“At the global level, HALE [Health Life Expectancy] as a proportion of life expectancy at birth has remained largely constant since 2000 at around 88–89% for men and 84–87% for women. HALE as a proportion of life expectancy at age 60 years follows a similar trend, but is lower, at approximately 73–78% for men and 70–75% for women. In HICs [High-Income Countries] and UMICs [Upper-Middle-Income Countries], the latter proportion has decreased slightly since 2000. On average, people are living longer, but their extended longevity is accompanied by rising levels of ill health and disability.

“Globally, the average number of years an infant is expected to live in less than full health has risen by about one year since 2000, to 8.3 years in 2019 for a male infant and to 11.0 years for a female infant. The average number of years a person aged 60 years is likely to live with compromised health has also risen slightly over that period to 4.7 and 6.0 years for males and females, respectively (3). Irrespective of age, females on average live more years in disability than males, partly due to their longer life expectancy and their higher risk of experiencing function loss, especially at older ages. This sex gap is widening as life expectancy increases (5).

“The overall gains in life expectancy and HALE reflect profound changes in mortality and morbidity during the past two decades. Globally, across all WHO regions, age-standardized rates of death and disability-adjusted life years (DALYs) fell between 2000 and 2019 across all three broad categories of causes of death: communicable, maternal, perinatal and nutritional; NCDs [Non-Communicable Diseases]; and injuries. This trend was driven mainly by a steep decline in morbidity and mortality caused by communicable diseases, particularly in LICs and LMICs. In the latter settings, age-standardized rates of death due to communicable diseases declined by more than 50% since 2000, about double the decline seen for NCDs and injuries.”

Source: World health statistics 2022: monitoring health for the SDGs, sustainable development
goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

“Life expectancy has increased in all OECD countries over the past 50 years, but progress has slowed over the last decade. Furthermore, the COVID‑19 pandemic led to life expectancy falling in most OECD countries in 2020 (see Chapter 2 for an indepth analysis of the health impact of COVID‑19).

“In 2019, life expectancy at birth was 81 years on average across OECD countries – over 10 years higher than it was in 1970 (Figure 3.1). Japan, Switzerland and Spain lead a large group of 27 OECD member countries in which life expectancy at birth exceeds 80 years. A second group, including the United States and a number of central and eastern European countries, has a life expectancy between 77 and 80 years. Mexico, Latvia, Lithuania, Hungary and Colombia have the lowest life expectancy, at less than 77 years in 2019.

“Among OECD member countries, Turkey (+24 years), Korea (+21) and Chile (+18) have experienced the largest gains in life expectancy since 1970. Stronger health systems have contributed to these increases, by offering more accessible and higher quality care. Wider determinants of health matter too – notably rising incomes, better education and improved living environments. Healthier lifestyles, influenced by policies within and beyond the health system, have also had a major impact (James, Devaux and Sassi, 2017[1]).”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Circulatory diseases – notably heart attack and stroke – were the main cause of mortality in most OECD countries in 2019, accounting for almost one in three deaths across the OECD. While mortality rates have declined in most OECD countries over time, population ageing, rising obesity and diabetes rates may hamper further reductions (OECD, 2015[11]). Indeed, prior to the COVID‑19 pandemic, slowing improvements in heart disease and stroke were one of the principal causes of a slowdown in life expectancy gains in many countries (Raleigh, 2019[2]). Furthermore, COVID‑19 may indirectly contribute to more deaths from circulatory diseases, owing to disruptions to acute, primary and preventive care.

“In 2019, heart attacks and other ischaemic heart diseases (IHDs) accounted for 11% of all deaths in OECD countries. IHDs are caused by the accumulation of fatty deposits lining the inner wall of a coronary artery, restricting blood flow to the heart. Mortality rates are 80% higher for men than women across OECD countries, primarily because of a greater prevalence of risk factors among men, such as smoking, hypertension and high cholesterol.

“Among OECD countries, central and eastern European countries had the highest IHD mortality rates – particularly in Lithuania, where there were 340 deaths per 100 000 people (age‑standardised). Rates were also very high in Russia. Korea, Japan, France and the Netherlands had the lowest rates among OECD countries, at about one‑third of the OECD average and around one‑tenth of the rates in Lithuania and Russia (Figure 3.11). Between 2000 and 2019, IHD mortality rates declined in nearly all OECD countries, with an average reduction of 47%. Declines were most marked in France, Estonia, the Netherlands, Israel, Norway and Australia, where rates fell by over 60%. Mexico is the one country where IHD mortality rates increased. This is closely linked to increasing obesity rates and diabetes prevalence. Survival rates following a heart attack are also much lower in Mexico than in all other OECD countries (see indicator “Mortality following acute myocardial infarction (AMI)” in Chapter 6).”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“In partner countries, life expectancy remains well below the OECD average. Still, levels are converging rapidly towards the OECD average, with considerable gains in longevity since 1970 in India, the People’s Republic of China (China), Brazil and Indonesia. There has been less progress in the Russian Federation (Russia), due mainly to the impact of the economic transition in the 1990s and a rise in risky health behaviours among men. South Africa has also experienced slow progress, due mainly to the HIV/AIDS epidemic, although longevity gains over the last decade have been more rapid.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Higher national income is generally associated with greater longevity, particularly at lower income levels. Life expectancy is also, on average, longer in countries that invest more in health systems – although this relationship tends to be less pronounced in countries with the highest health spending per capita (see Chapter 1 for further analysis).

“COVID‑19 is expected to have a major impact on life expectancy, due to the exceptionally high number of deaths this pandemic has caused. Indeed, OECD countries recorded around 1.7 million excess deaths, compared with the average number of deaths over the five preceding years (see indicator “Excess mortality”). In 2020, life expectancy fell in all OECD countries for which data are available, other than Norway, Japan, Costa Rica, Denmark, Finland and Latvia (Figure 3.2). The annual reduction reached one year or more in nine countries, and was particularly large in the United States (-1.6 years) and Spain (‑1.5 years).

“Even before COVID‑19, gains in life expectancy had been slowing down markedly in a number of OECD countries over the last decade. This slowdown was most marked in the United States, France, the Netherlands, Germany and the United Kingdom. Longevity gains were slower for women than men in almost all OECD countries.

“The causes of this slowdown in life expectancy gains over time are multi-faceted (Raleigh, 2019[2]). Principal among them is slowing improvements in heart disease and stroke. Rising levels of obesity and diabetes, as well as population ageing, have made it difficult for countries to maintain previous progress in cutting deaths from such circulatory diseases. Respiratory diseases such as influenza and pneumonia have claimed more lives in recent years – most notably in 2015, but also in the winters of 2012‑13 and 2016‑17. In some countries – particularly the United States and Canada – the opioid crisis has caused more working-age adults to die from drug-related accidental poisoning. More broadly, economic recessions and related austerity measures, as in the 2008 global economic crisis, have been linked to deteriorating mental health and increased suicide rates, but with a less clear-cut impact on overall mortality (Parmar, Stavropoulou and Ioannidis, 2016[3]). What is clear is that continued gains in longevity should not be taken for granted, with better protection of older people and other at-risk populations paramount to extending life expectancy.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Women live longer than men in all OECD member and partner countries. This gender gap averaged 5.3 years across OECD countries in 2019 – life expectancy at birth for women was 83.6 years, compared with 78.3 years for men (Figure 3.3). The gender gap in life expectancy has narrowed by one year since 2000, however, reflecting more rapid gains in life expectancy among men in most countries.

“In 2019, life expectancy at birth for men in OECD member countries ranged from around 71 years in Latvia and Lithuania to 81 years or higher in Switzerland, Japan, Iceland, Sweden, Italy, Norway, Spain and Israel. For women, life expectancy reached 87.5 years in Japan, but was less than 80 years in Mexico, Hungary and Colombia.

“Gender gaps are relatively narrow in Iceland, the Netherlands, Sweden, Norway, New Zealand, Switzerland, the United Kingdom, Israel and Ireland – at less than four years. However, there are large gender differences in many central and eastern European countries – most notably in Lithuania and Latvia (over 9 years), Estonia (8.5 years) and Poland (7.8 years). In these countries, gains in longevity for men over the past few decades have been much more modest. This is partly due to greater exposure to risk factors among men – particularly greater tobacco use, excessive alcohol consumption and less healthy diets – resulting in more deaths from heart diseases, cancer and other diseases. For OECD partner countries, the gender gap stands at ten years in Russia, and around seven years in Brazil and South Africa. China (4.4 years) and India (2.5 years) have smaller gender gaps.

“Socio‑economic inequalities in life expectancy are also evident in all OECD countries with available data (Figure 3.4). On average among 24 OECD countries, a 30‑year‑old with less than an upper secondary education level can expect to live for 5.2 fewer years than a 30‑year‑old with tertiary education (a university degree or equivalent). These differences are higher among men, with an average gap of 6.5 years, compared with an average gap of 3.9 years among women.

“Socio‑economic inequalities are particularly striking among men in many central and eastern European countries (Slovak Republic, Latvia, Poland, Hungary), where the life expectancy gap between men with lower and higher education levels is over ten years. Gaps in life expectancy by education are relatively small in Italy and Sweden.

“More deaths among prime‑age adults (25‑64 years) with lower education levels drive much of this education gap in life expectancy. Mortality rates are almost four times higher for less educated prime‑age men, and about twice as high for less educated prime‑age women, compared to those with tertiary education (analysis based on data from 23 OECD countries).

“Differences in mortality rates among older men and women, while less marked, remain higher among the less educated, driven mainly by more deaths from circulatory diseases and cancer (Murtin et al., 2017[4]).”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“In 2019, across OECD countries, over 3 million premature deaths amongst people aged under 75 years could have been avoided through better prevention and health care interventions. This amounts to over one‑quarter of all deaths. Of these deaths, about 1.9 million were considered preventable through effective primary prevention and other public health measures, and over 1 million were considered treatable through more effective and timely health care interventions.

“Some cancers that are preventable through public health measures were the main causes of preventable mortality in 2019 (31% of all preventable deaths) – particularly lung cancer (Figure 3.9). Other major causes were injuries, such as road accidents and suicide (21%); heart attack, stroke and other circulatory diseases (19%); alcohol and drug-related deaths (14%); and some respiratory diseases such as influenza and COPD (8%).

“The main treatable cause of mortality in 2019 was circulatory diseases (mainly heart attack and stroke), which accounted for 36% of premature deaths amenable to treatment. Effective, timely treatment for cancer, such as colorectal and breast cancers, could have averted a further 27% of all deaths from treatable causes. Respiratory diseases such as pneumonia and asthma (9%) and diabetes and other diseases of the endocrine system (8%) are other major causes of premature death that are amenable to treatment.

“The average age‑standardised mortality rate from preventable causes was 126 deaths per 100,000 people across OECD countries. It ranged from 90 or fewer per 100,000 in Luxembourg, Israel, Iceland, Switzerland, Japan, Italy and Spain to over 200 in Latvia, Hungary, Lithuania and Mexico (Figure 3.10). Higher rates of premature death in these countries were mainly due to much higher mortality from ischaemic heart disease, accidents and alcohol-related deaths, as well as lung cancer in Hungary.

“Mortality rates from treatable causes across OECD countries were much lower, at an average of 73 per 100,000 population. They ranged from fewer than 50 deaths per 100,000 people in Switzerland, Korea, Iceland, Australia, Norway, Japan, France, Sweden and the Netherlands, to over 130 in Mexico, Latvia, Lithuania and Hungary. Ischaemic heart diseases, strokes and some types of treatable cancers (including colorectal and breast cancers) were the main drivers in Latvia, Lithuania and Hungary – countries with some of the highest treatable mortality rates.

“Preventable mortality rates were 2.5 times higher among men than among women across OECD countries (185 per 100,000 population for men compared with 73 for women). Similarly, mortality rates from treatable causes were about 36% higher among men than women, with a rate of 86 per 100,000 population for men compared with 63 for women. These gender gaps are explained by higher mortality rates among men, which are in part linked to different exposure to risk factors such as tobacco smoking (see indicator “Main causes of mortality” and Chapter 4 for an in-depth analysis of risk factors for health).”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“With these limitations in mind, almost 9% of adults considered themselves to be in poor health, on average across OECD countries in 2019 (Figure 3.22). This ranged from over 15% in Korea, Lithuania, Portugal and Latvia to under 4% in Colombia, New Zealand, Canada, Ireland, the United States and Australia. However, the response categories used in OECD countries outside Europe and Asia are asymmetrical on the positive side, which introduces a comparative bias to a more positive self-assessment of health (see the “Definition and comparability” box). Korea, Japan and Portugal stand out as countries with high life expectancy but relatively poor self-rated health.

“Among the few countries with data available for 2020, nearly all reported a reduction in the proportion of the population reporting themselves to be in bad or very bad health compared with 2019, with Finland reporting no change and no countries reporting an increase. While the data must be interpreted with caution – data are available for only seven countries and these include countries where the COVID‑19 pandemic did not severely test health systems – it could be an indication of the influence of context on perceived health: health issues that may previously have been considered more serious may be downplayed in the context of the pandemic.

“People on lower incomes are on average less positive about their health than those on higher incomes in all OECD countries (Figure 3.23). Almost 80% of adults in the highest income quintile rated their health as good or very good in 2019, compared with under 60% of adults in the lowest income quintile, on average across OECD countries. Socio‑economic disparities are particularly marked in Latvia, Estonia, the Czech Republic and Lithuania, with a percentage point gap of 40 or more between adults on low and high incomes. Differences in smoking, harmful alcohol use and other risk factors are likely to explain much of this disparity.

“Socio‑economic disparities are relatively low in Australia, Colombia, Greece, Israel and Italy, at less than 10 percentage points. Self-rated health tends to decline with age. In many countries, there is a particularly marked decline in how people rate their health when they reach their mid‑40s, with a further decline after reaching retirement age. Men are also more likely than women to rate their health as good.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Globally 2.4 million children died in their first month of life in 2020, a steep drop compared with the estimated 5 million children who had died at that age in 1990. However, this still amounted to approximately 6500 newborn deaths every day in 2020. The decline in neonatal mortality from 1990 to 2020 has been slower than that in post-neonatal under-five mortality. Neonatal mortality accounted for about 47% of all deaths among children under five years of age in 2020, up from 40% in 1990.

“The chances of survival from birth vary widely depending on where a child is born. The African Region had the highest neonatal mortality rate in 2020, with 27 (UI 24 to 31) deaths per 1000 live births, followed by the Eastern Mediterranean Region, with 25 (UI 22 to 29) deaths per 1000 live births (Fig. 2.7). A child born in the African Region was 10 times more likely to die during its first month of life compared with a child born in a HIC.

“On average, boys are expected to have a higher under-five mortality rate than girls. However, in some countries, the underfive mortality rate for girls is significantly higher than would be expected based on global sex ratio patterns. The number of countries with higher-than-expected under-five mortality for girls has decreased over time, from 22 countries in 1990 to 5 in 2020 (4).”

Source: World health statistics 2022: monitoring health for the SDGs, sustainable development
goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

“A sharp reduction in maternal mortality has been observed since 2000. Thirty-five percent fewer women died globally from causes related to or aggravated by pregnancy and childbirth in 2017 compared with 2000 (Fig. 2.5). Nevertheless, the estimated toll of 295,000 (279,000 to 340,000) deaths in 2017 was unacceptably high. The vast majority of those women––an estimated 94%––died in LICs [Lower-Income Countries] and LMICs [Lower-Middle-Income Countries].

“The Sustainable Development agenda requires reducing the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030 (SDG Target 3.1.1). The steepest reductions between 2000 and 2017 were observed in the SouthEast Asia Region (57%; from 355 to 152 maternal deaths per 100,000 live births) and the African Region (39%; from 827 to 525 maternal deaths per 100,000 live births) (11).

“Several factors are contributing to the progress in reducing maternal mortality. They include advances towards UHC [Universal Health Coverage] and improvements in addressing inequities in access to and the quality of sexual, reproductive, maternal and newborn health care. Many health systems have adapted to respond better to the needs and priorities of women and girls and interventions aimed at reducing social and structural inequities have increased.

“The global lifetime risk of maternal death was nearly halved between 2000 and 2017, from one in 100, to one in 190. However, large differences remained in 2017 between the lifetime risk of maternal death in HICs [High-Income Countries] (one in 5400) and LICs (one in 45) continue to exist. Partly due to those disparities, global reductions in maternal mortality are not sufficient to reach the SDG target. From 2000 to 2017, the global maternal mortality ratio declined by an estimated 38%––from 342 deaths to 211 deaths per 100,000 live births. Only 16 countries have achieved an annualized rate of reduction of at least 6.1% per year, the rate needed to reach the SDG target by 2030. “

Source: World health statistics 2022: monitoring health for the SDGs, sustainable development
goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

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Page last updated August 7, 2022 by Doug McVay, Editor.