People in richest countries live 23 years longer than those in poorest, finds WHO

BMJ 2011; 342 doi: (Published 17 May 2011) Cite this as: BMJ 2011;342:d3061
  1. John Zarocostas
  1. 1Geneva

Life expectancy worldwide is edging upwards, but big gaps still exist between rich and poor countries in spending on fighting infectious and chronic diseases, says a report by the World Health Organization.

The 2011 edition of the World Health Statistics series, which tracks more than 100 health indicators worldwide, says that poor countries are lagging behind and still struggle to cut numbers of maternal and child deaths caused by infectious diseases. But these countries also face a growing epidemic of chronic diseases such as diabetes, heart diseases, and cancers.

Poor countries need “strong health systems” with more doctors, funds, and drugs to tackle this “double burden” of disease, said Ties Boerma, WHO’s director for health statistics and informatics.

Average global life expectancy at birth, the report says, rose to 68 years in 2009, up from 64 in 1990. In the 40 poorest countries life expectancy at birth rose to 57 in 2009 from 52 in 1990, while in the 50 richest countries it advanced to 80 years from 76 years in 1990.

In 2009 global life expectancy for women was on average 71 years, five years greater than the 66 reported for men, it says.

Colin Mathers, WHO’s coordinator of mortality and burden of disease, said that Iraq and South Africa were among the few countries that in the past decade saw a fall in life expectancy, because of the conflict and HIV epidemic, respectively.

The report shows that in 2009 Japan and San Marino had the highest life expectancy in the world, both with 83 years, and Malawi the lowest, with 47 years.

Other countries with low life expectancies included Afghanistan, Chad, the Central African Republic, Lesotho, and Zambia, all at 48 years.

Poor and rich countries still vary enormously in spending on health, the statistics indicate. In 2008 per capita health expenditure averaged $32 (£20; €22) in the poorest countries or in total about 5.4% of gross domestic product, and $4590 in rich countries, or about 11% of GDP.

Dr Boerma told reporters that spending on health is one of the factors that determines countries’ success in efforts to boost life expectancy. But he emphasised that how funds are spent and distributed are critical in determining the level of benefits delivered.

If spending is on expensive curative care, he noted, it may not have as much of an effect on population health. And if the resources allocated are high but not equitably distributed, the benefits derived will not be as good. For example, Dr Boerma noted that Costa Rica and Cuba were performing quite well in terms of life expectancy for the amount of money they spent on health (at $618 per person (9.4% of GDP) and $672 (12% of GDP), respectively, in 2008) in comparison with the United States, which ranked high in the expenditure rankings ($7164 (15.2% of GDP)), behind Norway, Luxembourg, and Monaco. Life expectancy was similar in all three countries (79 in Costa Rica and the US and 78 in Cuba).

The report also shows a wide gulf between rich and poor countries in availability of doctors. It says that the poorest nations had only 2.8 doctors per 10 000 people, whereas in wealthy countries the number was 28.6 per 10 000.

The density of doctors varied from lows of 0.2 per 10 000 in Malawi (a total of 257 doctors) and Rwanda (221), 0.3 in Mozambique (548), and 0.4 in Somalia (300) to highs of 35.3 in Germany (around 292 000), 42.4 in Italy (247 000), and 60.4 in Greece (67 540). The United Kingdom had a doctor density of 27.4 per 10 000 (165 317).

Finally, the report says that in the poorest countries private expenditure accounted for 60% of total expenditure on health, of which patients’ own out of pocket spending accounted for 86%.


Cite this as: BMJ 2011;342:d3061


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