As I enter my 67^th year, I am reminded, according to several sources, that as a male born in in the UK in 1959, my life expectancy was deemed to be a remarkably specific 67.8 years[i].  In two areas of wellbeing and health in which I am involved (self-care and health inequalities), the concept of prevention of ‘premature death’ is writ large. Globally, however, there is lack of agreement on the definition of premature death.

‘Normal’ life and ‘preventable death’: a history

An extensively analysed paper, assumed to have been written around 3500 years ago[ii] reported the average human lifespan to be threescore years and ten (70) and fourscore years (80) achievable ‘by reason of strength’. It is worth noting that the traditional author of this paper was reputed to have lived to the age of 120.

In a paper presented in 1878[iii], Wilhelm Lexis coined the term ‘premature death’ as occurring before the ‘normal life of man’ at 70 years old.  At this time, in the UK, ‘overall life expectancy’ (the average total life span or the mean age at death) was 40, with ‘median age of death’ (age at which exactly half the deaths in a given time period were below that age and half the deaths were above that age) at  46, but ‘modal age of death’ (the age where death is most likely or most common) reached 70.

In 1959, the year referred to above, the WHO was still in its infancy, grappling with the immediate global problem of communicable diseases and the urgent need for widespread vaccination programmes. At the time, the average life expectancy globally was 49.6[iv] and premature death was rarely referred to. The global burden of disease subsequently shifted, assisted by international and country-specific preventive efforts. By 1990 non-communicable diseases (NCDs) had surpassed communicable diseases as causes of death globally[v].

However, even by its Global Health Report of 1998[vi], the WHO was still referring to premature death as ‘deaths before the age of 50’. Since then, the date before which death is classed as ‘premature’ has increased significantly. Both the 1993 UK health inequalities paper by Eames and Marmot[vii] and the Acheson report in 1997[viii], referred to deaths under 65 as premature. It is entirely possible that those individuals who were in their receptive professional infancy at the time might believe that this definition is extant. 

Prevention of premature death in 2025

The WHO largely defines premature death as before the age of 70[ix] [x], but the NHS uses age 75[xi]. 

According to the WHO 2030 Agenda for Sustainable Development 3.4, the aim is to reduce premature deaths (before the age of 70) from NCDs by a third by 2030. Prevention of NCDs through self-care and lifestyle changes is a powerful potential tool. Yet the UK has no formal self-care strategy and although it is signed up to the sustainable development aim, locating the national figures that support the NCD reduction in under 70s is problematic.

In addition, recent research demonstrates a willingness to self-care in individuals which is not supported by the system[xii]. If we are to deliver the NCD prevention aims to which we are signed up, the NHS requires a self-care preventive strategy that includes appropriate national goals and that harnesses and encourages the public enthusiasm for self-care.