those experiencing poverty) are more likely to experience associated harms, and are less likely to benefit from public health interventions [113]. Ethiopia is one of a handful of African countries that has shown life expectancy gains since 2000 despite the country having a low per capita GDP [16]. The most obvious explanation behind the connection between life expectancy and income is the effect of food supply on mortality. Universal health coverage [http://apps.who.int/uhc/en/about/ ]. The Brazilian government has introduced several policies to reduce child labour and slavery, increase job stability and wages, reduce unemployment, narrow inequalities in income, and improve food security [89, 90]. By using this website, you agree to our We synthesised relevant quantitative and qualitative information from the included articles. Escuder MML, Venancio SI, Pereira JCR. Bristol: Policy Press; 2016. Matern Child Health J. Wealthy countries such as Japan, Switzerland and Australia have the highest life expectancies, though the estimates vary slightly depending on the methodology used. Article What makes a successful health system? Brazil punched above its weight by 2years. Breastfeeding duration increased from 2.5months in the 1970s to 14months in 2006; and exclusive breastfeeding in children under 6months increased from 3.6% in 1986 to 37.1% in 2006 [85]. 2017;5:e114251. In 2012, Slovakia had lower life expectancy than much poorer Dominica. the UK, Australia, Sweden or New Zealand), the United States system is a complex hybrid. We performed a comprehensive literature search of electronic databases Google Scholar, PubMed, MEDLINE, CINAHL and Web of Sciences, from 1997 (to constrain the search to recent factors that may explain current PAW or PBW performance) to December 2019. The researchers collected health indicator data, reviewed literature, and drew on theoretical frameworks to analyse the case studies. w/ access to physical activity locations: 80.9% (state: 91.5%) > Primary care physicians: 52.1 per 100,000 (state: Google Scholar. 2019. The Health Development Army comprises over 3 million volunteers (predominantly women) who engage in multi-purpose health promotion activities including community empowerment and disease prevention [49]. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country. Since research has shown punching above or below weight status can change over time [6], we checked for persisting performance over time by calculating the Preston Curve for equivalent 2014, 2015, 2016, and 2017 data as well as for 2018. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. These neoliberal reforms resulted in large increases in income inequality; a smaller social safety net; and higher rates of poverty and unemployment. WebChanges in life expectancy also differ sharply across areas. There are national health insurance programs (Medicare for those aged 65 and over, The Child Health Insurance Program for children), National Health Services for some population (the Veterans Health Administration and the Indian Health Service), employer-sponsored health insurance, and completely private insurance options that are paid 100% out of pocket. Why do some countries do better or worse in life expectancy relative to income? 2016;20. Similarly, the strength and growth of civil society in recent decades in Ethiopia and Brazil contrasts with the poor unionisation and low political participation in the United States. CAS The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Addis Ababa: FDRE (Federal Democratic Republic of Ethiopia), MoH (Minstry of Health); 2015. Among them, 17 countries outranked the The theory and practice of Meles Zenawi. The United States is also being held to a higher standard as a wealthier country than Ethiopia and Brazil in our determinations. J Afr Econ. Milbank Q. In total, 31 countries saw a drop in life expectancy out of the 37 analyzed, according to NBC News. Table2 shows the life expectancy and selected key indicators of context and social determinants of health for each country. Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. [http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf]. In Tampa, FL the poor lost 2.2 years of life expectancy over the same period. We found within-country equity data was not always as readily available or comparable as general life expectancy data. Tameru W. Affordable houses for middle and low income group in Ethiopia: self help housing with innovative construction technology. 6. Int J Equity Health. 2019;19:342. 49. The road to serfdom. This has been accompanied by an increase in housing supply with adequate electricity. Being wealthy adds nine years to healthy life expectancy: a life free from disability and pain, according to transatlantic research. 2015;74:5876. UNESCO. Anurio Estatstico do Brasi. Medicaid waivers: public health consequences under the trump administration. 2007;36:4989. Society at a glance 2011: OECD social indicators. EG led the review and write up for Brazil. It is of note that per capita energy use, oil use, and carbon dioxide emissions are far higher in the United States, our punching below weight country, than for every other country in the world [149]. J Atheroscler Thromb. Correspondence to WebLife expectancy and Healthy life expectancy Regional Average Scatter Map Gathering global data Table Indicator name: Life expectancy at birth (years) Short name: Life expectancy at birth Data type: Statistic Indicator Id: 65 Topic: Mortality and burden of disease Rationale: 2013;368:133543. Final draft. Similarly, and rather interestingly, Cuba, despite its relatively low GDP per capita, had a similar level of life expectancy to the US. This paper used a mixed-methods approach involving: 1) quantitative analysis of life expectancy relative to national per capita income, 2) an expert opinion study, and 3) scoping reviews of existing literature and data to examine factors that may affect the relationship between life expectancy and GDP in our three case study countries: Ethiopia, Brazil and the United States. Ethiopia and Brazil punched above weight in all years, while the United States punched below weight for all years. Higher income also implies better access to housing, education, health services and other items which tend to lead to improved health, lower rates of mortality and higher life expectancy. [1] Meanwhile, fighting obesity and smoking two increasingly pressing issues in the developed world could add more healthy years to life expectancy averages in todays rich countries. Successive governments implemented economic deregulation including increased labour market flexibility (e.g. for HIV, we used 2017 data in Ethiopia, 2015 in Brazil and 2016 in the United States. Neves RG, Flores TR, Duro SMS, Nunes BP, Tomasi E. Time trend of family health strategy coverage in Brazil, its regions and federative units, 2006-2016. However, our findings show that the role of drivers outside of the health system social, commercial and political determinants are also important. Research has shown that the political incorporation of minority groups is robustly associated with better health amongst those groups [129, 130]. 2012;22:25765. National programs targeting food security and nutrition were introduced in 2000 [93]. Ethiopia ratifies WHO framework convention on tobacco control. This research was produced as a result of the Punching Above their Weight Network, which is supported by the UK Academy of Medical Sciences Global Challenges Research Fund Networking Grant (ACP Ref No. Table1 lists the search terms for each concept. Schrecker T, Bambra C. How politics makes us sick: neoliberal epidemics: Springer; 2015. Only 12% of the United States workforce is a member of a trade union compared to 68% in Sweden [128]. If not, select "Manage Preferences" to learn more about managing your cookie preferences. Health sector development program IV 2010/112014/15 vol. While healthy life expectancy (HALE) has also increased by 8% from 58.3 in 2000 to 63.7, in 2019, this was due to declining mortality rather than reduced years lived with disability. 2017;95:22932. 2011;377:177897. Unlike other wealthy countries that operate a social insurance system (whereby the government, employers and employees co-fund health care via regular set contributions e.g. Addis Ababa: Housing Development Department, Ministry of Works and Urban Development, Ethiopia; 2009. One possible approach would be to continue this work by building a database of political, environmental, and social determinants with a greater number of countries in the punching above or below weight categories, that could be interrogated to look for relationships between policies, social determinants, and population health outcomes. Clare Bambras contribution was funded by a grant awarded by the Norwegian Research Council (project number 288638). Population living in slums (% of urban population). Brazils economy changed from a focus on mining and agriculture to manufacturing and service industries. Oxford: Blackwell Publishing; 2007. Although 99.3% of the population in the US used at least basic drinking water services in 2017 [114], the statistics among minority and low-income populations are lower (e.g. 2012;112:14855. World Bank data show that in 1982, life expectancy in low-income countries was about 66% of that in high-income countries. WebLife expectancy is a measure of premature death and it shows large differences in health across the world. The United States has relatively worse population health behaviours than other comparable countries. Ethiopia has implemented healthy urban planning, infrastructure policy, and public health regulations. 2014;4:3740. J Public Health Manag Pract. Am J Public Health. The socioeconomic gradient in life expectancy has also flattened [17]. The 2013 Mais Mdicos programme (More Doctors Programme), further expanded access to health care, encouraging doctors, including foreign doctors, to go to underserved remote areas [82]. The sources for the table are available in a supplementary document (S1 doc). MoH. Int J Equity Health. In the UK, average life expectancy at birth was 81 years, according to 2021 data from the World Bank - the same as in Slovenia, Portugal, Germany, the Netherlands, For example, a study conducted in 2019 revealed high inequities in the distribution of doctors, nurses, midwives, and health officers across Ethiopia [39]. It is not surprising, therefore, that aggregate income has been a pretty good predictor of life expectancy historically. Google Scholar. Ibrhim MA, Demissie M, Medhanyie AA, Worku A, Berhane Y. How repealing portions of the affordable care act would affect health insurance coverage and premiums. B. Possible drivers of these outcomes are discussed below. Leal MDC, Szwarcwald CL, Almeida PVB, Aquino EML, Barreto ML, Barros F, Victora C. Reproductive, maternal, neonatal and child health in the 30 years since the creation of the unified health system (SUS). Conversely, we use the term punching below their weight (PBW) for those countries that fail to translate their wealth into better population health and high life expectancy. Richest Research Sources. MEDICC Rev. 2013;47:12058. PubMed Central Rural Remote Health. The 10-year study, conducted This aided them in achieving global coverage, and including low, middle, and high income country participants. Franklin R: Brasil, Ministrio do Planejamento, Oramento e Gesto. Diverse global public health expert opinions were gathered through two formal meetings of the PAW Research Network. Regional differences and differences between the richest and poorest have decreased, reflected in an improvement in the Gini coefficient from 0.635 in 1989 to 0.533 in 2017 [88]. Our reviews reinforce findings from earlier research that investment in PHC, maternal and child health, and universal health coverage have a strong role to play in achieving positive and equitable population health outcomes - in all countries regardless of their wealth. Ward K, England K. Introduction: Reading Neoliberalization. Hence, in emerging economies in particular, it is not growth in aggregate incomes that matters but a reduction in poverty. Secondly, higher income also correlates with a number of unhealthy habits, such as tobacco and alcohol consumption and less healthy diets, which in turn leads to weakening health. We extract and organise ecommerce data from over 1,500 online retailers in 40 countries providing daily updates on pricing, assortment size and key attributes. 2018;27:e2017170. > Life expectancy: 81.1 years (state: 78.1 years) > Pop. CAS Note: 34 (developed), 169 (emerging and developing). In 2018 to 2020, male healthy life expectancy at birth in the most deprived areas of England was estimated at 52.3 years, compared with 70.5 in the least deprived areas. Population health is affected by policies and actions in and beyond health care systems that act on the social determinants of health such as alleviating poverty and hunger; providing education, access to safe water, housing, sanitation and labour rights; and action on climate change [11]. By 2015 the family health strategy (ESF) covered 60.6% of the population [81]. 1). Some Singapore, Japan, Israel, and South Korea are in Asia, Canada and the United States are in North America, and Australia and New Zealand are in Oceania. Effectiveness of community health workers in Brazil: a systematic review. While we did not seek to directly compare the countries, this shows the challenges in establishing good quality, comparable data. This resulted in the selection of Ethiopia (low income, PAW), Brazil (middle income, PAW) and the United States (high income, PBW). Currency; 2012. The 1988 Brazilian Constitution established a universal health system that is free-of-charge for users and launched major investments in training of health professionals, production of pharmaceuticals, public health surveillance and health research and technology development [71]. The two positive countries should not be seen as simple hagiographies, but an attempt to isolate the positive factors contributing to their punching above weight. An analysis of Brazil, Ethiopia, and the United States of America. Book Framework for investigating why some countries punch above or below their economic weight in terms of life expectancy (adapted from Baum et al. Health inequalities: critical perspectives. 4th ed. Higher Income Does Not Always Lead to Higher Life Expectancy Policy and practice information for action: quarterly health bulletin, Federal Democratic Republic of Ethiopia, Minstry of Health, vol. They had experience with research, civil society or policy on determinants of health and health inequities. Secular trends in breastfeeding in Brazil. WebLife expectancy at birth, total (years) - Low & middle income ( 1 ) United Nations Population Division. Pan Afr Med J. More unequal societies have worse health, and other social outcomes [101]. Costa ND, Marcelino MA, Duarte CM, Uhr D. Social protection and people with disabilities in Brazil. One clear remaining question is how to ascertain attribution of population health outcomes, and how best to tease out the role of different policy approaches and sectors. . Track existing and future opportunities to support critical decision-making across all functions within your organisation. Mebratie AD, Sparrow R, Yilma Z, Alemu G, Bedi AS. Popul Stud. Maternity leave in the United States: facts you need to know. In this context, average income fails to act as a representative health indicator, and rich nations can actually perform worse on a number of health indicators compared to relatively poor economies. Minstry of Health: Addis Ababa; 2008. Int J Gynaecol Obstet. Cities are hubs for spending, with 80% of expenditure expected to be generated by urban areas in 2023. Here are two to try: Social Security Life Expectancy Calculator: Based on Social Security actuarial tables, this simple calculator estimates your lifespan based on your current age. Life Expectancy by Country . To alleviate this, the government established a health care financing (HCF) strategy in 1998 [36, 37] which included a fee-waiver for people who could not pay for health services. This framework was further refined during brainstorming sessions at the second meeting. The social security and affordable housing initiatives in Brazil and Ethiopia are likely to play an important role in the life expectancy gains experienced by these two countries in the recent past. In terms of political participation, the United States ranks amongst the lowest of wealthy countries for voting participation rates and levels of trust [127]. Brazil has achieved significant milestones in gender equality in participation in senior/leadership positions particularly in science, technology and innovation [76]. Home While the findings clearly highlight the importance of studying a countrys policy context, there were limitations to what we could achieve with this approach. Addis Ababa: Minstory of Health; 2010. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. Doherty T, Rohde S, Besada D, Kerber K, Manda S, Loveday M, Nsibande D, Daviaud E, Kinney M, Zembe W, et al. The next countries in the longevity list were Italy, Switzerland, Japan and France, all of which have a rather significant variation in income. CBO. Res Soc Stratification Mobility. GINI index (World Bank Estimate). There was also a real rise in the minimum wage and employment rate in the mid 2000s [89]. The results of scoping review of the three countries presented here shine a light on possible political, structural, and social determinants that are driving global inequities in life expectancy, and help explain why some countries punch above or below their economic weight. WebHow does U.S. life expectancy compare to other countries? Pereira L, Santos L, Santos W, Oliveira A, Ratner D. Mais Mdicos program: provision of medical doctors in rural, remote and socially vulnerable areas of Brazil, 20132014. Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in Ethiopia. There were instances where timelines of available data differed slightly between countries, e.g. Bloom DE, Canning D. Commentary: the Preston curve 30 years on: still sparking fires. The Seqota declaration is managed under the National Nutrition Program [61], an initiative established in 2013 to improve the nutritional status of women, adolescents, young children and infants [62]. New York: The Rockefeller Foundation; 1985. 2011;13:469. Ethiopian demographic health survey 2016. Ziso E. From Dergue socialism to an Ethiopian neoliberalism: transition and reform under the EPRDF since 1991. The three Eastern European countries the Czech Republic, Slovakia and Estonia recent entrants to the developed countries list, have comparably lower incomes and also lower life expectancy. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 20142018. Sustainability. 2nd ed: University of California Press; 2008. We then undertook a narrative synthesis of these three sources - quantitative indicators, expert opinion, and existing literature and data on the context, history, and policies- for each country [13] to identify possible driving factors of population health performance relative to GDP. Finally, our review emphasised the importance of considering the equity of the distribution of population health within countries, as well as overall population health outcomes. It appears, however, that its significance lies in the way that benefits are distributed between people, rather than growth of average income per se. Life expectancy is highest in most of the worlds wealthiest countries. This was accompanied by new voluntary associations, new practices and institutions for democracy and policy making. > Life expectancy: 79.0 years (state: 77.3 years) > Pop. A study in central Ethiopia [52] found that most water schemes were located at a distance of less than 2km with less than a 30min round trip to fetch the water. 2020;30:58998. Yntiso G. Reality checks: the state of civil society organizations in Ethiopia. International Monetary Fund's World Economic Outlook database Life Giulianotti R, Itkonen H, Nevala A, Salmikangas A-K. WebGlobally, life expectancy has increased by more than 6 years between 2000 and 2019 from 66.8 years in 2000 to 73.4 years in 2019. Woolf S, Aron L. US health in international perspective: shorter lives, poorer health. J Ambul Care Manage. Venancio SI, Saldiva SRDM, Monteiro CA. N Engl J Med. A nations life expectancy reflects its social and economic conditions and the quality of its public health and healthcare infrastructure, among other Preliminary results of the scoping reviews for each country were presented at the 2019 expert opinion meeting by lead researchers (Ethiopia: HG, Brazil: EG, United States: CB). Part of So the list of developed countries already includes a number of assumptions that do not allow for objective comparison of income and life expectancy. Evaluation of the impact of the family health program on infant mortality in Brazil, 19902002. Crit Public Health. Life expectancy in Brazil has increased from 54 in the 1960s, to 68.5 in 1995 and 76.3 (72.8years for men, 79.9years for women) in 2018 [67].
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