Globally, improvements in life expectancy are increasingly taken for granted as natural features of the general advance of human progress. Since it effectively summarises mortality at all ages, it can serve as an indicator — perhaps the most basic indicator — of the quality of life. Studies have found significant positive correlation between various economic indicators such as incomes and life expectancy rates, but in addition this also reflects human security and stability in societies, the degree of conflict and the condition of health services in the country.
For all of these reasons, inter-country variations in life expectancy rates can also provide some indication of the extent of international inequality, one that goes well beyond the information provided by differences in per capita incomes. Overall, as Chart 1 suggests, there has been some global convergence in terms of life expectancy rates between developed and less developed regions. While life expectancy rates have improved everywhere, the less developed regions on average have improved their positions somewhat relative to the higher rates of the developed countries, and even more so if the least developed countries are excluded.
Not impressive
However this last point already suggests one significant feature of the overall convergence: the less impressive performance of the least developed countries in terms of life expectancy improvements. Chart 2 makes this clear, by plotting the gap between regions, defined as the percentage gap in life expectancy of the region relative to the developed countries average. While the developing regions (excluding the least developed ones) have narrowed the gap with the average of the developed world, for the least developed countries the gap with the developed world has actually increased, and it has continued to increase even during the global economic boom of the past decade when many LDC economies were growing at significantly higher rates than developed countries.
In terms of the regional variations, it is clear that Africa — and Sub-Saharan Africa in particular — remains the most backward region. Despite some recent improvements for the region as a whole, average life expectancy rates in Sub-Saharan Africa are still only around three-quarters of those in developing Asia. Much of the relative lack of improvement in Sub-Saharan Africa can be traced to the ravages of the HIV-AIDS epidemic that swept through much of the continent, but this is not sufficient explanation. In any case, the point is that the same virus did not cause equivalent devastation in other parts of the world, which in turn points to the overall conditions of public health and of curative facilities in the region.
Role of conflict
Another frequently mentioned cause of low longevity is conflict. And indeed it is fairly obvious that civil wars and other violent contexts are likely to be associated with higher mortality — not only because of the direct deaths that they result in, but because they affect nutrition by disrupting food supplies, affect the provision of health services and the basic amenities that assist human survival especially in emergencies.
However, a look at Chart 4 suggests that even that may not provide enough of an explanation for the variations in life expectancy across countries. Some countries that have undergone severe conflict and major disruptions to life in the period being considered, such as Afghanistan, nevertheless show some improvement in life expectancy. By contrast, Swaziland and Lesotho, which have not experienced major internal conflict, actually show substantial declines in life expectancy between 1990-95 and 2005-10, largely due to the inability to contain the AIDS epidemic. Similarly, DR Congo, another heavily conflict-affected society, shows similar performance in terms of life expectancy as Zambia, which has not experienced similar levels of conflict-driven disruption.
There are other features of interest in Chart 4. Among the BRICS (Brazil, Russia, India, China, South Africa), the remarkable performance of China stands out and confirms the other related evidence pointing to China’s rise as a major power, not just because of rising real incomes and falling poverty, but because of significantly improved life expectancy rates that are now only slightly lower than those of a developed country such as the United States. Brazil and India show reasonable improvements, but not remarkable ones — rather similar to many other developing countries. This could reflect the limited reach of economic growth in reaching health benefits to the mass of people in what are unequal societies.
Russia experienced a mortality crisis in the early 1990s, with life expectancy ratios actually falling compared to the previous decade. This was related not just to the cutbacks in the health system following the collapse of the Soviet Union, but severe stress on the population during the economic transition, which was associated with high unemployment, growing inequality and many other social dislocations. The recovery thereafter has been muted at best.
Chart 4 also brings out the extent of some inter-country inequalities in life expectancy. For example, in the early 1950s, the gap in life expectancy between Japan (one of the highest performers in this regard) and poor performing countries, was 20 years for Zambia and Lesotho, 23 years for DR Congo, 29 years in the Central African Republic, 32 years for Sierra Leone, and 33 years for Afghanistan.
By 2005-10, the gap had actually widened in all of these countries, rising to as much as 36 in Afghanistan, Zambia and DR Congo, and 37 years in Sierra Leone and the Central African Republic.
Child mortality
Child mortality constitutes one of the most significant elements of overall mortality rates and therefore is a major determinant of life expectancy as well. Indeed, countries with low life expectancy are typically those with high infant and child mortality.
Here too, while there has been some aggregate improvement in most parts of the world, there is no real convergence for the poorest regions. Chart 5 shows the movement of under-five mortality rates for various parts of the world.
East Asia has shown the most rapid decline in child mortality since 1990, while Latin America and the Caribbean have also performed well. These two regions (along with Southeast Asia to some extent) explain why overall there appears to be some closing of the gap in average child mortality rates between developed and developing regions.
But the reductions in child mortality have been much slower in Sub-Saharan Africa and South Asia.
This is reflected in the current geographical distribution of child mortality in the world. Chart 6 makes the striking point that nearly half of all the estimated child death in 2011 were in Sub-Saharan Africa, while this region and South Asia combined account for a staggering 80 per cent of all deaths of children under five years.
From Chart 1 it is evident that the gap between LDCs and the rest of the world grew most in the period from the early 1970s to the end of the 1990s — the lost decades of Sub-Saharan Africa, when brutal adjustment measures and neo-liberal policies of opening up the economy generated a downward spiral in per capita incomes. This obviously also affected the public finances required for providing essential health services even as lack of employment opportunities and shift away from food production to cash crops were associated with under-nutrition. These forces also left societies in much weaker positions to combat tendencies such as the spread of HIV-AIDS.
In the 2000s, a combination of faster economic growth (led by the commodity boom) and more heterodox economic policies have led to surprising changes, not just in income inequalities that have declined in many countries, but also in improvements in maternal and child mortality. But the recovery has still been halting and certainly not enough to undo the effects of decades of deterioration.
In the most basic health indicators of life expectancy and child mortality, therefore, the divergence within the developing world is now as striking as that between developed and developing worlds on average. Inequalities in conditions of life clearly persist, even as they change their geographical location.
But they are still very much driven by policies within countries, only some of which can be blamed on global economic processes.
(Source for Chart 1 to 4: United Nations, Department of Economic and Social Affairs, Population Division (2011) World Population Prospects: The 2010 Revision,
CD-ROM Edition. Source for Charts 5 and 6: The Millennium Development Goals Report 2013, UN, New York.)