Life expectancy: a comparison

Life Expectancy

- Comparison of st

atus at national and international level

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Outline of presentation• Background• Life Expectancy: Global level• Life Expectancy: Regional level• Life Expectancy: Among South Asian countries• Life Expectancy: National level• Summary

BackgroundLife Expectancy at birth: Average number of years that a newborn is expected to

live if current mortality rates continue to apply.

Longevity has increased, but people are living with more disease and disability.

Healthy life expectancy (HALE): Average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury.

In general average LE at birth of women is higher than men. (5 years difference in general)

It is a mortality indicator which describes overall health status and development of particular place.

Determinants of Life Expectancy• Mainly determined by other mortality indicators• But in real, determinants of health also determines LE.Some of them are:• Socioeconomic determinants (Huge impact but decrease over time) (1)

Economy-GDP, Per capita expenditure in health Education and social security Health services (Health care system, Equity and effectiveness) Culture and ethnicity Women empowerment (decision making over health care)

• Political determinants (weak in short run but strong in long-term) (1)• Conflicts and wars (2)• Diseases, epidemics and disasters (Communicable, NCD and injuries)

1. http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-852. The Determinants of Average Life Expectancy: A Cross-Country Analysis, Lyle Kossis

Source: Conceptual Framework of SDH, WHO

Global Overview• Life Expectancy at birth: 71 years (WHS-2015)

(Max-84 yrs./ Min-46 yrs./ Med-74 yrs.)(WHS-2015)

• Healthy Life Expectancy at birth: 62 years (WHS-2015)

• Global life expectancy increased by 5.8 years in men and 6.6 years in women between 1990 and 2013 (GBD 2013) • But there is exception among sub-Saharan region where deaths from

HIV/AIDS have erased over 5 years of life expectancy.

Some accepted reasons behind the maximum LE of Japan are Equity in health care distribution, Better nutrition and diet

Life Expectancy and Wealth of country

Countries by Wealth

Life Expectancies at birth HALE at birth

1990 2013 2013

Low income 53 62 53Lower middle

income 59 66 57

Upper middle income 68 74 66

High income 75 79 70

Some reasons behind global increase in LE• Reduction in infant and child mortality

- Public health measures and control of various infectious and vaccine preventable diseases

• In high income countries decrease in mortality of older people esp. attributable to NCDs

- Medical advancement and technological development enabling treatment of various diseases

Regional level comparisonWHO Regions

Life Expectancies at birth HALE at birth

1990 2013 2013African Region 50 58 50

Region of the Americas 71 77 67

South-East Asia Region 59 68 59

European Region 72 76 67Eastern

Mediterranean Region

62 68 59

Western Pacific Region 69 76 68

Why Africa has lower LEB than other regions?

HIV/AIDS epidemic hit hardest in Africa esp. Sub-Saharan Poverty, social and political upheaval High risk of death from infectious diseases

Source: http://www.deathreference.com/Ke-Ma/Life-Expectancy.html

Why Europe and North America have higher LEB?

• Better nutrition and hygiene practices • Enhanced knowledge of public health measures

Source: http://www.deathreference.com/Ke-Ma/Life-Expectancy.html

Comparison among South Asian Countries

South Asian countries

Life Expectancies at birth HALE at birth

1990 2013 2013

Afghanistan 49 61 50Bangladesh 60 71 61

Bhutan 53 68 59India 58 66 58

Maldives 58 78 68Nepal 54 68* 59

Pakistan 60 66 57Sri Lanka 69 75 65

Source: WHO-World Health Statistics 2015

* LE of Nepal was 69.6 yrs. According to HDR 2015, UNDP

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Afghanistan Bangladesh Bhutan IndiaMaldives Nepal Pakistan Srilanka

HALE 2013LE 2013LE 1990

• Maldives has highest LE at birth among South Asian countries whereas Afghanistan has lowest.• Some facts about Maldives:

Only south Asian country among Upper Middle Income countries Its Per capita expenditure on health (PPP int. $) is 1283 which

exceeds the sum total of other seven nations. Lower child mortality rate similar to Sri Lanka

Source: WHO-World Health Statistics 2015

Nepal• Nepal has done significant progress in LEB since 1990• 54 in 1990 to 68 in 2013 (WHS 2015)• Main reason behind this is significant decrease in infant and child

mortality • It is outcome of investment in child health programs

Life expectancy of Nepal: Ecological belt

Ecological belt Life expectancy

Mountain 66.98

Hill 69.02

Terai 68.81

Source: UNDP ,HDR 2014

There is not more disparity in LE based on ecological regions.

Life expectancy of Nepal: Development RegionDevelopment region Life expectancy

Eastern development region 69.02

Central development region 69.84

Western development region 69.03

Mid western development region 66.8

Far western development region 66.84

Life expectancy of Nepal: Urban vs Rural

Urban 68.93

Rural 68.81

In urban life expectancy is higher than rural because :In urban there is access and availability of tertiary level of health facility.Good access of transportation.There is no geographical barrier.

Here are the five districts with the highest life expectancy rates in Nepal:• Ramechhap: 72.9 years• Gorkha: 71.7 years• Saptari: 71.34 years• Siraha: 71.29 years• Rautahat: 70.99 years

Key facts• Despite global improvements in life expectancy, death rates for some causes continue to rise• Despite dramatic drops in child deaths over the last 23 years, lower respiratory tract infections,

malaria, and diarrhoeal disease are still in the top 5 global causes of death in children younger than 5 years

• Top ten leading causes of premature death worldwide have hardly changed since 1990. Nine causes remained in the top ten in 2013, with HIV/AIDS moving in and tuberculosis moving to 11th

• While worldwide deaths from HIV/AIDS have declined substantially every year since its peak in 2005, HIV/AIDS is still the greatest cause of premature death in 20 of 48 countries in sub-Saharan Africa

• War is the leading cause of premature death in Syria. The conflict in Syria has killed an enormous number of people

• In eastern Europe, half of all premature deaths in 2013 were due to five causes: ischemic heart disease, stroke, self harm, cirrhosis, and road injury

• Suicide is a major and growing public health problem in India with half of the word's suicide deaths occurring in India and china alone

• Road injury and interpersonal violence are key contributors to premature deaths in Latin America and the Caribbean

Source: http://www.eurekalert.org/pub_releases/2014-12/tl-tlw121614.php

"The huge increase in collective action and funding given to the major infectious diseases such as diarrhoea, measles, tuberculosis, HIV/AIDS, and malaria has had a real impact. But there are some major chronic diseases those have been largely neglected but are rising in importance, particularly drug disorders, liver cirrhosis, diabetes, and chronic kidney disease” _Dr. Christopher Murray, Professor of Global Health, University of Washington

Bibliography1. An equity-effectiveness framework linking health programs and healthy life expectancy,

Banham D, Lynch J, Karnon J., 20112. Causes of international increases in older age life expectancy, Colin D Mathers, Gretchen A

Stevens, Ties Boerma, Richard A White, Martin I Tobias, Lancet, 20153. The Great Escape: Health, Wealth, and the Origins of Inequality, Angus Deaton. Princeton

University Press, 2013. Pp 3764. Connection between wealth and health? Michael Marmot, Lancet, 20135. Culture and health, Lancet 2014; 384: 1607–39 6. http://www.eurekalert.org/pub_releases/2014-12/tl-tlw121614.php , [Accessed: 22 Feb 2016]7. Explaining Divergent Levels of Longevity in High-Income Countries. E.M. Crimmins, S.H.

Preston, and B. Cohen, Eds. Panel on Understanding Divergent Trends in Longevity in High-Income Countries. Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2011

8. Prolonging life at all costs: quantity versus quality, Lancet, 2016, http://dx.doi.org/10.1016/

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South Asian countries

Infant mortality rate

Under-five mortality rate CPR TFR per

womenPer capita

expenditure on health (PPP int. $)

2013 2013 2013 2013 2012

Afghanistan 70.2 97.3 21 4.9 159Bangladesh 33.2 41.1 61 2.2 85

Bhutan 29.7 36.2 66 2.2 264India 41.4 52.7 55 2.5 196

Maldives 8.4* 9.9 35 2.3 1283***Nepal 32.2 39.7 50 2.3 118

Pakistan 69.0 85.5 35 3.2 122Sri Lanka 8.2** 9.6 68 2.3 270

*67.8 per 1000 live births in 1990**18.2 per 1000 live birth in 1990***274 in 2000 AD