One of the clearest metrics for defining healthy lives is longevity. As a metric, longevity rates are widely published and reveal differences in average life expectancy by age between countries. These differences reinforce the striking disparities associated with birthplace.
According to data published by the World Health Organization (WHO) in 2019 – thus excluding the impact of the COVID-19 pandemic – the life expectancy at birth in the top two countries on the list, Japan and Switzerland, are 84.3 years of age and 83.4 years, respectively, while the bottom two countries, Lesotho and Central African Republic, have a life expectancy at birth of 50.7 years and 53.1.
Inequities are of course not just between countries but within them. This is often termed the “Scotland or Glasgow effect” after the city in Scotland, where in less than a few kilometers a difference of 15 years in life span can be found. This is also true in the US where we have wide disparities in longevity by zip code.
Wicked problems call for collaboration, that’s why the World Economic Forum has partnered with Mercer on a new initiative to reduce the burden of non-communicable diseases (NCDs). New platforms and new models of care are being explored. Through the Digital Health Action Alliance, we are engaging with public and private partners to identify digital solutions across the continuum, taking a systems-change approach to reduce the morbidity and mortality of NCDs worldwide.
According to WHO, NCDs such as diabetes and hypertension account for 71% of all deaths. Premature death is defined as a death from a NCD in the age group 30-69. And it is precisely these premature deaths from NCDs that are one of the most tractable and treatable outcomes of health inequity.
Premature deaths from NCD’s account for 15 million deaths annually with 85% of the deaths occurring in low and middle-income countries (LMICs). Prior to the COVID-19 pandemic, trends in death due to NCDs were dropping in high-income countries as well as some LMICs in Latin American and Asia. In fact, progress in health-related Sustainability Development Goals (SDGs) was noted to be much better than compared to other SDGs in these regions. Thus we know it can be done.
However, COVID-19 has disrupted efforts and dramatically overwhelmed health systems. It has also amplified the vulnerability of people with NCDs who faced higher rates of infection, hospitalization and mortality.
Most LMICs have lost ground and many high-income countries are stagnating or even regressing on NCD deaths: in the US, research looked at county level data on premature death due to NCDs from 1999 to 2017, again prior to COVID-19. What they found was that the overall rate of decline for premature death due to NCDs had stagnated. What they also found was that the gap between rich and poor counties had widened. Thus, longevity rates in high-income counties were still rising, albeit slowly, but mortality rates were also rising in low-income counties.
Disparities in NCD outcomes in the US are impacted by income and another social determinant: race. It has been estimated that 30% of the differences in mortality between Black men and White men and 40% of the differences between Black women and White women is driven by disparities in Cardiovascular (CVD) outcomes. Racial and ethnic disparities in prevention, diagnosis, treatment and ongoing care related to CVD are documented in other jurisdictions including Brazil, the UK, and Canada amongst others.
Thus the imperative to close the gap on premature death from NCDs is a key initiative on economic, health and social justice agenda’s for all stakeholders.
The defined age group of 30-69 are prime working years and serve as a reminder that reducing deaths and improving health also improves economic and social participation. Thus we think that with a renewed focus and engagement across private and public partnerships, including employers we can close this close this gap.
We are finding that a mix of new tech and new funding when coupled with tried and trusted treatments and people can help turn this tide. We are also encouraged by a global community of spirited advocates and entrepreneurs, including employers who are collaborating to meet this challenge. Join us as we highlight opportunities for action and stay tuned for updates as we herald in a new era for NCD care.