Public health: someone must have been doing something right! (original) (raw)
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RESEARCH ARTICLE Are Global and Regional Improvements in Life Expectancy and in Child, Adult and
2016
Improvements in life expectancy have been considerable over the past hundred years. Forecasters have taken to applying historical trends under an assumption of continuing improvements in life expectancy in the future. A linear mixed effects model was used to estimate the trends in global and regional rates of improvements in life expectancy, child, adult, and senior survival, in 166 countries between 1950 and 2010. Global improvements in life expectancy, including both child and adult survival rates, decelerated significantly over the study period. Overall life expectancy gains were estimated to have declined from 5.9 to 4.0 months per year for a mean deceleration of-0.07 months/year 2 ; annual child survival gains declined from 4.4 to 1.6 deaths averted per 1000 for a mean deceleration of-0.06 deaths/ 1000/year 2 ; adult survival gains were estimated to decline from 4.8 to 3.7 deaths averted per 1000 per year for a mean deceleration of-0.08 deaths/1000/year 2. Senior survival gains however increased from 2.4 to 4.2 deaths averted per 1000 per year for an acceleration of 0.03 deaths/1000/year 2. Regional variation in the four measures was substantial. The rates of global improvements in life expectancy, child survival, and adult survival have declined since 1950 despite an increase in the rate of improvements among seniors. We postulate that low-cost innovation, related to the last half-century progress in health-primarily devoted to children and middle age, is reaping diminishing returns on its investments. Trends are uneven across regions and measures, which may be due in part to the state of epidemiological transition between countries and regions and disparities in the diffusion of innovation, accessible only in high-income countries where life expectancy is already highest.
The slowing pace of life expectancy gains since 1950
BMC Public Health, 2018
Background: New technological breakthroughs in biomedicine should have made it easier for countries to improve life expectancy at birth (LEB). This paper measures the pace of improvement in the decadal gains of LEB, for the last 60-years adjusting for each country's starting point of LEB. Methods: LEB increases over the next 10-years for 139 countries between 1950 and 2009 were regressed on LEB, GDP, total fertility rate, population density, CO2 emissions, and HIV prevalence using country-specific fixed effects and timedummies. Analysis grouped countries into one-of-four strata: LEB < 51, 51 ≤ LEB < 61, 61 ≤ LEB < 71, and LEB ≥ 71. Results: The rate of increase of LEB has fallen consistently since 1950 across all strata. Results hold in unadjusted analysis and in the regression-adjusted analysis. LEB decadal gains fell from 4.80 (IQR: 2.98-6.20) years in the 1950s to 2. 39 (IQR:1.80-2.80) years in the 2000s for the healthiest countries (LEB ≥ 71). For countries with the lowest LEB (LEB < 51), decadal gains fell from 7.38 (IQR:4.83-9.25) years in the 1950s to negative 6.82 (IQR:-12.95-1.05) years in the 2000s. Multivariate analysis controlling for HIV prevalence, GDP, and other covariates shows a negative effect of time on LEB decadal gains among all strata. Conclusions: Contrary to the expectation that advances in health technology and spending would hasten improvements in LEB, we found that the pace-of-growth of LEB has slowed around the world.
PLOS ONE, 2015
Improvements in life expectancy have been considerable over the past hundred years. Forecasters have taken to applying historical trends under an assumption of continuing improvements in life expectancy in the future. A linear mixed effects model was used to estimate the trends in global and regional rates of improvements in life expectancy, child, adult, and senior survival, in 166 countries between 1950 and 2010. Global improvements in life expectancy, including both child and adult survival rates, decelerated significantly over the study period. Overall life expectancy gains were estimated to have declined from 5.9 to 4.0 months per year for a mean deceleration of-0.07 months/year 2 ; annual child survival gains declined from 4.4 to 1.6 deaths averted per 1000 for a mean deceleration of-0.06 deaths/ 1000/year 2 ; adult survival gains were estimated to decline from 4.8 to 3.7 deaths averted per 1000 per year for a mean deceleration of-0.08 deaths/1000/year 2. Senior survival gains however increased from 2.4 to 4.2 deaths averted per 1000 per year for an acceleration of 0.03 deaths/1000/year 2. Regional variation in the four measures was substantial. The rates of global improvements in life expectancy, child survival, and adult survival have declined since 1950 despite an increase in the rate of improvements among seniors. We postulate that low-cost innovation, related to the last half-century progress in health-primarily devoted to children and middle age, is reaping diminishing returns on its investments. Trends are uneven across regions and measures, which may be due in part to the state of epidemiological transition between countries and regions and disparities in the diffusion of innovation, accessible only in high-income countries where life expectancy is already highest.
Mortality improvement: understanding the past and framing the future
2018
Recent developments in mortality Slowdown in mortality improvement Over the past half century, mortality rates-the number of deaths as a share of the population over a particular period-have been generally declining. In developed economies, this has led to a sustained improvement in life expectancy since at least 1850 (see Figure 1) linked in large part to the many advances in living conditions, medicine and health technology. In the postwar period, mortality improved on average by around 1-2% per year among developed countries. Advanced economies still enjoy longer life expectancy than developing countries, but the gap has narrowed in some regions. There are signs in many developed countries, however, that improvements in mortality have slowed in recent years compared with earlier decades. For instance, in England and Wales, standardised mortality rates (SMR), which take into account changes in the populationʼs age structure, have drifted lower since 2011 but at a much slower pace than in the previous decade. 1 Similar slowdowns in the rate of mortality improvement (MI)-the annual relative change in the mortality
Journal of Health Economics, 2008
economic growth, while in the paper, for the sake of consistency, we used the growth of GDP per capita as the measure of economic growth. Since both indicators correlate strongly, the results using one or the other are quite similar. In some analysis we found effects of GDP growth on ageand-sex-specific mortality in the 20 th century that were marginally significant, with P values between 0.05 and 0.10. However, in these models, P values went slightly above 0.10 when the growth of GDP per capita instead of GDP growth was used as the regressor. In general, regression estimates show the effect of GDP growth on mortality as slightly stronger than the effect of GDP per capita growth.
Changing life expectancy in the 1980s: why was Denmark different from Sweden?
Journal of Epidemiology & Community Health, 1996
Objective -To identify the contribution from specific causes of death to the changes in life expectancy at birth in Denmark relative to Sweden in different age groups during the 1980s and to compare the difference in life expectancy between the two countries in 1990. Design -Mortality data from WHO mortality tapes grouped in smaller series of clinically meaningful categories were used to calculate the contribution of each of these categories at each 10 year age group to the difference in life expectancy at birth in each country between 1979 and 1990 and between the two countries. Setting -Denmark and Sweden. Results -Between 1979 and 1990 life expectancy increased in both Denmark and Sweden. However, the increase in Sweden was more than two years while that in Denmark was less than one year. In both countries a decrease in cardiovascular disease mortality contributed most to the increase in life expectancy in males as well as females. In both sexes the smaller increase in life expectancy in Denmark was a result of differences in mortality trends in cardiovascular diseases and respiratory and non-respiratory cancers.
The pace and distribution of health improvements during the last 40 years: some preliminary results
2004
This paper juxtaposes changes over the last forty years in income growth and distribution with the mortality changes recorded at the aggregate level in about 170 countries and at the individual level in 21 countries with at least two Demographic and Health Surveys covering the last twenty years. Over the 1980s-and 1990s, the infant-mortality rate (IMR), under-5 mortality rate (U5MR) and Life Expectancy at Birth (LEB) mostly continued the favourable trends that characterized the 1960s and 1970s. Yet, especially, the 1990s the pace of health improvement was slower than that recorded during the prior decades. In addition, the distribution between countries of aggregate health improvements became markedly more skewed. These trends are in part explained by the negative changes recorded in Sub-Saharan Africa and Eastern Europe, but are robust to the removal of the two regions from the sample. This tendency is observed also at the intra-regional level, with the exception of Western Europe. Thirdly, DHS data for 21 developing countries point to a frequent divergence over time in the within-country distribution of gains in IMR and U5MR among children living in urban vs. rural areas and belonging to families part of different quantiles of the asset distribution, while IMR differentials by level of education of the mother show mixed trends The paper concludes by underscoring the similarities and linkages between changes in income inequality and health inequality and suggests some tentative explanations of these trends without, however, formally testing them. JEL: I12, I21, I31,J13, J16