Christian Science Monitor (US),
November 4, 2004
In Some Nations,
the Rise of 'Shortgevity'
It's an article of faith among most 21st-century
humans that life is getting longer. In the
last three decades, the average life span at
birth has increased from about 60 years to
67 years worldwide, a remarkable achievement.
But in two dozen countries, human life spans
are shortening for one of the few times since
the bubonic plague swept through Europe and
elsewhere in the 14th century. One expert calls
the situation a "shortgevity" crisis.
The greatest setback has been in sub-Saharan
Africa, swept by the HIV/AIDS epidemic. In
all, 10 African countries have seen projections
for their average life span fall below 40 years
of age. The good news is that in Russia and
in some of its close neighbors, the decline
seems to have been reversed. Such trends are
key to future prosperity.
"We talk a lot about the inequality of wealth
[between the developed and developing worlds],
and it seems to me we don't talk enough about
the inequality in length of life, because connected
with that of course is education, vigor, productivity,"
says Robert Butler, founder and chief executive
of the International Longevity Center in New
York and professor of geriatrics at Mount Sinai
Medical Center there.
The world should care about what he calls shortgevity
for self-interested reasons, he adds. "If
we really are serious about the concept of
global trade, then we'll realize that those
other nations have to be given a fighting chance
to be productive as well. And if they're not,
they are not going to have the money to buy
all our wonderful products and exchange goods
For Russians and other members of the former
Soviet bloc, the situation looked bleak a few
years ago. The fall of the Soviet state in
1991 left "a degree of disorder that was
disadvantageous to health," says Kenneth
Hill, a demographer and director of the population
center at the school of public health at Johns
Hopkins University in Baltimore.
While infant mortality didn't rise significantly,
self-destructive behaviors by adults did, including
alcoholism. A clear social structure, based
on party loyalty, had collapsed, and nothing
had replaced it.
"It wasn't so much that the healthcare system
worsened, but that the people's general spirit
worsened," Dr. Hill says. That feeling
of helplessness was associated with high mortality.
"There's some evidence that being depressed
isn't just bad for your mental health, it's
bad for your physical health as well,"
Today illicit drugs and alcoholism are still
major social ills in the region. But the outlook
has begun to improve as those countries stabilize
socially and economically, though longevity
rates have still not returned to their peak
levels of the 1980s.
In sub-Saharan Africa, the picture remains alarming.
Experts attribute much of the problem to the
HIV/AIDS epidemic there, which accounts for
25 million of the 40 million cases of HIV/AIDS
in the world. According to the latest United
Nations Human Development Report, life expectancy
in Zimbabwe plummeted from 56 years in 1970-75
to just 33.1 today. Zambia went from 49.7 years
to 32.4 in the same period, Lesotho from 49.5
to 35.1, and Botswana from 56.1 to 39.7.
"With the onset of HIV/AIDS we have seen
a lot of the work we have done, and the gains
we have achieved, being eroded," says
Wilfred Mlay, who directs African operations
for World Vision, a privately funded Christian
relief and development organization at work
in 25 sub-Saharan countries. Consequently,
Dr. Mlay says by phone from Nairobi, Kenya,
World Vision now is working hard to help African
governments provide AIDS education and assist
the most vulnerable, teaching both sexual abstinence
outside marriage and the use of condoms. Some
99 percent of HIV infections in Africa in 2001
were caused by unsafe sex practices, according
to a study by the World Health Organization
(WHO) released in 2002. That leaves hope that
lifestyle changes can lower infection rates.
World Vision also supports people with AIDS by
giving them nutrition and medications Keeping
parents healthy and alive longer means fewer
orphans who must be cared for. "We are
beginning to see some minor changes" in
behaviors, Mlay says.
"If you were to take AIDS away, I think
you would see gains [in longevity] everywhere,"
says John Bongaarts, vice president for policy
research at the Population Council in New York.
"Overall, the developing world is a success
Based on current UN projections, HIV/AIDS is
expected to be the source of so many fatalities
that by 2025 these countries will have 14 percent
fewer people than they would have otherwise.
Projections of HIV/AIDS fatalities in China
and India suggest a difficult battle ahead
for those two countries as well.
The burden on families will be "staggering,"
the report says. But it adds: "The course
of the HIV/AIDS epidemic is by no means predetermined.
The eventual course of the disease depends
on how individuals, communities, nations, and
the world respond to the HIV/AIDS threat today
Still, the cost of caring for those already sick
and their families can be overwhelming. In
the United States, it costs about $ 10,000
per year to treat a person who is diagnosed
with HIV, Dr. Bongaarts says. "In many
of these sub-Saharan countries, the governments
spend less than $ 10 per year per capita on
health. So there's not much you can do with
that money to treat people." Generic versions
of AIDS drugs can substantially cut the cost.
"But even so, that is an enormous expense,"
Every year of life expectancy gained is estimated
to raise per capita gross domestic product
in a country by about 4 percent. That's prompted
some researchers to question whether development
aid to Africa, only about 10 percent of which
is aimed at improving health, is being properly
spent. It's in everyone's interest "to
overcome what I call the 'longevity di- vide,'
" Dr. Butler says.
While the per capita GDPs of sub- Saharan countries
have not dipped as dramatically as their longevity
rates, that measure can be deceiving, Hill
says. The deaths of young adults have reduced
the labor force, but that has allowed survivors
to pick up extra work and boost their own earnings.
Thus, the fall in per capita GDP doesn't look
Longevity is one of several measures the UN uses
to determine a population's well-being, rather
than simply tracking wealth per capita. Its
Human Development Index also includes school
enrollment, literacy, and income to produce
a broader picture. "People are the real
wealth of nations," concludes a report
last July by the UN Development Program.
To attack Africa's health problems, not only
money but new ideas are needed, Butler says,
such as a vaccine to protect against malaria,
which is linked to more than 1 million deaths
a year worldwide. Some $ 2.5 billion a year
- 10 times what is being spent now - is needed
to combat malaria in Africa, the WHO said this
week. Also needed is a way to get vaccines
to remote villages without spoiling.
Though vaccines are seen as important, traditionally
researchers cite rising incomes, better education,
healthier lifestyles, and cleaner environments
as the major keys to increasing longevity.
Long life spans
Residents of developed nations usually live longest,
experts believe, because they have access to
basic amenities such as clean drinking water
and modern sanitation. Places with the longest
life expectancy at birth are:
Country Life expectancy*
1. Japan 81.5 years
2. Sweden 80.0
3. Hong Kong 79.9
4. Iceland 79.7
5. Canada 79.3
6. Spain 79.2
7. Australia 79.1
(tie) Israel 79.1
(tie) Switzerland 79.1
10. France 78.9
*for a child born in 2002
Source: UN Development Program
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