Following over half a century of rapid improvements to medicine, public hygiene and healthcare infrastructure, progress is beginning to decelerate and lifespan disparities based on geography and socioeconomic status are growing. The 15th edition of the World Economic Forum’s Global Risks Report, created in partnership with Marsh & McLennan and Zurich Insurance Group, examines the factors behind this slowdown, and the repercussions for the broader (re)-insurance market and industry.
Global investments in health in recent decades have yielded substantial gains to both longevity and quality of life. Over the long history of our species, the average life expectancy at birth for people in most societies ranged from 20 to 50 years. Since 1950, this has improved significantly — to 72 years globally (1), of which 63 years on average are lived in good health, free of disease or disability. (2)
Many factors have contributed to this success: scientific breakthroughs; better hygiene, sanitation and nutrition; health policies and investments made possible by prosperity; international cooperation; and individual choices. Vaccines illustrate this point: after germ theory took hold in the late 19th century, scientists developed vaccines for many deadly infectious diseases including smallpox, measles, polio, pertussis, diphtheria, tetanus and tuberculosis. Smallpox — once among the deadliest diseases — was the first to be eradicated by national programs and international cooperation in surveillance and containment, reinforced by people’s trust in health systems and their willingness to be vaccinated. Coordinated immunization programs continue to prevent millions of deaths annually. (3)
However, strained health systems are leading to worrying trends. Gains in lifespan and healthspan (the number of years spent in good health) seem to be slowing in both developed and developing countries. (4). For example, recent data published by the Centers for Disease Control and Prevention shows that US life expectancy declined in 2017 for the third year in a row, the longest sustained drop for a century — since the combined effects of World War I and a global influenza pandemic. (5) In Singapore, although life expectancy has increased since 1990, people are spending more of their lives in sickness. (6) Disparities in health outcomes persist within and across countries. A baby born in Hong Kong SAR can expect to live for 85 years, versus just 52 years in the Central African Republic (see chart below). (7) Meanwhile, rich-poor health gaps are growing in countries including the United Kingdom and the United States. (8)
1. WHO (World Health Organization). 2019. Global Health Observatory (GHO) Data: Life Expectancy. https://www.who.int/gho/ mortality_burden_disease/life_tables/situation_trends/en/
2. WHO (World Health Organization). 2019. Global Health Observatory (GHO) Data: Healthy Life Expectancy (HALE) at Birth. https://www.who.int/gho/mortality_burden_ disease/life_tables/hale_text/en/
3. WHO (World Health Organization). 2019. “The Power of Vaccines: Still Not Fully Utilized”. https://www.who.int/publications/10-year-review/vaccines/en/
4. Cardona, C. and D. Bishai. 2018. “The Slowing Pace of Life Expectancy Gains since 1950”. BMC Public Health (2018) 18:151. DOI 10.1186/s12889-018-5058-9. https:// bmcpublichealth.biomedcentral.com/track/ pdf/10.1186/s12889-018-5058-9
5. Murphy, S. L. B. S., J. Xu, K. D. Kochanek and E. Arias. 2018. “Mortality in the United States, 2017”. Centers for Disease Control and Prevention, NCHS Data Brief No. 328, November 2018. https://www.cdc.gov/nchs/ products/databriefs/db328.htm; Bernstein, L. 2018. “U.S. Life Expectancy Declines Again, a Dismal Trend Not Seen since World War I”. The Washington Post. 29 November 2018. https://www.washingtonpost.com/national/ health-science/us-life-expectancy-declinesagain-a-dismal-trend-not-seen-since-worldwar-i/2018/11/28/ae58bc8c-f28c-11e8-bc7968604ed88993_story.html
6. Lim, J. 2018. 2019. “Singaporeans Living Longer but Spending More Time in Ill Health: Study”. Today. 20 June 2019. https://www. todayonline.com/singapore/singaporeans-living-longer-spending-greater-proportion-time-ill-health-study
7. World Bank Open Data. Life Expectancy at Birth. https://data.worldbank.org/indicator/ SP.DYN.LE00.IN?most_recent_value_desc=false, accessed 01 December 2019.
8. Public Health England, Gov.UK. 2018. “Health Profile for England 2018. Chapter 5: Inequalities in Health”. https://www.gov. uk/government/publications/health-profilefor-england-2018/chapter-5-inequalities-inhealth; Bleich, S. N., M. P. Jarlenski, C. N. Bell and T. A. LaVeist. 2012. “Health Inequalities: Trends, Progress, and Policy”. Annual Review of Public Health. 33 (1): 7–40. https:// www.annualreviews.org/doi/full/10.1146/annurev-publhealth-031811-124658