Japanese have the longest healthy life expectancy of 74.5 years
among 191 countries, versus less than 26 years for the lowest-ranking country
of Sierra Leone, based on a new way to calculate healthy life expectancy
developed by the World Health Organization (WHO).
Previously, life expectancy estimates were based on the overall length
of life based on mortality data only.
For the first time, the WHO has calculated healthy life expectancy for
babies born in 1999 based upon an indicator developed by WHO scientists,
Disability Adjusted Life Expectancy (DALE). DALE summarizes the expected
number of years to be lived in what might be termed the equivalent of "full
health." To calculate DALE, the years of ill-health are weighted according
to severity and subtracted from the expected overall life expectancy to
give the equivalent years of healthy life.
The WHO rankings show that years lost to disability are substantially
higher in poorer countries because some limitations -- injury, blindness,
paralysis and the debilitating effects of several tropical diseases such
as malaria -- strike children and young adults. People in the healthiest
regions lose some 9 percent of their lives to disability, versus 14 percent
in the worst-off countries.
In terms of DALE, the rest of the top 10 nations are Australia, 73.2
years; France, 73.1; Sweden, 73.0; Spain, 72.8; Italy, 72.7; Greece, 72.5;
Switzerland, 72.5; Monaco, 72.4; and Andorra, 72.3.
DALE is estimated to equal or exceed 70 years in 24 countries, and 60
years in over half the Member States of WHO. At the other extreme are 32
countries where disability-adjusted life expectancy is estimated to be
less than 40 years. Many of these are countries with major epidemics of
HIV/AIDS, among other causes.
The United States rated 24th under this system, or an average of 70.0
years of healthy life for babies born in 1999. The WHO also breaks down
life expectancy by sex for each country. Under this system, U.S. female
babies could expect 72.6 years of healthy life, versus just 67.5 years
for male babies.
"The position of the United States is one of the major surprises of
the new rating system," says Christopher Murray, M.D., Ph.D., Director
of WHO's Global Programme on Evidence for Health Policy. "Basically, you
die earlier and spend more time disabled if you’re an American rather than
a member of most other advanced countries."
The WHO cites various causes for why the United States ranks relatively
low among wealthy nations. These reasons include:
* In the United States, some groups, such as Native
Americans, rural African Americans and the inner city poor, have extremely
poor health, more characteristic of a poor developing country rather than
a rich industrialized one.
* The HIV epidemic causes a higher proportion of
death and disability to U.S. young and middle-aged than in most other advanced
countries. HIV-AIDS cut three months from the healthy life expectancy of
male American babies born in 1999, and one month from female lives;
* The U.S. is one of the leading countries for cancers
relating to tobacco, especially lung cancer Tobacco use also causes chronic
lung disease.
* A high coronary heart disease rate, which has
dropped in recent years but remains high;
* Fairly high levels of violence, especially of
homicides, when compared to other industrial countries.
All of the bottom 10 countries were in sub-Saharan Africa, where the
HIV-AIDS epidemic is rampant. In ascending order beginning with 191, those
countries were Sierra Leona, 25.9 years of healthy life for babies born
in 1999; Niger, 29.1; Malawi, 29.4; Zambia, 30.3; Botswana, 32.3; Uganda,
32.7; Rwanda, 32.8; Zimbabwe, 32.9; Mali, 33.1; and Ethiopia, 33.5.
The overall life expectancy in sub-Saharan Africa has dropped precipitously
over the past 10 years, mostly because of the AIDS epidemic, the WHO says.
Life expectancy dropped for female babies from 51.1 years to 46.3 years.
For males, the level dropped from 47.3 years to 44.8 years.
AIDS is now the leading cause of death in Sub-Saharan Africa, far surpassing
the traditional deadly diseases of malaria, tuberculosis, pneumonia and
diarrheal disease. AIDS killed 2.2 million Africans in 1999, versus 300,000
AIDS deaths 10 years previously.
"Healthy life expectancy in some African countries is dropping back
to levels we haven’t seen in advanced countries since Medieval times,"
says Alan Lopez, Coordinator of WHO’s Epidemiology and Burden of Disease
Team. "This is just one example why the WHO decided to measure healthy
life expectancy for all member countries using DALE for the first time,
to give a truer picture of where good health reigns, and where it doesn’t."
Life expectancy in several countries in southern Africa has been cut
15-20 years off what the WHO would expect it to be in Africa without HIV.
Other African countries have lost 5-10 years of life expectancy because
of HIV.
"The DALE system is simple," says Dr. Lopez. "In the old system, we
measured a total life expectancy based on the average numbers of years
males and females could expect to live in each country. However, people
don’t live all those years in perfect health. At some point in your life,
you will have some level of disability. These years with disability are
weighted according to their level of severity to estimate the total equivalent
lost years of good health. You subtract this from total life expectancy,
and what remains is the expected number of years of healthy life."
This is the first time that anyone has measured every country’s healthy
life expectancy using the DALE system.
High-ranking countries
Several factors go into making Japan number one in the rankings. One
is the low rate of heart disease, associated with the traditional low fat
diet. The national diet is changing, with high fat foods such as red meat
becoming common. The effect of tobacco has also been mild until recently,
with low lung cancer rates. These rates for men are expected to jump in
coming years as the long-term effects of the post-World War II smoking
popularity begin to hit.
In Australia, smoking rates have dropped sharply from their earlier
peaks, leading to lower lung cancer and heart problem rates.
France registered high because of the health of its women, which pulled
up the overall average.
French women never smoked in any large numbers until recently. Many
young French women, however, have begun smoking, which will lead to rapid
increases in lung cancer rates and other diseases associated with tobacco
in 10 to 20 years. French men are already suffering from growing rates
of these diseases from tobacco.
Sweden ranks high because of its health care system and because tobacco
use is relatively low.
Women Living Longer, Healthier
Studies have shown consistently that as countries get richer, male mortality
tends to decline less than female mortality. This WHO study shows that
the same patterns hold when healthy life expectancies are measured.
In the early 1900s, the gap between female and male life expectancy
was 2-3 years in richer countries around the world. By 1999, women were
living on average 7-8 years more than men in those same countries.
Women are generally more health conscious while in rising economies,
men have much higher smoking rates and exercise much less. Women have been
living longer and healthier lives in richer countries basically because
they have always smoked less than men, the WHO says. Women in these countries
have been smoking much more in recent years, which will translate into
higher disability and death rates in the coming years, the WHO warns. In
addition, men in richer countries tend to have poorer diets than women
do, and men exercise much less than did their grandfathers.
In poorer countries, men are victims of more disabling injuries than
women. They also get more diseases than women, for a variety of reasons.
Regional Results
North African and Middle East -- Males and females have similar levels
of healthy life expectancy, which is unusual. Also, the position of women
in these societies is often not good, Less care is given to female children,
and they have a higher risk for reproductive deaths than in other countries.
In Saudi Arabia, the overall healthy life expectancy is 64.5 years --
65.1 for male babies and 64.0 for female babies. In Bahrain, the overall
healthy life expectancy is 64.4, but 63.9 for male babies and 64.9 for
female babies; Qatar, 63.5 overall, and 64.2 for male babies, 62.8 for
females; and Kuwait, 63.2 overall, with 63.0 for male babies and 63.4 for
female babies.
East Asia – China has 20 percent of the world population, so that it
is of major significance that the Chinese have a fairly good healthy life
expectancy, at 62.3 years, 63.3 years for women and 61.2 for men. "This
is a very impressive performance for that level of income," says Dr. Lopez.
Russia -- Healthy life expectancy is a fair 66.4 for female babies but
just 56.1 years for males. This is one of the widest sex gaps in the world.
The most common explanation is the high incidence of male alcohol abuse,
which led to high rates of accidents, violence and cardiovascular disease.
From 1987 to 1994, the risk of premature death increased by 70% for Russian
males. Since 1994, life expectancy has been improving for males.
Similar rates exist for other major countries of the former Soviet Union.
In Ukraine, female babies can expect to live an equivalent of 67.5 years
of healthy life versus 58.5 years for male babies. In Belarus, the rates
are 67.2 years for female babies and 56.2 years for male babies.
Southeast Asia -- Countries of the region have produced very mixed results.
Viet Nam has been improving dramatically in health profiles and healthy
life expectancy, rising to 58.2 years, while Thailand has not improved
significantly over the past decade, though it is still ahead of Viet Nam
at 60.2 years. Myanmar has not done very well, with a healthy life expectancy
of just 52 years, substantially behind its Southeast Asian neighbors. This
shows that even countries with the same levels of income can have very
different healthy life expectancies.
Latin America -- Cuba has the highest healthy life expectancy in the
region, at 68.4 years, near U.S. levels. It is followed by Uruguay at 67.0
years; Argentina at 66.7 years and Costa Rica at 66.7 years. Brazil is
split, with a high healthy life expectancy in its southern half, and a
lower one in the north. The total average is a relatively low 59.1 years,
at 55.2 for men and 62.9 for female babies.