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
Previously, life expectancy
estimates were based on the overall length of life based on mortality data
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,
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
- 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
- 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
"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
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.
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.
– 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.
-- 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.
-- 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.
-- 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.