Peaceful Societies Promote Longer Life
By Dr Syed Amir
Bethesda, MD
Countless terrorist bombings, vicious ethnic and sectarian strife and surging religious extremism have overshadowed the enormous human toll that disease and death from preventable causes extract from the population in Pakistan.
The country did not score well in a recent global population study sponsored by the University of Washington, Seattle, and undertaken by 500 scientists in 50 countries that examined global health and disease profiles. The researchers compared changes in health status of various countries, grouping together countries with comparable per capita incomes, during the twenty-year period from 1990 to 2010. The findings, the authors hope, will stimulate a dialogue on how best to combat the global menace of premature morbidity and mortality.
The average life expectancy in Pakistan at birth during the twenty-year period moved up slightly from 62 to 66 years, placing it at 9th position among fifteen developing countries with similar per capita incomes (a score of 15 is the worst and 1.0 the best). Vietnam, battered by years of warfare, has now recovered fully and has an impressive average life expectancy of 76 years, placing it at the top of the 15 nations studied. India on the other hand fared slightly worse than Pakistan, with a ranking of 10 and life expectancy of 65 years. However, its average longevity did go up by seven years. Papua New Guinea in the southwest Pacific Ocean and one of the poorest countries of the world found itself at the bottom of the 15-nation list, with a life span of only 59 years. Rich, industrialized Western nations were grouped separately and not included in this list.
Although infant mortality in Pakistan still remains a big problem largely because of deaths from lower respiratory infections (bronchitis and pneumonia) and diarrheal diseases, there is a silver lining. With the increasing availability of childhood immunizations, there has been a sharp (41%) decline in infant mortality during the past two decades. In adults, diseases such as diabetes, heart disease, stroke and chronic kidney disease in particular have been on the rise, with a corresponding increase in the death toll from these causes. Worse yet, these diseases cause disability affecting mostly men in their most productive years of life.
The World Health Organization (WHO) estimates that Pakistan spends 2.5 percent of its GDP on health. It is one of the three countries where polio is still endemic and the incidence of tuberculosis (TB) is the sixth highest in the world. Diabetes which was ranked 32 as the cause of death in Pakistan in 1990 moved up to a position of 14 in 2010. Similarly, heart disease, now the 6th leading cause of death, was not as deadly and ranked 10th twenty years ago. The WHO employs an ingenious criterion to measure the true burden of morbidity and death on the population. Termed disability adjusted life years (DALY), it estimates the number of productive years lost by a country due to illness, premature disability and death.
Of the developed countries, Russia presents an intriguing case. It is a vast and powerful country; yet, the health profile of its population is dismal, with a life expectancy of 69 years, just a few years ahead of Pakistan, but significantly worse than Philippines (70 years), Malaysia (74 years) and Botswana (71 years). In fact, of the fifteen countries it is clustered with, Russia has the worst average life span, except for Gabon in Africa. And, paradoxically, the country has the largest number of doctors, nurses and trained health care professionals per capita than any other country.
Since the breakup of the Soviet Union, the health status of Russians has been progressively worsening. Heart disease, stroke and, more ominously, HIV/AIDS (in that order) are the three main causes of premature death in Russia. While cases of all three have been on the upswing, the most worrying is the phenomenal jump in the incidents of HIV/AIDS and related TB cases, spread mostly via intravenous drug use and heterosexual sex. Furthermore, extensive use of tobacco and alcohol strongly contributes to the incidents of morbidity and death. An estimated 60 % of Russian males smoke, as compared to 22% in the US, while nearly half the population is overweight.
In a recent article in Washington Post, the Moscow-based correspondent, Kathy Lally cited some sobering statistics on the spread of HIV/AIDS in Russia. According to the data, there were few, if any, known HIV/AIDS cases in 1990 in the former Soviet Union, but now 1.2 million Russians may be HIV positive, although official figures are much lower. Many AIDs patients suffer from and die of TB, and its treatment has become a major problem for hospitals, because of the growing resistance of the TB germs to normal antibiotics. As a result of higher mortality rate and lower childbirth, the Russian population has gone down by 1.59% in the past two decades, causing much concern to the Government. It is offering a variety of incentives to women to have more children.
The United States presents another interesting case study. The only remaining superpower, it has an average life span of 78.5 years, lagging behind a number of smaller countries in longevity, including Japan (83.9), European Union (79.8) and Singapore (81). Only three countries in the group of 15, with comparable per capita income - Brunei, United Arab Emirate and Kuwait - have a worse average life expectancy than the US. Yet, the US expenditure on health care in 2008 was the highest as a percentage of its GDP (15.2%) than any other country. The huge expenditure on medical care notwithstanding, there were 49.9 million Americans or 16.3 percent of the population who were without medical insurance in 2010. Much relief for the uninsured, however, is expected when the new affordable care act, or Obama Care as scornfully dubbed by the Republicans, comes into full effect.
With the advent of antibiotics and the institution of hygienic practices, infectious diseases have greatly subsided in the US. Heart disease, lung cancer and stroke are responsible for the greatest number of deaths and disability as measured by the number of years of life lost. The most impressive success has been achieved in the control of HIV/AIDS, which has dropped from the 7th place to 23rd as the cause of early morbidity and death.
Some conclusions can be drawn from the data from the global study. The three countries with the highest life span are Japan, Switzerland and Hong Kong. Besides a high level of education and prosperity, they are also blessed with a peaceful way of life and freedom from ethnic and religious violence.
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