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Note: This document is from the archive of the Africa Policy E-Journal, published by the Africa Policy Information Center (APIC) from 1995 to 2001 and by Africa Action from 2001 to 2003. APIC was merged into Africa Action in 2001. Please note that many outdated links in this archived document may not work.


Africa: Life Expectancy

Africa: Life Expectancy
Date distributed (ymd): 000703
Document reposted by APIC

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains new data on life expectancy in African and non-African countries, taken from the new World Health Report of the World Health Organization (WHO) released last month. It also contains a press release from the WHO with an overview of the new statistics for 'Disability-adjusted Life Expectancy.' The full World Health Report text (in PDF format) is available at the WHO web site (http://www.who.int).

Due primarily to the impact of the HIV/AIDS pandemic, life expectancies for African children have dropped significantly over the past ten years. Life expectancies for children born in Africa in 1999, shown in the WHO report, are far below those even in most other developing countries. Only 9 of the 53 African countries for which the WHO shows data have life expectancies of 50 years and over, as compared to 130 of the 138 countries outside Africa. Among the 52 countries with life expectancies less than 50 years, 44 are African and only 8 are outside Africa.

+++++++++++++++++end profile++++++++++++++++++++++++++++++

Press Release WHO
Released in Washington, D.C. and Geneva, Switzerland
4 June 2000

WHO Issues New Healthy Life Expectancy Rankings
Japan Number One in New 'Healthy Life' System

Press contact: Marshall Hoffman (703) 820-2244 Home (703) 533-8482

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. [see below for full list]

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.


Disability-adjusted Life Expectancy
Source: World Health Report 2000 (Table 5)

24 Countries with DALE over 70
(24 non-African)

1 Japan                  74.5
2 Australia              73.2
3 France                 73.1
4 Sweden                 73.0
5 Spain                  72.8
6 Italy                  72.7
7 Greece                 72.5
8 Switzerland            72.5
9 Monaco                 72.4
10 Andorra               72.3
11 San Marino            72.3
12 Canada                72.0
13 Netherlands           72.0
14 United Kingdom        71.7
15 Norway                71.7
16 Belgium               71.6
17 Austria               71.6
18 Luxembourg            71.1
19 Iceland               70.8
20 Finland               70.5
21 Malta                 70.5
22 Germany               70.4
23 Israel                70.4
24 United States         70.0

78 Countries with DALE from 60 to 70
(3 African; 75 non-African)

25 Cyprus                69.8
26 Dominica              69.8
27 Ireland               69.6
28 Denmark               69.4
29 Portugal              69.3
30 Singapore             69.3
31 New Zealand           69.2
32 Chile                 68.6
33 Cuba                  68.4
34 Slovenia              68.4
35 Czech Republic        68.0
36 Jamaica               67.3
37 Uruguay               67.0
38 Croatia               67.0
39 Argentina             66.7
40 Costa Rica            66.7
41 Armenia               66.7
42 Slovakia              66.6
43 Saint Vincent         66.4
44 Georgia               66.3
45 Poland                66.2
46 Yugoslavia            66.1
47 Panama                66.0
48 Antigua & Barbuda     65.8
49 Grenada               65.5
50 United Arab Emirates  65.4
51 Republic of Korea     65.0
52 Venezuela             65.0
53 Barbados              65.0
54 Saint Lucia           65.0
55 Mexico                65.0
56 Bosnia                64.9
57 Trinidad and Tobago   64.6
58 Saudi Arabia          64.5
59 Brunei Darussalam     64.4
60 Bulgaria              64.4
61 Bahrain               64.4
62 Hungary               64.1
63 Lithuania             64.1
64 Macedonia             63.7
65 Azerbaijan            63.7
66 Qatar                 63.5
67 Cook Islands          63.4
68 Kuwait                63.2
69 Estonia               63.1
70 Ukraine               63.0
71 Paraguay              63.0
72 Oman                  63.0
73 Turkey                62.9
74 Colombia              62.9
75 Tonga                 62.9
76 Sri Lanka             62.8
77 Suriname              62.7
78 Mauritius             62.7
79 Dominican Republic    62.5
80 Romania               62.3
81 China                 62.3
82 Latvia                62.2
83 Belarus               61.7
84 Algeria               61.6
85 Niue                  61.6
86 Saint Kitts & Nevis   61.6
87 El Salvador           61.5
88 Moldova               61.5
89 Malaysia              61.4
90 Tunisia               61.4
91 Russian Federation    61.3
92 Honduras              61.1
93 Ecuador               61.0
94 Belize                60.9
95 Lebanon               60.6
96 Iran                  60.5
97 Samoa                 60.5
98 Guyana                60.2
99 Thailand              60.2
100 Uzbekistan           60.2
101 Jordan               60.0
102 Albania              60.0

37 Countries with DALE from 50 to 60
(6 African; 31 non-African)

103 Indonesia            59.7
104 Micronesia           59.6
105 Peru                 59.4
106 Fiji                 59.4
107 Libyan Arab Jama.    59.3
108 Seychelles           59.3
109 Bahamas              59.1
110 Morocco              59.1
111 Brazil               59.1
112 Palau                59.0
113 Philippines          58.9
114 Syrian Arab Rep.     58.8
115 Egypt                58.5
116 Viet Nam             58.2
117 Nicaragua            58.1
118 Cape Verde           57.6
119 Tuvalu               57.4
120 Tajikistan           57.3
121 Marshall Islands     56.8
122 Kazakhstan           56.4
123 Kyrgyzstan           56.3
124 Pakistan             55.9
125 Kiribati             55.3
126 Iraq                 55.3
127 Solomon Islands      54.9
128 Turkmenistan         54.3
129 Guatemala            54.3
130 Maldives             53.9
131 Mongolia             53.8
132 Sao Tome & Principe  53.5
133 Bolivia              53.3
134 India                53.2
135 Vanuatu              52.8
136 Nauru                52.5
137 Democratic PR Korea  52.3
138 Bhutan               51.8
139 Myanmar              51.6

20 Countries with DALE from 40 to 50
(13 African: 7 non-African)

140 Bangladesh           49.9
141 Yemen                49.7
142 Nepal                49.5
143 Gambia               48.3
144 Gabon                47.8
145 Papua New Guinea     47.0
146 Comoros              46.8
147 Lao People's DR      46.1
148 Cambodia             45.7
149 Ghana                45.5
150 Congo                45.1
151 Senegal              44.6
152 Equatorial Guinea    44.1
153 Haiti                43.8
154 Sudan                43.0
155 C“te d'Ivoire        42.8
156 Cameroon             42.2
157 Benin                42.2
158 Mauritania           41.4
159 Togo                 40.7

29 Countries with DALE from 30 to 40
(28 African; 1 non-African)

160 South Africa         39.8
161 Chad                 39.4
162 Kenya                39.3
163 Nigeria              38.3
164 Swaziland            38.1
165 Angola               38.0
166 Djibouti             37.9
167 Guinea               37.8
168 Afghanistan          37.7
169 Eritrea              37.7
170 Guinea-Bissau        37.2
171 Lesotho              36.9
172 Madagascar           36.6
173 Somalia              36.4
174 Dem. Rep. Congo      36.3
175 Central African R.   36.0
176 Tanzania             36.0
177 Namibia              35.6
178 Burkina Faso         35.5
179 Burundi              34.6
180 Mozambique           34.4
181 Liberia              34.0
182 Ethiopia             33.5
183 Mali                 33.1
184 Zimbabwe             32.9
185 Rwanda               32.8
186 Uganda               32.7
187 Botswana             32.3
188 Zambia               30.3

3 Countries with DALE under 30
(3 African)

189 Malawi               29.4
190 Niger                29.1
191 Sierra Leone         25.9

This material is being reposted for wider distribution by the Africa Policy Information Center (APIC). APIC provides accessible information and analysis in order to promote U.S. and international policies toward Africa that advance economic, political and social justice and the full spectrum of human rights.

URL for this file: http://www.africafocus.org/docs00/life0006.php