Holocaust Paradox: Long Lives for Those Who Survived

(Bloomberg Opinion) -- Sunday was Holocaust Remembrance Day, causing me to think about an assertion I heard from an elementary school teacher. She said that even those who survived the Holocaust were so debilitated that the rest of their lives would be short. As with many things I learned in elementary school, the reality is more complicated, and my 10-year-old self would be glad to know that my teacher was probably more wrong than right.

Living through a horrendous event, like confinement in a concentration camp or prisoner-of-war camp, does create health problems serious enough to shorten most people’s lives. But those who survive also seem to have other characteristics — perhaps a stronger immune system and a more optimistic outlook than the general population — that tend to make people live longer. New research suggests that such resilience can often overcome scarring. 

The most comprehensive evidence on Holocaust survivors comes from a new analysis in the American Medical Association publication JAMA by a team of Israeli researchers. It compared Holocaust survivors born in Europe between 1911 and 1945 who later moved to Israel to people born in Palestine over the same period. The sample included more than 38,000 Holocaust survivors and a comparison group of almost 35,000 Israelis born in the territory that became their country in 1948. Data on both the survivors and the control group came from the Maccabi Healthcare Services, which provides health insurance to about a quarter of the Israeli population.

The results show that the camp survivors had higher rates of hypertension, cancer, dementia and obesity than native-born people of the same age and sex. For example, 83 percent of the survivors had hypertension, compared to 67 percent of the control group. Whether the Holocaust experience caused these differences is unclear, but they are consistent with my elementary school teacher’s statement.

The surprising part is that despite being in worse health, the Holocaust survivors lived 7.1 years longer — their average age at death was 85 years, compared to 78 among the control group. Those differences persist even after adjusting for socioeconomic status (Holocaust survivors tend to be poorer than their contemporaries), sex and other factors. Some other research has similarly found longer lives among survivors.

The economist Dora Costa of the University of California at Los Angeles has studied prisoners of war during the Civil War and found similar results, though with more nuances. Costa’s analysis examines former Union army soldiers who were held as POWs during the war, and separately assesses the period before mid-1863 (when the Union and Confederacy were exchanging prisoners and conditions in the camps were better) and afterwards (when the exchanges largely stopped and conditions deteriorated). Remarkably, fewer than 5 percent of POWs captured before July 1863 died in captivity, compared to 27 percent of those captured later.

Costa finds different effects depending on the age at capture and the date it occurred. Thirty-five years later, the former POWs who were 30 or older when captured had better survival rates than other soldiers, even if they were captured after conditions deteriorated in the POW camps. Former POWs who were under 30 and captured after mid-1863 had worse subsequent survival rates, however, and the effect occurred because of higher mortality from heart disease.

What about the children of survivors? The Israeli team speculates that their findings “may be important in understanding the favorable figures of life expectancy in Israel, because the genetic characteristics of Holocaust survivors may be associated with the long-term health of their children.” 

But Costa, working with Noelle Yetter and Heather DeSomer of the National Bureau of Economic Research, recently studied the children of former Civil War POWs. They found that the sons of former POWs captured after mid-1863 died sooner than either the sons of non-POWs or POWs captured earlier. There was no effect for daughters. For the sons, the impact was lower for sons born toward the end of the calendar year. (The authors speculate that’s because mothers had better access to food during their pregnancies for those children.)

What’s the conclusion, beyond answering a question that has stuck with me for four decades? First and most importantly, it’s not that a traumatic time is anything but hideous. It’s instead that those surviving such an event may be sturdier than others, and by so much that it more than offsets the additional ailments they wind up with. In other words, survivors can wind up living longer than average, but they would presumably have lived even longer in the absence of their gruesome experiences. Second, the effects of extreme events may be passed on to future generations: Whatever the effect on survivors, the Civil War evidence suggests their children may wind up paying a price.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Peter R. Orszag is a Bloomberg Opinion columnist. He is a vice chairman of investment banking at Lazard. He was director of the Office of Management and Budget from 2009 to 2010, and director of the Congressional Budget Office from 2007 to 2008.

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