Abstract
BackgroundNew 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.MethodsLEB 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 time-dummies. Analysis grouped countries into one-of-four strata: LEB < 51, 51 ≤ LEB < 61, 61 ≤ LEB < 71, and LEB ≥ 71.ResultsThe 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.ConclusionsContrary 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.
Highlights
New technological breakthroughs in biomedicine should have made it easier for countries to improve life expectancy at birth (LEB)
When we compare countries at a similar starting point of LEB, we find that the pace of growth of LEB has slowed over the last 60 years for countries at all levels of starting LEB
Unadjusted results show that between the 1950s–2000s LEB decadal gains got smaller by approximately 14 years, from an average decade gain of 7.38 (SD 3.59) years in 1950–59 to an average decade loss of 6.82 (SD 6.64) years in 2000–09 (Fig. 1)
Summary
New technological breakthroughs in biomedicine should have made it easier for countries to improve life expectancy at birth (LEB). New technological breakthroughs in biomedicine consume an increasing share of the global economy. In the production of population health, one would expect that the discovery of new vaccines, drugs, and surgeries would enable more rapid improvement of population health even if investments in health remained the same. In the last 60 years with both improved biomedical technology and the large increases in health care spending per capita one would expect to see progress in the rate at which a country with a low life expectancy of say 50 or 60 years could achieve improvements. Multiple factors must work together to improve a country’s life expectancy at birth (LEB). People in lower income countries have lower levels of life expectancy than developed countries, and live in poor health a high proportion of their lives [3]
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