Levels and Trends in Health Status

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The tables provide convincing evidence of the substantial improvements in health outcomes occurring in most countries. Over the past 35 years, life expectancy has increased in virtually all countries, with infant and child mortality also improving substantially. Table D shows changes in life expectancy by region, and figure 11 shows trends in infant mortality rates for the world by region. Even in the Sub-Saharan African and South Asia regions, where health conditions are poorest, there have been large improvements in infant mortality rates and life expectancy.

These regional and income aggregates mask an important fact, however: while only a handful of countries have higher mortality now than in 1960, some countries have made much more progress than others. Moreover, there have been cases of reversals in the decline in mortality due to AIDS, chronic diseases, and regional conflicts. Figures 12 and 13 show trends in life expectancy in a number of countries, contrasting those

Table D. Life Expectancy at Birth, by Income Group and Region, 1960-95

Region or income group

1960

1970

1980

1990

1995

World

50

59

62

66

67

Low-income

40

54

58

61

63

Excluding China and India

42

46

51

53

56

Middle-income

55

59

64

67

68

Low- and middle-income

45

56

58

63

65

East Asia and Pacific

39

59

65

68

68

Europe and Central Asia

65

68

68

69

69

Latin America and the Caribbean

56

61

65

68

69

Middle East and North Africa

47

53

59

64

67

South Asia

44

49

54

59

62

Sub-Saharan Africa

41

44

48

51

52

High-income

70

71

74

76

78

Figure 11. Decline in Infant Mortality, by Region, 1960 and 1995

Figure 11. Decline in Infant Mortality, by Region, 1960 and 1995

1960

1960

Sub-Saharan Middle East and South Asia East Asia

Africa North Africa and Pacific

World Latin America Europe and High-income arid the Caribbean Central Asia

Sub-Saharan Middle East and South Asia East Asia

Africa North Africa and Pacific

World Latin America Europe and High-income arid the Caribbean Central Asia

Figure 12. Mortality Decline in Six Countries that Have Made Little Progress: Trends in Live Expectancy, 1960-95

Life expectancy at birth (years)

Bulga

Ukraine

Uganda

Hungary

Zambia

Uganda

Zambia

1970

1980

1990

Figure 13. Mortality Decline in Six Countries that Have Made Good Progress: Trends in Live Expectancy, 1960-95

Life expectancy at birth (years) 80

1960

1970

1980

1990

1995

Vietnam

Nicaragua

Figure 13. Mortality Decline in Six Countries that Have Made Good Progress: Trends in Live Expectancy, 1960-95

Life expectancy at birth (years) 80

Vietnam

Nicaragua

Indonesia

Indonesia

1960

1970

1980

1990

1995

Figure 14. Adult Mortality, by Region, 1960-95

500 400 300 200 100 0

East Asia Europe and Latin America Middle East and Pacific Central Asia and the Caribbean and North Africa

Figure 14. Adult Mortality, by Region, 1960-95

East Asia Europe and Latin America Middle East and Pacific Central Asia and the Caribbean and North Africa

South Asia

Sub-Saharan Africa

High-income

South Asia

Sub-Saharan Africa

High-income that have made a great deal of progress with those where life expectancy has increased much less or even recently declined.

Improvements in health status have not only been uneven across countries, but also across the life span. Generally, infant and child mortality rates have improved most, which is also reflected in increased life expectancy at birth. But adult mortality is rising in certain parts of the world. In some countries, this has occurred only since the mid-1980s, as a result of AIDS mortality; in other countries, adult male health has been declining due to chronic diseases since the 1960s. The increase in adult mortality has been particularly large in Russia and some of the other former Soviet republics. Figure 14 shows trends in adult male mor tality rates (shown as the probability of dying between ages 15 and 60) by region, over a 35-year period.

Most countries and regions have substantially reduced morbidity and mortality from certain causes, but are making less progress in other areas. For example, while overall mortality in South and East Asian countries has declined greatly, child malnutrition and maternal health problems there remain among the worst in the world (figure 15). HIV/AIDS has impacted mortality mostly in Sub-Saharan Africa so far (figure 16) but is now spreading in Asia and the Latin America and the Caribbean region as well. Tuberculosis has reemerged in all of the Bank's regions (figure 17), while high fertility remains a source of poor maternal health in three regions (figure 18).

Figure 15. Child Malnutrition, by Region, 1985-95

Percentage of malnourished children

Figure 15. Child Malnutrition, by Region, 1985-95

Percentage of malnourished children

East Europe Latin Middle South Sub- High-

Asia and and America East and Asia Saharan income

Pacific Central and the North Africa Asia Caribbean Africa

East Europe Latin Middle South Sub- High-

Asia and and America East and Asia Saharan income

Pacific Central and the North Africa Asia Caribbean Africa

Figure 16. Adult HIV Prevalence, by Region, about 1995

Percentage HIV positive

Figure 16. Adult HIV Prevalence, by Region, about 1995

Percentage HIV positive

Sub- Latin South High- East Middle Europe

Saharan America Asia income Asia East and and

Africa and the and North Central

Caribbean Pacific Africa Asia

Sub- Latin South High- East Middle Europe

Saharan America Asia income Asia East and and

Africa and the and North Central

Caribbean Pacific Africa Asia

Figure 17. Tuberculosis Incidence, by Region, 1995

Smear positive incidence per 100,000 population 120

Sub- Middle South Latin East Europe High-Saharan East and Asia America Asia and income

Africa North and the and Central

Africa Caribbean Pacific Asia

Figure 18. Fertility above Replacement Level, by Region, 1995

Total fertility rate above 2.1 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 -0.5

Sub- Middle South Latin East Europe High-Saharan East and Asia America Asia and income Africa North and the and Central

Africa Caribbean Pacific Asia

Projected changes in the age structure of populations will change disease patterns, causes of death, and the demand for health care. The number of people over age 60 is projected to increase in all of the Bank's regions, but especially in the Europe and Central Asia (ECA) and East Asia and Pacific (EAP) regions (figure 19). The composition of the burden of disease is projected to change not only because of demographic changes, but also because of the epidemiological transition that many low- and middle-income countries are currently experiencing. Changes in epidemiology are shifting the burden of disease from infectious and parasitic diseases to non-communicable diseases and injuries. This trend is

Figure 19. Population over Age 60, by Region, 1990 and 2020

Percentage of total population over age 60 25

High-

Europe and Central Asia

High-

Europe and Central Asia

IIIII

East Latin South Sub- Middle

Asia America Asia Saharan East and and and the Africa North

Pacific Caribbean Africa amplified by changes in age structure, as those age groups that are most subject to communicable diseases become a smaller proportion of the total, whereas the working-age adult populations and the elderly increase in number (figures 20, 21).

Figure 20. Global Burden of Disease, 1990

(percent) Injuries

Noncommunicable

Infections and parasitic 34

Figure 20. Global Burden of Disease, 1990

(percent) Injuries

Infections and parasitic 34

Noncommunicable

Figure 21. Global Burden of Disease, 2020

(percent)

Infections and parasitic 15

Figure 21. Global Burden of Disease, 2020

(percent)

Infections and parasitic 15

¬ęcommunicable 73

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