The fragility of the future and the tug of the past: Longevity in Latin America and the Caribbean

BACKGROUND The cohorts who will reach age 60 after 2010 in the Latin American and Caribbean region (LAC) are beneficiaries of a massive mortality decline that began as early as 1930. The bulk of this decline is due to the diffusion of low-cost medical technologies that improved recovery rates from infectious diseases. This decline has led to distinct changes in the composition of elderly cohorts, especially as those who could experience as adults the negative effects of adverse early conditions survive to old age. OBJECTIVE Our goal is to compute the bounds for the size of the effects on old-age mortality of changes in cohorts' composition by their exposure to adverse early conditions. We calculate estimates for countries in the LAC region that span the entire range of the post-1950 mortality decline. METHODS We use counterfactual population projections to estimate the bounds of the changes in the composition of cohorts by their exposure to adverse early conditions. These are combined with the empirical effects of adverse early conditions on adult mortality to generate estimates of foregone gains in life expectancy at age 60. RESULTS According to somewhat conservative assumptions, life expectancy at age 60 will at best increase much more slowly than in the past, and will at worst reach a steady state or decline. The foregone gains may be as high as 20% of the projected values over a period of 30 to 50 years; i.e., the time it takes for cohorts who reaped the benefits of the secular mortality decline to become extinct. CONCLUSIONS The changing composition of cohorts by early exposures represents a powerful force that could drag down or halt short-run progress in life expectancy at older ages.