Africa Health Quality Similar To Middle Ages

by Gustavo Capdevila

Sub-Saharan Africa, meanwhile, has plunged to levels not seen in the developed world since the middle ages, said one WHO official.

According to the new measurement, among the 191 members of WHO, people in Japan can expect 74.5 years of healthy life, while those in Sierra Leone can expect less than 26.

The new system, DALE (Disability Adjusted Life Expectancy), created by a team of WHO scientists, estimates the expected number of years to be lived in "what might be termed the equivalent of 'full health,'" stated the new WHO report.

Previous estimates of life expectancy were based on the total length of life, calculated solely on the basis of mortality rates.

With the new method, the United States ranks 24th in the world, with an average healthy life expectancy of 70 years for children born in 1999.

In sub-Saharan Africa, life expectancy has fallen sharply in recent years -- from 51.1 to 46.3 years for newborn girls and from 47.3 to 44.8 for boys -- mainly due to the AIDS epidemic, reported WHO.

To calculate DALE, years of disability or illness are weighted according to severity and subtracted from expected overall life expectancy, in order to estimate the expected years of healthy life.

The WHO ranking based on the new methodology shows that the number of years lost to illness and disability is considerably higher in poor countries, due to a number of factors that affect both children and adults, such as injuries, blindness, paralysis and the effects of tropical diseases like malaria.

People in countries enjoying the best levels of health spend, on average, nine percent of their lives suffering from ill-health or disability, compared to 14 percent in the countries at the bottom of the list.

Healthy life expectancy, according to DALE, stands at or above 70 years in 24 countries, and at or above 60 in over half of the UN agency's member countries.

At the other extreme are 32 countries where people can expect less than 40 years of healthy life. Many of these countries have been hit hard by AIDS.

Topping the list are Australia, with 73.2 years of expected healthy life, France (73.1), Sweden (73), Italy (72.66), Greece and Switzerland (72.5), Monaco (72.4) and Andorra (72.3).

The leading developing country is Dominica (69.8 years), followed by Chile (68.6), Cuba (68.4), Jamaica (67.3), Uruguay (67), and Argentina and Costa Rica (66.7).

In Brazil, meanwhile, healthy life expectancy is relatively high in the south and much lower in the north. The average is 59.1 years -- 62.9 for women and 55.2 for men.

Christopher Murray, director of WHO's Global Program on Evidence for Health Policy, said "the position of the United States is one of the major surprises of the new rating system. Basically, you die earlier and spend more time disabled if you're an American rather than a member of most other advanced countries."

Among the reasons for that cited by WHO were the fact that some groups in the United States, such as Native Americans, rural African-Americans and the urban poor suffer from extremely poor health, more similar to conditions in impoverished developing countries than conditions in the industrialized world.

The UN agency also reported that the AIDS epidemic caused more death and disability among young and middle-aged Americans than among those sectors of the population of other industrialized countries.

The United States is one of the countries with the highest rates of smoking-related cancer, especially lung cancer, as well as other chronic lung diseases, WHO added.

Other reasons explaining the relatively low healthy life expectancy in the United States were a high rate of heart disease -- despite a recent decline -- and high levels of violence, especially murders, in comparison with other industrialized countries.

The report also highlighted the situation in sub-Saharan Africa, where the AIDS epidemic has been spreading.

The bottom ranking countries are all found in Africa: Sierra Leone, with 25.9 years of expected healthy life for babies born in 1999, Niger (29.1 years), 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).

AIDS is the primary cause of death today in sub-Saharan Africa, having surpassed malaria, tuberculosis, pneumonia and dysentery. In 1999, AIDS claimed 2.2 million lives in Africa, up from 300,000 a decade earlier.

"Healthy life expectancy in some African countries is dropping back to levels we haven't seen in advanced countries since Medieval times," said Alan Lopez, coordinator of WHO's Epidemiology and Burden 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."

The WHO study on healthy life expectancy confirmed the trend revealed by other research, pointing to a slower decline in mortality rates among men than women, in countries where wealth is growing.

But in North Africa and the Middle East, men and women have similar healthy life expectancy, says the study, which points out that females are in a disadvantaged position in those societies, where girls receive less health care and women face a higher risk of childbirth-related mortality than women in other countries.

In China, home to 20 percent of the global population, healthy life expectancy stands at 62.3 years -- 63.3 for women and 61.2 for men -- which Lopez described as a positive performance, given the country's income level.

In Southeast Asia, Vietnam has made significant progress in improving overall life expectancy, and people can now expect to live an average of 58.2 healthy years. Thailand, on the other hand, has not registered any advance in the past decade, and healthy life expectancy averages 60.2 years.