In healthcare, there is no more noble act than that of saving lives.

Ask anyone working in the clinical field why they do this type of work and they will consistently answer: to save lives, help others, ease pain and improve lives. But on reflection, if this is truly our aim, then we are in the wrong profession.

In gerontology you rarely hear care workers talking about saving lives. We all know that eventually one of the many long-term diseases will eventually take us out. So, one of the aims has been to try and find a way to stay alive longer.

The search for immortality has a long history, but it has now been taken on by new champions. The richest people on earth are frantically funding scientific studies to find a cure for ageing. As the oldest story ever recorded – that of the Epic of Gilgamesh – will tell us, it is futile searching for immortality.

The search for immortality is a mirage. It is more than likely that for rich people, even all this money and searching for immortality, their biology will eventually kill them. For the rest of us, we are likely to die from other causes. Causes that can be preventable.

Worldwide, the most common preventable cause of death is the lack of clean water. The World Health Organisation (WHO) has reported that 870,000 deaths occurred in 2016 from unsafe drinking water, unsafe sanitation and lack of hygiene. Every year more than the population of Malta dies because they are lacking clean water.

Only seven out of 10 people in the world has access to clean water, while only one in three has access to sanitation. On a global perspective, if we want to ‘save’ lives we need to become sewage and water engineers. Even in industria­lised countries with variably clean water, there are many ways to die other than through ill-health.

To truly save lives we must develop management systems in order to stop killing patients

In 2016, Martin Makary and Michael Daniel from Johns Hopkins University revealed that after analysing deaths over an eight-year period in the US, more than 250,000 deaths per year are due to medi­cal errors. Medical mistakes are the third-leading killer in the US. As few as five per cent and no more than 20 per cent of these mistakes are ever reported. In some countries, these errors are not even recorded.

Such deaths are known as iatrogenic, a word that comes from Greek word iatros, meaning ‘healer’, ‘genesis’, and ‘origin’. Iatrogenesis was popularised by Ivan Illich, the great Austrian philosopher when he wrote Medical Nemesis: The Expropriation of Health in 1976. It is difficult to assess the extent of iatrogenic deaths in countries where data is not so rigorously collected.

As early as 1969, Victor Griffiths, writing about these types of deaths from surgery in Malta, highlighted how common such mistakes can be, even when we follow protocol.

Most medical errors are also not due to inherently bad healthcare workers but represent systemic problems such as inadequate management of patients and their medications. But these deaths do highlight how management can cause someone’s death.

In 1994, Lucien Leape, professor at Harvard School of Public Health, one of the first clinicians to address this problem, said these deaths were equivalent to three jumbo-jet crashes every two days. To truly save lives we must develop management systems in order to stop killing patients.

In addition to iatrogenic disease, there are other behavioural causes of death; things we do that will eventually harm us. In 2014 in the US, cigarette smoking accounted for more than 480,000 deaths. Drinking too much alcohol is responsible for 88,000 deaths each year, more than half of which are due to binge drinking.

In 2011, more than half of adults aged 18 years or older are considered physically lazy; they refrain from physical activity. Being inactive is probably the main cause of early death in industrialised countries. To save lives, perhaps we need to become physical education teachers or drug abuse therapists.

In most cases, there is also luck. We cannot do very much about luck. Jean Calment, who lived to see her 122nd birthday, outlived her daughter Yvonne, who died of pneumonia, and her grandson Frédéric, who died of a motorcycle accident. Both died at the age of 36. You might have great potential for longevity but you cannot completely control the environment, just minimise the randomness of accidents.

Among centenarians – those who are 100 years of age and older – randomness also plays a role in their death. A 2016 report by Jiaquan Xu from the US National Centre for Health Statistics shows that between 2000 and 2014, death rates for centenarians increased by a third as a result of unintentional injuries. Having lived for a century, evaded most diseases that brought down most of your family and friends, what gets you in the end might be that small rug in the hallway or tripping over your pet. Better ergonomics and home safety might save more older adult lives.

It is not just the medical field that saves lives. There are many professions that make life easier, safer and healthier, especially for older adults. Acknowledging this truth makes us appreciate how illness is not just a virus or bacteria or a pathogen, but also the social and physical environment that we live in.

Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.

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