively improve the educational outcomes of children from more disadvantaged backgrounds. These are the kids who, if they don’t do well in school, are at risk of finding themselves in the dark world that Deaton warns of. Just look at how stark the division by educational attainment is in the graph below.

The EEF has now run over 185 RCTs with more than a million kids. It’s hard work. As EEF CEO Sir Kevan Collins shared with a wider audience this week, only about 1 in 4 of EEF trials go on to find a significant positive effect at scale. Indeed, as Dr. Hugues Lortie-Forgues noted in a seminar in BIT this week, the average effect size of EEF trials—and identically in comparable US trials—is only around 0.06 sd. Still, that’s about the equivalent of two months of extra schooling for a 10 year old. As in progress on health, if we can keep this flow of results going, and crucially adopt the successful changes, there’s every reason to expect the kinds of increases in educational attainment in the coming decades as we’ve already seen in health outcomes.

Don’t worry. The EEF isn’t ending. But Sir Kevan, who has been at EEF since the outset, has just announced that he’s stepping down. He’ll be a great loss. (Also a big pair of shoes to fill – the search is now on for a fantastic randomista with a strong interest in education…). If Deaton is right, history may yet show that Kevan didn’t just help to transform the world of education, he may also have saved more lives than almost any medic alive today.

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