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"In this world," Benjamin Franklin once said, "nothing can be said to be certain, except death and taxes." While we all know that we will die, how and when have changed dramatically over the last century. We've seen common illnesses brought to the brink of eradication because of the invention of vaccines. We've seen quality of life — like nutrition, sanitation — go up in many parts of the world, while infections from communicable diseases dropped. With antibiotics, surgery became safer. So did one of the most common acts of all: childbirth. All this has amounted to a vast extension in the number of years many of us spend on the planet. But we've also seen that this progress is not evenly distributed across societies and may soon be undone if we don't alter some of our behavior. Here are 27 charts and maps that explain how we die.
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There’s been a dramatic increase in life expectancy
Babies born in the early 20th century could not expect to live past what we now consider middle age, according to the National Institute on Aging. This chart, on female life expectancy in developed countries, illustrates just how quickly lives got longer in the 20th and early 21 centuries. While a woman born in 1840 didn’t generally live past 50, by 2009, her life expectancy surpassed 80 years. This incredible rise can mostly be attributed to one thing: the knowledge we gained from science about human health.
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Vaccine-preventable diseases have nearly been eradicated
Before the first mass-vaccination programs were rolled out, in the early 20th century, it was not uncommon for people to die of diseases that have now been brought to the brink of eradication in many parts of the world. Consider measles. If your parents were born before 1960, there’s a good chance they suffered through the spotty and feverish infection. They probably lived to tell about it, but they may have had friends who didn’t. In the US, before a vaccine was introduced in 1963, there were four million measles cases with 48,000 hospitalizations and 500 deaths every year. Now, there are very few cases and near zero deaths.
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The discovery of antibiotics changed how we die
With the discovery of bacteria-fighting antibiotics, such as penicillin in 1928, many of the diseases that routinely killed people or shaved years off their lives were suddenly treatable. Surgeries also became radically less risky, as antibiotics became a preventive measure in hospitals to help people fight off infections they might be exposed to. The maternal mortality rate dropped, too, as the drugs made childbirth and Cesarean sections much safer. Here you can see that the death rates during childbirth started to plummet in the 1930s, as streptococcal-bacteria-killing antibiotics were used to treat mothers.
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Hygiene improved dramatically
The availability of clean water has had perhaps the greatest impact on public health. Because of the introduction of sewage systems and chlorine into the water supply, around the turn of the 20th century, people weren’t exposed to the germs that had previously made them very sick. These improvements in sanitation reduced the rate of childhood infections and food poisoning. Consider typhoid, a bacterial disease that’s transmitted by eating contaminated food or drinking dirty water. Between 1920 and 1960, the incidence of typhoid fever in the US dropped from 33.8 per 100,000 to less than 1 per 100,000.
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Some of the infectious diseases that used to kill us we can now often control
Throughout history, humans have gone head to head with pathogens, and before the advances of 20th-century medicine and public-health measures, these diseases were extremely deadly. Consider the black plague of the 14th century: it wiped out up to 70 percent of Europe. As you can see in this chart, the black plague was the only pandemic that actually decreased the overall trend toward exponential population growth over time. But, again, advances in infection control and the global governance of health have helped to minimize the impact of such plagues.
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A shift from infectious diseases to chronic illness
The New England Journal of Medicine looked back over a century to see how the causes of death in America have changed. As medicine, our understanding of the germ theory of disease, and public health progressed, deaths from infectious agents (tuberculosis and pneumonia) fell away. With longer lifespans, chronic killers (such as cancer and heart disease) gained prominence, and so did other diseases of aging (Alzheimer's).
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There’s an inequality gap in life expectancy
The world has gained unevenly in life expectancy over the past century. As of 2012, the World Health Organization found that men and women (globally) could expect to live 62 healthy years, plus another possible eight in poorer health. But there was also a great intercontinental divide in how long people could expect to live: in Africa, as of 2012, life expectancy hovered in the 40s, while it has surpassed 80 for those living in some parts of Europe, the Americas, and the Western Pacific.
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The global burden of disease
While the leading causes of death in America are now chronic killers like heart disease and cancer, this isn’t true everywhere. This chart shows the "cause of lost years of life." You’ll note that some countries continue to struggle to control infectious diseases such as malaria and HIV/AIDS. War, road injuries, preterm births, and violence are major killers in others, meaning people in many parts of the world don’t live long enough to experience the diseases of aging that are now common in developed countries.
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Childhood mortality has dropped around the world
Still, the global trend is a positive one. Between 1990 and 2013, worldwide childhood mortality was nearly halved, according to a recent UNICEF report. This chart shows the cumulative drop in every country. Darker colors reflect bigger dips in the mortality rate of kids under 5.
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Every minute, someone dies of heart disease
Half of US deaths in 2009 were due to heart disease, according to the American Heart Association. Coronary heart disease is the most common type; in the US, every 34 seconds, someone has a heart attack. Every minute, someone passes away from a heart disease-related event. It’s just an omnipresent killer. The people who are most at risk for heart disease are those who have high blood pressure, high cholesterol, and those who smoke. Diabetes, obesity, a poor diet, excessive alcohol consumption, and a lack of physical activity also increase one’s odds of dying from heart disease.
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Cancer is the second leading cause of US death
Cancer is the second leading cause of death in the US. But not every cancer is equal, and not every cancer is a death sentence. The word — which comes from the Greek word for crab, probably because of the multiplying cells that grow out of control in many directions — refers to more than 100 diseases. These are the top 10 cancers in the US, according to the Centers for Disease Control and Prevention (CDC). These cancers can be caused by genetics or lifestyle factors — such as smoking, diet, or sun exposure — or some combination of both.
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Smoking remains a huge killer in America
More than anything else, tobacco is far and away the leading cause of preventable death in this country and around the world. About one-fifth of Americans still smoke. If this final 20 percent kicked the habit, the life span in this country would increase. That’s because, even today, tobacco use contributes to four of the five leading causes of death (heart disease, cancer, lung disease and stroke).
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Smoking is becoming increasingly prevalent abroad
Even though the prevalence of smoking has fallen off in developed countries like the US, the burden shifted over to the developing world. This means the number of smokers actually rose because of population growth in these regions. As of 2012, about half of all smokers live in in Southeast Asia, East Asia, and Oceania — where cigarette regulation is lax and smoking still very common.
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Obesity is a big, deadly problem
Obesity is another leading contributor to preventable death. "Excess weight, especially obesity, diminishes almost every aspect of health," according to the Harvard School of Public Health, "from reproductive and respiratory function to memory and mood. Being obese raises one’s risk of death from a range of diseases, including diabetes, high blood pressure, stroke, heart disease, asthma, infertility, sleep apnea, kidney stones, and several types of cancer. Obesity is also associated with shorter lifespans; the higher one’s body mass index (BMI), the more years of life lost. For example, a 20-year-old man with a BMI of 40 will live six years less than a non-obese man the same age.
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Today’s top killers
To fully comprehend how much dying has changed, from extreme singular events to chronic illnesses, this illustration from Britain's National Health Service is instructive. It’s no longer wars or infections that kill most people; it’s the quiet killers like heart disease and cancer. "Every day we are told of lethal new threats to our health and lives," the NHS explained. "Food additives, knife crime, pollution, terrorism ... It's not that these threats are not potential killers, but in this blizzard of health warnings it's easy to lose perspective and worry about small or insignificant risks while ignoring, or being unaware, of major threats."
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A long, slow march
The gains in life expectancy, while incredible, also come with a price: it has drastically altered the process of dying. Consider these illustrative charts from the book Being Mortal by Atul Gawande. Death has gone from being a sudden event to an extremely gradual one. Modern medicine and public health measures stretched people’s life spans, nearly doubling them so that, Gawande writes, "The curve of life becomes a long, slow fade."
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Most Americans want to die at home with palliative care
In a national survey of American Medicare beneficiaries over the age of 65, researchers found that the overwhelming majority of respondents would prefer to die at home instead of in hospice or hospital. "Faced with a hypothetical terminal illness," the researchers wrote, "the respondents were almost evenly split between those who were concerned about getting too little treatment (40.4%) and those who were concerned about too much treatment (45.0%)." What’s more, most people said they did not want "potentially life-prolonging drugs" and instead would opt for palliative drugs, even if they were life-shortening.
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More Americans don't die at home
The number of Americans who spend their dying days in a hospice or hospital is on the rise while care in the home plummets. When researchers gathered data looking at trends between 2000 and 2009, published in the journal JAMA, they found that the ICU utilization rate, and transition rate from home to hospice (or hospital), actually increased during the period.
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We spend lots of money on end-of-life care
People at the end of life also eat up the largest chunk of the health-care-spending pie. They wind up in hospital or hospice situations; they require treatment for multiple, chronic conditions; and they disproportionately use pharmaceuticals and physician services. As a result, while people over the age of 64 make up only 13 percent of the US civilian population, they represent nearly half of those with the top health-care spending habits. And Medicare beneficiaries in their last two years of life consume 32 percent of the program’s overall spending.
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The elderly use more pharmaceuticals than anyone else
To cope with the long tail of life, people near the end rely more and more on prescription drugs. The CDC found that the overwhelming majority of people using multiple pharmaceuticals were the elderly, and the longer people lived, the more drugs they used. This, perhaps, isn’t surprising given that the Institute of Medicine concluded, in a recent report, that dying has become more painful in America: between 1998 and 2010, the number of Americans reporting pain near the end of their lives increased by 12 percent while incidence of depression rose by more than 26 percent.
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Debates about the "right to die" are now front and center
As medicine has gotten so good at helping people live, even in decrepit old age and with crippling chronic illness, societies are now grappling with questions about when medicine should be allowed to take life away. So far, only a few countries have legalized assisted suicide: Belgium, the Netherlands, Luxembourg, Switzerland, and most recently, Canada. (Each country has their own provisions over how death rights should be given.) In the US, five states — Oregon, Washington, New Mexico, Montana, and Vermont — have "right-to-die" laws for the terminally ill.
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Sleep more
Most of us aren’t getting enough sleep. And this has knock-on effects on our quality of life. When we get less than seven hours a night, according to CDC data, we have more difficulty concentrating, remembering, working on hobbies, and looking after finances — all the basics we need to take care of to live healthy lives. Those who sleep seven to nine hours per night perform better on all these measures. Sleep deprivation is also linked with weight gain and early death.
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Eat better
Most Americans over-indulge on meat and grains, and skimp on fruits and vegetables. Americans also eat too much added sugar. As the Center for Science in the Public Interest reported, the average American is now consuming 23 teaspoons of added sugar each day, more than half of the recommended amount. Obesity experts agree that in order to maintain a healthy weight, people need to cut back on added sugar and make sure that half of every meal comes from plants.
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Stop sitting and start moving
This chart came from a 2009 study that followed more than 17,000 Canadians from 1981 to 1993, looking at how much time people spent sitting and comparing that value to their lifespans. They found that the more time a person spent sitting, the lower her chances of survival. According to the CDC, less than half of all adults now meet America's Physical Activity Guidelines.
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Stop smoking
The latest research on smoking data from nearly a million people suggests the habit is even worse for health than previously thought. In addition to contributing to lung cancer, lung disease, and heart attacks and stroke, smoking also seems to increase people's risks of infection, kidney disease, intestinal disease, and a variety of heart and lung illnesses that hadn’t before been attributed to the addictive habit. Quitting smoking at any age adds years to one’s life expectancy.
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Care for the environment
The presence of greenhouse gases are as high as ever, and their rate of emission continues to increase. According to Dr. Margaret Chan, Director-General of the World Health Organization, this is a matter of global health. "The evidence is overwhelming: climate change endangers human health. Solutions exist and we need to act decisively to change this trajectory." According to the WHO's latest data, "Climate change is already causing tens of thousands of deaths every year from shifting patterns of disease, from extreme weather events, such as heat-waves and floods, and from the degradation of water supplies, sanitation, and impacts on agriculture."
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Ignore this advice at your peril
As obesity and diabetes become more prevalent, and the environment more polluted, researchers have scaled back their forecasts for projected life expectancy. They're now anticipating that the previous century of exponential growth may actually stall or decline within the next 40 years. "The steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today may, on average, live less healthy and possibly even shorter lives than their parents," write researchers in the New England Journal of Medicine. This means, simply, that ours could be the first generations in a very long time to live fewer years on average than our parents — unless we make meaningful change.
We live longer than we ever have
How we die now
The difficulty of dying in America
How to live longer and better
