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Longevity Progressiveness Ranking of 50 Regions

Health-adjusted life expectancy is affected by various factors and their impact varies across countries. For this reason, the Ranking is based on five domains: economy, health and healthcare, environment and infrastructure, society and demography.
 
These domains consist of 50 indicators derived from international data sources, including the World Bank, the World Health Organization (WHO), the International Labour Organization (ILO), Organization of Economic Cooperation and Development (OECD).
 
The rankings show how countries compare in terms of health and wellbeing. The values, on which the rankings are based, show how countries are performing. In particular, they show how different countries compare with the best-performing countries and their potential for improvement. The difference in Index values between countries is sometimes minimal, as there several countries with high level of life expectancy and of the same level of development. A difference of 0.1 or more points can be considered statistically significant.
 
The Ranking has been calculated using the most relevant, reliable data for 2016 from international sources that is comparable across countries. Data from national sources is often more up to date than international data sets because of the time it takes to process, standardise and introduce data into international data sets. This means that the Ranking does not necessarily reflect the current situation, such as the outcomes of policies that have recently been introduced.

● Economy:

Measured by unemployment rate, poverty rate in old age, living standards using GDP per capita, income Gini coefficient.

 

● Health and Healthcare:

 

Measured by life expectancy at birth, healthy life expectancy at birth, chronicle disease burden, healthcare expenditures and psychological well-being. Good physical and mental health is critical to social and economic engagement of people.

 

● Environment and Infrastructure:

 

Measured by access to safe water sources, physical safety, natural factors. These indicators capture the enabling attributes of the communities in which older people live.

 

● Society:

 

Measured by social connection and development of human capital.

 

● Demography:

 

Measured by major demographic indicators.

To conduct an in-depth analysis of Global Healthy Longevity, we applied a compound annual growth rate (CAGR) to several metrics from 1-3 levels of key importance. What is CAGR? Compound annual growth rate is a business and investing specific term for the geometric progression ratio that provides a constant rate of return over the time period. It could be calculated using the following formula:
 
 
 
 
 
 
 
Therefore, we were able to explore different dimensions of countries’ performance in some of the crucial indicators. As a result, the following 4-6 levels of metrics have been set up to evaluate countries’ HALE and their impact factors (some of them may have been mentioned on the previous page, but it’s worth to mention them separately to highlight their importance):

Longevity Ranking of 50 Countries

Inequality in health, education and income levels of population across countries is increasing between top-ranked, high-income countries and bottom-ranked, predominantly low-income countries. The countries doing best in the Ranking have social and economic policies to improve healthcare systems, and wellbeing, decrease disease burden and engage healthy lifestyle. They have long-standing social welfare policies on better access to healthcare, as well as, minimization of behavioural risk factors including smoking and alcohol use, as well as diet and low physical activity. At the same time, bottom-rank low-income countries care about their citizens less than countries doing best in the Ranking. It comes out medicine, insurances, policies, dealing with economics issues. This complex is a reason to inequality in health.

Health-adjusted Life Expectancy and Ranking Score

Ranking is correlated with health-adjusted life expectancy (HALE) across observed countries. It means that a combination of macroeconomic indicators influences the span of living in good health . The rankings show how countries compare in terms of health and wellbeing.
 
Among observed countries Singapore has the highest HALE and topped the ranking with Israel at the second place. It prioritised health and education and established universal health insurance and social pensions. South Africa has the lowest HALE and score. Older people in the country experience many hardships, with few able to access basic services. Family ties remain strong, but traditional support systems are changing and older people are increasingly left with the responsibility of childcare without any formal support. Low quality of healthcares services and poverty contribute to low HALE and high mortality.

Economy

By economic factors Luxemburg has the highest score. Luxembourg has the highest level of GDP per capita, which measures the level of living standards. Top 25 countries ranked by economic factors are developed countries with low level of unemployment, low inflation, high level of income and wealth. They are capable of maintaining high living standards and quality of life. Japan has a higher GDP per capita among other countries from Asia-Pacific region and its ranking reflects progressive economic policies. It prioritese health and education Developing countries have lower scores as in developing countries level of poverty is higher compared to developed. South Africa has the worst score according the ranking. The highest income inequality, low level of GDP per capita are the major factors that contribute to such results.

Gross Domestic Product and Healthy Longevity

There is relationship between GDP per capita and health adjusted life expectancy. Economic growth not only through an increase in total GDP, but also through long term gains in human and physical capital that raise productivity leads to better health. Population of wealth nations live longer and healthier life comparing to low-income countries, such as India, Indonesia, South Africa.
 
There is also inverse relationship. Better health and longer life lead to increase in economy’s health, which is measured by gross domestic product. That is why promotion of better health both in developed and developing countries is in priority for their potential economic benefits.

Income Inequality

Greater economic inequality appears to lead to worse health outcomes. High levels of inequality negatively affect the health, socio-economic inequality leads to more stress, fear, and insecurity for everyone. The World Bank’s Gini index shows South Africa to be the most unequal society in the world, Gini Coefficient equals 63%. Among observed countries South Africa has also the lowest level of health-adjusted life expectancy. That proves hypothesis of positive correlation between poverty and poor health. So, the major factor that affects public health and life expectancy is not the level of wealth but how evenly it is distributed. One of the wealthiest nations in the world, the United States, has some of the worst health outcomes because inequality is rife. Nations, such as Sweden, Belgium, Czech Republic, with the smallest income gaps between households have significantly fewer infant deaths than other nations, higher level of public health and life expectancy, better access for healthcare and medical services among different socio-economic groups.

Unemployment and Health

South Africa has the highest level of unemployment rate among chosen countries. Unemployment creates poverty which is in tum a major cause of ill health. People who are obliged to follow the cheapest diets have little scope for healthy eating. Unemployment also leads to increase in mental health disorders. Populations of developing countries with higher unemployment rate, such as Greece, Turkey, Brazil, Iran, Argentina, are far more likely to be diagnosed with depression and report feelings of sadness and worry.
 
Developed countries through government initiatives and social programmes maintain financial security, provide proactive health care and retrain for re-employment to reduce the impact of unemployment on health.

Health and Healthcare

Japan is the first in health and healthcare ranking with the highest life expectancy in the world. Singapore is the second and Israel is the third. Singapore has developed and effective healthcare system, developed medical facilities and improved access to healthcare infrastructure, relatively low level of chronic disease. Although it is worth noting that the difference in Index values between top-ranked countries is not large. Panama leads the Latin America and Caribbean region. The relatively high scores are due in large part to the existence and effectiveness of government policies, with an orientation towards social policy in general and policies on ageing in particular. By health and healthcare assessment India is 49. Good services are scarce in rural areas where most people live.

Public Healthcare Expenditures

It is vital for all countries to appropriately invest in their health sector. Evidence shows that investing in health significantly benefits the economy. Bigger share of healthcare expenditures in developing countries will lead to improvement of the health status of the population in the region.
 
The exception is the United States. Relative to the size of its wealth, the United States spends a disproportionate amount on health care, which leads to financial burden but not to increase in public health.

Out-of-pocket Expenditure

Reliance on out-of-pocket payments varies considerably across the globeю It is used to monitor how well a health system is performing in terms of financial protection.
 
The highest level of out-pocket expenditure across chosen countries is in India. The Indian government is unable to cover the full spectrum of health-care needs because of persistently low public investment in health, a lack of human resources and poor health infrastructure, which increase the cost and the financial burden of care.

Annual Cigarette Consumption

The highest level of annual cigarette consumption per capita is in Luxembourg. There is negative correlation between smoking and HALE across countries. Smoking leads to disease and disability and harms nearly every organ of the body. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.

Alcohol Consumption per Capita

Heavy drinking and beer are linked to increased weight gain, while moderate drinking and wine are linked to reduced weight gain or even weight loss. Moderate consumption can benefit health reducing the risk of heart disease, but heavy drinking may increase it. Hard drinking alcohol increases risk of certain cancers, especially mouth and throat cancer.

Tuberculosis

Tuberculosis is one of the top 10 causes of death worldwide. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death.
 
Tuberculosis occurs in every part of the world. In 2016, the largest number of new tuberculosis cases occurred in the South-East Asia and Western Pacific regions, followed by the African region.

Disability-adjusted Life Years (DALYs)

DALY represents the loss of the equivalent of one year of full health. The highest burden of disease among chosen countries is in India and China. The burden of disease, expressed in DALYs per 1000 population, has decreased in all regions during the period of 2000-2016, with the WHO African region having attained the largest decline (44%). This region, however, still bore the highest burden in 2016, 587 DALYs per 1000 population. This is over two-fold the burden of disease in the region with the lowest DALY rates (270 per 1000 population) in 2016: the WHO Western Pacific region.

Environment and Infrastructure

Israel is the first in Environment and Infrastructure followed by Spain, Singapore and Chile. All countries in the top of the ranking have high level of usage of adequate sanitation facilities and improved water sources. Favourable climate conditions are major factors that affect subranking. Israel’s location is characterized as a subtropical region. The northern and coastal regions of Israel show Mediterranean climate characterized by hot and dry summers and cool rainy winters. The climate of Spain is temperate with hot summers and cold winters inland and cloudy, cool summers and cool winters along the coast. Italy climate is also considered to be one of the healthiest in the world. The climate is Mediterranean with hot summer and mild relatively rainy winter. In Italy and Spain there are from 300 to 340 sunny days a year.

Mortality Attributable to Ambient Air Pollution

Ambient air pollution results from emissions from industrial activity, households, cars and trucks which are complex mixtures of air pollutants, many of which are harmful to health. Of all of these pollutants, fine particulate matter has the greatest effect on human health. Countries with higher level of environmental pollution have lower public health and health-adjusted life expectancy.

Society

By evaluation of society the first country is the United States. The second and the third are Iceland and Norway respectively. The United States has the largest network of age-friendly cities and communities among chosen countries. There are 357 of them. The main purpose of such public and private initiatives is to create age-friendly environments fostering healthy and active ageing. They enable older people to age safely, continue to develop personally. Norway and Iceland have small number of age-friendly cities but have relatively high level of gender equality and place higher positions in Human Development Index. These countries have relatively advanced opportunities for development of human potential. They divide well their resources and opportunities among their male and female populations

WHO Age Friendly Cities and Communities

There is relationship between GDP per capita and health adjusted life expectancy. Economic growth not only through an increase in total GDP, but also through long term gains in human and physical capital that raise productivity leads to better health. Population of wealth nations live longer and healthier life comparing to low-income countries, such as India, Indonesia, South Africa.
 
There is also inverse relationship. Better health and longer life lead to increase in economy’s health, which is measured by gross domestic product. That is why promotion of better health both in developed and developing countries is in priority for their potential economic benefits.

Gender Gap

There are gender-based differences in life expectancy, healthy life years. Women live longer than men but spend fewer years in good health. The gender pay and pension gaps put older women in particular at risk of poverty which creates barriers to health services. This is partly due to the socially roles of men and women, and the relationships between them. Reduction gender gap in economic opportunities, education, politics leads to increase in public health and population wellbeing.

Demography

Panama is the first by demography situation. The annual growth rate in Panama is very much on track with that of the world at large, with the population growing 1.77% as of 2016. The country has seen reasonable, positive migration since 1995 and the birth rate is also very near to the worldwide average with 2.51 children being born to the average woman in the Panama. This rate of growth is very healthy and sustainable. Israel has the highest value of crude birth rate among chosen countries, relatively low levels of population over 65 years (11.5% of total population) and age dependency ratio. In the top of this subranking developing countries, such as Turkey, Qatar, Mexico, dominate. Most developing country populations have a young age distribution with considerable potential for population growth.

Natural Population Growth

Countries, such as South Africa, India, Indonesia, Iran, Mexico, with higher birth rate have lower life span and healthy years. High birth rates in developing nations correlates with higher death rates and more mortality from infectious diseases, comparing to developed countries.
 
In case of Japan, death rate is bigger than birth rate, but life expectancy is one of the highest in the world. High life expectancy in Japan is the result of the growing population of older people.

Old-Age Dependency Ratio

The old-age dependency ratio is the ratio of the number of elderly people at an age when they are generally economically inactive, compared to the number of people of working age. It is an indicator of how many potential retirees a potential worker has to support. It also illustrates ageing populations.
 
The evolution of dependency ratios depends on mortality rates, fertility rates and migration. Developed countries have seen prolonged increases in life expectancy, which most analysts project to continue, implying an increasing number of older people and most likely of pensioners too. There have also been substantial declines in fertility, which, of course, will eventually diminish the number of workers entering the labour market. Developing countries opposite trend of increase in birth rate and relatively low old-age dependency ratio.
 
Japan has the highest old-age dependency ratio among chosen countries, it equals 439 in 2016. High old-age dependency ratios in Finland, Italy, Germany, France suggest increases in economic activity at older ages may help to offset the impact of population ageing on the economy in the future.