The document provides an overview of life expectancy trends globally and regionally, with a focus on South Asian countries. It finds that while life expectancy has increased worldwide over the past few decades, there remain large disparities between regions and countries. The highest life expectancies are seen in East Asia and Europe, while sub-Saharan Africa has the lowest levels due to issues like HIV/AIDS. Among South Asian nations, Maldives has the highest life expectancy of 78 years, whereas Afghanistan is the lowest at 61 years. Key determinants of life expectancy discussed include socioeconomic development and access to healthcare.

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439. Dip Narayan
440. Gauree Shankar
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2. Outline of presentation
• Background
• Life Expectancy: Global level
• Life Expectancy: Regional level
• Life Expectancy: Among South Asian countries
• Life Expectancy: National level
• Summary

3. Background
Life Expectancy at birth: Average number of years that a newborn is expected to
live if current mortality rates continue to apply.
Longevity has increased, but people are living with more disease and disability.
Healthy life expectancy (HALE): Average number of years that a person can expect
to live in "full health" by taking into account years lived in less than full health due
to disease and/or injury.
In general average LE at birth of women is higher than men. (5 years difference in
general)
It is a mortality indicator which describes overall health status and development of
particular place.

4. Determinants of Life Expectancy
• Mainly determined by other mortality indicators
• But in real, determinants of health also determines LE.
Some of them are:
• Socioeconomic determinants (Huge impact but decrease over time) (1)
 Economy-GDP, Per capita expenditure in health
 Education and social security
 Health services (Health care system, Equity and effectiveness)
 Culture and ethnicity
 Women empowerment (decision making over health care)
• Political determinants (weak in short run but strong in long-term) (1)
• Conflicts and wars (2)
• Diseases, epidemics and disasters (Communicable, NCD and injuries)
1. http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-85
2. The Determinants of Average Life Expectancy: A Cross-Country Analysis, Lyle Kossis

6. Source: Conceptual Framework of SDH, WHO

7. Global Overview
• Life Expectancy at birth: 71 years (WHS-2015)
(Max-84 yrs./ Min-46 yrs./ Med-74 yrs.)(WHS-2015)
• Healthy Life Expectancy at birth: 62 years (WHS-2015)
• Global life expectancy increased by 5.8 years in men and 6.6 years in
women between 1990 and 2013 (GBD 2013)
• But there is exception among sub-Saharan region where deaths from
HIV/AIDS have erased over 5 years of life expectancy.
Some accepted reasons behind the maximum LE of Japan are Equity in health care distribution, Better nutrition and diet

8. Life Expectancy and Wealth of country
Countries by
Wealth
Life Expectancies at birth HALE at birth
1990 2013 2013
Low income 53 62 53
Lower middle
income
59 66 57
Upper middle
income
68 74 66
High income 75 79 70

9. Some reasons behind global increase in LE
• Reduction in infant and child mortality
- Public health measures and control of various infectious and
vaccine preventable diseases
• In high income countries decrease in mortality of older people esp.
attributable to NCDs
- Medical advancement and technological development enabling
treatment of various diseases

10. Regional level comparison
WHO Regions
Life Expectancies at birth HALE at birth
1990 2013 2013
African Region 50 58 50
Region of the
Americas
71 77 67
South-East Asia
Region
59 68 59
European Region 72 76 67
Eastern
Mediterranean
Region
62 68 59
Western Pacific
Region
69 76 68

12. Why Africa has lower LEB than other regions?
 HIV/AIDS epidemic hit hardest in Africa esp. Sub-Saharan
 Poverty, social and political upheaval
 High risk of death from infectious diseases
Source: http://www.deathreference.com/Ke-Ma/Life-Expectancy.html

13. Why Europe and North America have higher LEB?
• Better nutrition and hygiene practices
• Enhanced knowledge of public health measures
Source: http://www.deathreference.com/Ke-Ma/Life-Expectancy.html

14. Comparison among South Asian Countries
South Asian
countries
Life Expectancies at birth HALE at birth
1990 2013 2013
Afghanistan 49 61 50
Bangladesh 60 71 61
Bhutan 53 68 59
India 58 66 58
Maldives 58 78 68
Nepal 54 68* 59
Pakistan 60 66 57
Sri Lanka 69 75 65
Source: WHO-World Health Statistics 2015
* LE of Nepal was 69.6 yrs. According to HDR 2015, UNDP

15. 0
10
20
30
40
50
60
70
80
90
Afghanistan Bangladesh Bhutan India Maldives Nepal Pakistan Srilanka
HALE 2013LE 2013LE 1990

16. • Maldives has highest LE at birth among South Asian countries whereas
Afghanistan has lowest.
• Some facts about Maldives:
 Only south Asian country among Upper Middle Income countries
 Its Per capita expenditure on health (PPP int. $) is 1283 which
exceeds the sum total of other seven nations.
 Lower child mortality rate similar to Sri Lanka
Source: WHO-World Health Statistics 2015

17. Nepal
• Nepal has done significant progress in LEB since 1990
• 54 in 1990 to 68 in 2013 (WHS 2015)
• Main reason behind this is significant decrease in infant and child
mortality
• It is outcome of investment in child health programs

18. Life expectancy of Nepal: Ecological belt
Ecological belt Life expectancy
Mountain 66.98
Hill 69.02
Terai 68.81
Source: UNDP ,HDR 2014
There is not more disparity in LE based on ecological regions.

19. Life expectancy of Nepal: Development Region
Development region Life expectancy
Eastern development region 69.02
Central development region 69.84
Western development region 69.03
Mid western development region 66.8
Far western development region 66.84

20. Life expectancy of Nepal: Urban vs Rural
Urban 68.93
Rural 68.81
In urban life expectancy is higher than rural because :
In urban there is access and availability of tertiary level of health
facility.
Good access of transportation.
There is no geographical barrier.

21. Here are the five districts with the highest life expectancy rates in Nepal:
• Ramechhap: 72.9 years
• Gorkha: 71.7 years
• Saptari: 71.34 years
• Siraha: 71.29 years
• Rautahat: 70.99 years

22. Key facts
• Despite global improvements in life expectancy, death rates for some causes continue to rise
• Despite dramatic drops in child deaths over the last 23 years, lower respiratory tract infections,
malaria, and diarrhoeal disease are still in the top 5 global causes of death in children younger
than 5 years
• Top ten leading causes of premature death worldwide have hardly changed since 1990. Nine
causes remained in the top ten in 2013, with HIV/AIDS moving in and tuberculosis moving to 11th
• While worldwide deaths from HIV/AIDS have declined substantially every year since its peak in
2005, HIV/AIDS is still the greatest cause of premature death in 20 of 48 countries in sub-Saharan
Africa
• War is the leading cause of premature death in Syria. The conflict in Syria has killed an enormous
number of people
• In eastern Europe, half of all premature deaths in 2013 were due to five causes: ischemic heart
disease, stroke, self harm, cirrhosis, and road injury
• Suicide is a major and growing public health problem in India with half of the word's suicide
deaths occurring in India and china alone
• Road injury and interpersonal violence are key contributors to premature deaths in Latin America
and the Caribbean
Source: http://www.eurekalert.org/pub_releases/2014-12/tl-tlw121614.php

23. "The huge increase in collective action and funding given to the major
infectious diseases such as diarrhoea, measles, tuberculosis, HIV/AIDS,
and malaria has had a real impact. But there are some major chronic
diseases those have been largely neglected but are rising in
importance, particularly drug disorders, liver cirrhosis, diabetes, and
chronic kidney disease” _Dr. Christopher Murray, Professor of Global Health, University of Washington

24. Bibliography
1. An equity-effectiveness framework linking health programs and healthy life expectancy,
Banham D, Lynch J, Karnon J., 2011
2. Causes of international increases in older age life expectancy, Colin D Mathers, Gretchen A
Stevens, Ties Boerma, Richard A White, Martin I Tobias, Lancet, 2015
3. The Great Escape: Health, Wealth, and the Origins of Inequality, Angus Deaton. Princeton
University Press, 2013. Pp 376
4. Connection between wealth and health? Michael Marmot, Lancet, 2013
5. Culture and health, Lancet 2014; 384: 1607–39
6. http://www.eurekalert.org/pub_releases/2014-12/tl-tlw121614.php , [Accessed: 22 Feb 2016]
7. Explaining Divergent Levels of Longevity in High-Income Countries. E.M. Crimmins, S.H.
Preston, and B. Cohen, Eds. Panel on Understanding Divergent Trends in Longevity in High-
Income Countries. Committee on Population, Division of Behavioral and Social Sciences and
Education. Washington, DC: The National Academies Press, 2011
8. Prolonging life at all costs: quantity versus quality, Lancet, 2016, http://dx.doi.org/10.1016/

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26. South Asian
countries
Infant
mortality rate
Under-five
mortality rate
CPR
TFR per
women
Per capita
expenditure on
health (PPP int. $)
2013 2013 2013 2013 2012
Afghanistan 70.2 97.3 21 4.9 159
Bangladesh 33.2 41.1 61 2.2 85
Bhutan 29.7 36.2 66 2.2 264
India 41.4 52.7 55 2.5 196
Maldives 8.4* 9.9 35 2.3 1283***
Nepal 32.2 39.7 50 2.3 118
Pakistan 69.0 85.5 35 3.2 122
Sri Lanka 8.2** 9.6 68 2.3 270
*67.8 per 1000 live births in 1990
**18.2 per 1000 live birth in 1990
***274 in 2000 AD