Health and Longevity - World Bank

8

Health and Longevity

The health of a country’s population is Global Trends Which factors
often monitored using two statistical account for most
indicators: life expectancy at birth and During the second half of the 20th cen- of the health
the under-5 mortality rate. These indi- tury health conditions around the world improvements in
cators are also often cited as overall improved more than in all previous the 20th century?
measures of a population’s quality of human history. Average life expectancy
life because they indirectly reflect many at birth in low- and middle-income
aspects of people’s welfare, including countries increased from 40 years in
their levels of income and nutrition, the 1950 to 65 years in 1996. Over the same
quality of their environment, and their period the average under-5 mortality
access to health care, safe water, and rate for this group of countries fell from
sanitation. 280 to 80 per 1,000. But these achieve-
ments are still considerably below those
Life expectancy at birth indicates the in high-income countries, where aver-
number of years a newborn baby would age life expectancy at birth is 77 years
live if health conditions prevailing at the and the average under-5 mortality rate is
time of its birth were to stay the same 7 per 1,000.
throughout its life. This indicator does
not tell how long a baby will actually Throughout the 20th century, national
live, but rather how long a baby born in indicators of life expectancy have been
a certain year is likely to live. The under- strongly associated with GNP per
5 mortality rate indicates the number of capita. If you compare Figure 8.1 (Life
children who are likely to die before expectancy at birth, 1995) with Figure
reaching age five per 1,000 live births. 2.1 (GNP per capita, 1995), you will
find that in general the higher a coun-
Because infants and children are most try’s income per capita, the higher is its
vulnerable to malnutrition and poor life expectancy—although this relation-
hygienic living conditions, they account ship does not explain all the differences
for the largest portion of deaths in most among regions and countries. (See Data
developing countries. Therefore, decreas- Tables 1 and 2 for country-specific
ing under-5 mortality is the most effec- data.) The two other factors believed to
tive way of increasing life expectancy at be the most important for increasing
birth in the developing world. national and regional life expectancies

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BEYOND ECONOMIC GROWTH

Figure 8.1 Life expectancy at birth, 1995

Years
100

90
81

80 74 72 68 70 65 68 73
70 66 64
61 62

60 50 53

50
40

30
20
10

0

High-income Latin East Asia Middle Europe South Asia Sub-Saharan
countries America and the East and and Africa
and the Pacific
Caribbean North Central
Africa Asia

Male Female

are improvements in medical technology vices, and education allows countries to
(with some countries clearly making bet- realize “more health” for a given income
ter use of it than others) and develop- than before. For example, in 1900 life
ment of and better access to public expectancy in the United States was
health services (particularly clean water, about 49 years and income per capita
sanitation, and food regulation). was more than $4,000. In today’s Sub-
Education, especially of girls and Saharan Africa life expectancy is more
women, makes a big difference too, than 50 years even though GNP per
because wives and mothers who are capita is still less than $500.
knowledgeable about healthier lifestyles
play a crucial role in reducing risks to In general, for nearly all countries, life
their families’ health. expectancy at birth continued to grow in
recent years (see Data Table 2 ). In devel-
These other factors help explain how oping countries this growth was largely
most developing countries are catching due to much lower under-5 mortality
up with developed countries in terms (Figure 8.2). Better control of communi-
of people’s health even though they are cable diseases that are particularly dan-
generally not catching up in terms of per gerous for children, such as diarrhea and
capita income (see Chapter 4). Progress worm infections, accounts for most of
in medical technology, public health ser- the gains. In many countries higher per

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8 HEALTH AND LONGEVITY

Figure 8.2 Mortality rate of children under age 5, 1980 and 1995

Per 1,000 children 174

200 193
180
160 157

140 141 75 82
53 47
120 108 72
100
Middle
80 East and

60 North 35
40 Africa
20

7

0

Sub-Saharan South Asia East Asia Latin Europe High-income
Africa and the America countriesa
Pacific and the and
Caribbean
Central
Asiaa

1980 1995

a. 1980 data not available

capita incomes (see Chapter 4 and Data where the rate of measles immunization
Table 1) also contributed to better nutri- is the lowest—about 60 percent. As
tion and housing for most families. many as 2 million people die every year
as a result of malaria and malaria-related
Governments of developing countries diseases, mostly in low income coun-
have invested in improving public health tries; and in Africa alone more than 2
measures (safe drinking water, sanita- million lives a year are claimed by AIDS.
tion, mass immunizations), training
medical personnel, building clinics and Population Age Structures
hospitals, and providing medical care.
But much remains to be done. The health and longevity of a country’s
Malnutrition, especially among women people are reflected in its population age
and children, is still a big problem. And structure—that is, the percentages of dif-
communicable, largely preventable dis- ferent age groups in the population of the
eases still claim millions of lives. For country. A population age structure can
example, the average rate of measles be shown by a population pyramid, also
immunization worldwide is just 80 per- known as an age-sex pyramid. In such
cent, and every year more than 1 million pyramids a country’s population is
children die of the disease. Many of divided into males and females as well as
those children are in Sub-Saharan Africa,

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BEYOND ECONOMIC GROWTH

Figure 8.3 Population pyramids for low- and high-income countries,
1995 and 2025

Low-income 1995 High-income Low-income 2025 High-income
countries Age countries countries Age countries

What are the social 75+ 75+
and economic 70–74 70–74
challenges that 65–69 65–69
result from 60–64 60–64
different 55–59 55–59
population age 50–54 50–54
structures? 45–49 45–49
40–44 40–44
35–39 35–39
30–34 30–34
25–29 25–29
20–24 20–24
15–19 15–19
10–14 10–14

5–9 5–9
0–4 0–4

6420246 6420246 6420246 6420246

Percentage of population Percentage of population Percentage of population Percentage of population

Males Females Males Females

age groups (for example, five-year age population is under 15, compared with
groups, as in Figure 8.3). Figure 8.3 less than one-fifth in high-income coun-
shows population pyramids typical of tries. From a demographic perspective,
low- and high-income countries in 1995 that means that larger age groups are
and expected to be typical in 2025. Note about to enter childbearing age, and the
how these shapes represent higher birth increase in the number of parents will
rates, higher death rates (particularly outweigh a decrease in the average num-
among children), and lower life expectan- ber of children per family. This phenom-
cies in low-income countries. Think enon, called population momentum, will
about why in poor countries the base of keep birth rates high despite a drop in
the pyramid is broader and the pyramid is fertility (see Chapter 3). From a social
basically triangular rather than pear- and economic perspective, a high per-
shaped or rectangular as in rich countries. centage of children in a population
Explain also the changes expected to hap- means that a large portion is too young
pen to both pyramids by 2025. to work and, in the short run, is depen-
dant on those who do. This is the main
As seen in Figure 8.3, in low-income reason for the relatively high age depen-
countries more than one-third of the dency ratio in most developing coun-

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8 HEALTH AND LONGEVITY

tries. While in high-income countries nounced in older age groups due to the How are major
there are roughly 2 people of working naturally higher longevity of females. In health risks
age to support each person who is too high-income countries on average there changing for
young or too old to work, in low-income are 133 females per 100 males 60 and different groups of
countries this number is around 1.0–1.5. over. In low-income countries the imbal- countries?
ance is smaller (104 females per 100
High-income countries currently face males), but the reasons for this seeming
the problem of an aging population— “advantage” of poor countries are higher
that is, a growing percentage of elderly, maternal mortality and gender discrimi-
nonworking people. In 1996 people 60 nation, including discrimination in
and above made up 18 percent of the access to health care.
population in these countries, and this
portion is expected to grow to almost Future Challenges
22 percent by 2010. In several of these
countries (Belgium, Germany, Greece, As the health of the world population has
Italy, Japan, Sweden) the share of improved, the burden of disease has
elderly people has already reached or declined. Simultaneously, the structure of
surpassed 21 percent. An aging popula- disease has shifted rapidly from a prepon-
tion puts greater pressure on a country’s derance of communicable disease (diar-
pension, health care, and social security rhea, worm infections, measles), which
systems. are the main health risks for infants and
children, to a preponderance of noncom-
As life expectancy continues to increase municable disease (heart and circulatory
in developing countries, they too will disease, cancer) that mostly affect adults.
face the problem of an aging popula- While there are inexpensive and effective
tion (see Figure 8.3). In fact, develop- ways to eliminate most communicable
ing countries are expected to be hit diseases, noncommunicable diseases are
even harder because they are financially generally much more expensive to treat.
less prepared to deal with it, because Moreover, substantially reducing their
the rate of growth in life expectancy incidence will require changing people’s
and therefore population aging is much behaviors and lifestyles.
faster than in developed countries, and
because there will be a high depen- The importance of lifestyle choices can
dency ratio of both children and be illustrated by the health gap between
elderly people. Eastern and Western Europe. The largest
contributors to this health gap are heart
Figure 8.3 also illustrates the issue of attacks and strokes, for which the main
gender imbalance increasingly pro-

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BEYOND ECONOMIC GROWTH

Figure 8.4 Adult smoking, 1985–95

Percentage of population over 15
80

70

60

Why is the 50 51% 48%
incidence of 40
smoking higher in
poorer countries? 30 39%
16% 22%

20 High-income
6% countries

10

0 Middle-income
Low-income countries
countries

Male Female

risk factors include unhealthy diet, lack The governments of most developed
of exercise, excessive consumption of countries have made efforts to reduce
alcohol, and smoking. All these factors, smoking and so lower its costs to society
particularly smoking, are more prevalent by introducing tobacco taxes, limiting
in Eastern Europe (Figure 8.4 and Data tobacco advertising, and educating peo-
Table 2). ple about the risks of smoking. Cigarette
taxes are highest in Western Europe.
Cigarette smoke does more damage to According to a 1998 report by the
human health than all air pollutants Worldwatch Institute, smokers in
combined. Smoking is hazardous not Norway pay $5.23 in taxes per pack of
only to smokers, about half of whom die cigarettes, which is 74 percent of the
prematurely from tobacco-related dis- total price. And in the United Kingdom
eases including cancer, heart disease, and smokers pay $4.30 in taxes, which is 82
respiratory conditions, but also to “pas- percent of the total price. Experience in
sive” smokers (those inhaling second- many countries has shown that tobacco
hand smoke). According to some taxes are effective in discouraging smok-
estimates, passive smokers increase their ing: a 10 percent increase in cigarette
risk of cancer by 30 percent and their prices leads to a 5 percent decrease in
risk of heart disease by 34 percent. smoking among adults and a 6-8 percent

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8 HEALTH AND LONGEVITY

decrease among young adults (age 15 to sales by entering the underregulated and
21), who usually have less disposable underinformed markets of less developed
income. countries. In the past 10 years exports of
cigarettes as a share of production have
According to the same report, while in doubled to 60 percent in the United
Western Europe and the United States the Kingdom and 30 percent in the United
number of smokers is declining, in most States, the two largest exporters. If current
developing countries smoking is on the smoking trends persist, the number of
rise, particularly among women and tobacco-related deaths worldwide will soar
young people. European and U.S. tobacco from 3 million a year today to 10 million
firms, facing declining demand in their a year in 2020, with 70 percent of the
home countries, have managed to increase deaths occurring in the developing world.

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