In 1980 Dr James Fries, Professor of Medicine at Stanford University School of Medicine, published the now well known Compression of Morbidity hypothesis in the New England Journal Of Medicine.  This theory holds that it may be possible to reduce cumulative lifetime morbidity.  Since chronic illness and disability usually occur in late life, cumulative lifetime disability could be reduced if Primary Prevention measures postponed the onset of chronic illness.  Decreases in health risks may also increase average age at death.

The hypothesis predicts that "the age at the time of initial disability will increase more than the gain in longevity", resulting in -

(i)         fewer years of Disability; and

(ii)        a lower level of cumulative lifetime Disability.

There is some controversy in this hypothesis with some contending that "healthier lifestyles may actually increase morbidity (and health expenditures) late in life by increasing the numbers of years with chronic illness and disability".

Fries et al published a special article in the New England Journal of Medicine in 1998 that was the result of a longitudinal study to determine whether persons with lower potentially modifiable health risks have more or less cumulative Disability.  The study involved 1,741 university alumni who were first surveyed in 1962 (average age 43 years) and then annually starting in 1986. Strata of high, moderate and low risk were defined on the basis of smoking, BMI and exercise patterns.

Cumulative disability from 1986 to 1994 (average age in 1994 was 75 years) or death was the measure of lifetime disability.  Persons with high health risks in 1962 or 1986 had twice the cumulative disability of those with low health risks. The onset of disability was postponed by more than five years in the low risk group as compared with the high risk group. They concluded that smoking, BMI and exercise patterns in midlife and late adulthood are predictors of subsequent disability and that persons with better health habits survive longer and that disability was postponed and compressed into fewer years at the end of life.

Further support for this hypothesis came from another longitudinal study of James Fries "Exercise and the Health of the Elderly" American Journal of Geriatric Cardiology 1997: 24-32 where 537 members of a runners’ club and 423 community controls were studied over eight years with an average initial age of 59 years. They found that exercising subjects developed disability at a rate of only one fourth that of the sedentary controls. Musculoskeletal pain was reduced by 20%. Medical care costs of exercisers were 25% less than controls. Mortality was significantly reduced in the exercising groups.

GPs are ideally placed to influence and minimise health risk with appropriate intervention with their patients, often in an opportunistic way. Smoking cessation, weight control and encouraging physical activity where appropriate are important interventions that long term may postpone disability, compress morbidity and improve quality of life for people in their later years. Encouraging Interested Adults to comply with these health measures is the challenge the YELP  SPV can facilitate.

A recent study by Lakdawalla, Goldman, and Shang in Health Affairs The Health And Cost Consequences Of Obesity Among The Future Elderly demonstrated that Obese and non-obese people have similar life expectancies, but the health care costs of an Obese person will be significantly higher than a non-obese person over the course of a lifetime.  Therefore, higher costs are not offset by reduced longevity.