1.1 Life expectancy gains since 2000
A long-term decline in mortality has led to consistent improvements in life expectancy for women and men. Since 1900, the global average life expectancy has more than doubled, and is now above 70 years (1) . Fertility around the world is also decreasing, down from 3.2 live births per woman in 1990 to 2.5 in 2019, and this drop is expected to continue (2). Longer lives and fewer babies means an aging population. In the Americas there are now 76 million people aged 70 or older, up from 46 million in 2000. As the population of the Region ages, the number of people living with and ultimately dying from chronic conditions increases, requiring a fundamental shift in health care and social support. This section explores trends and inequalities in life expectancy since 2000 using four simple measures: life expectancy (at birth and at 60 years of age), healthy life expectancy, and the number of years and proportion of time spent in less than full health (see Box 1 for details).
Box 1:
Measures of life expectancy
The average number of years that an individual is expected to live based on current mortality rates
The average number of years that an individual is expected to live in a state of self-assessed good or very good health, based on current mortality rates and prevalence of good or very good health
The difference between life expectancy and healthy life expectancy
The number of years in less than full health as a percentage of life expectancy
Regional life expectancy and healthy life expectancy at birth
In 2019, life expectancy for the Americas was 77.2 years, up from 74.1 years in 2000 and exceeding the global average by 3.9 years. Only two World Health Organization (WHO) regions had a higher life expectancy: Western Pacific (77.7 years) and Europe (78.2 years). Africa continued to have the lowest regional life expectancy (64.5 years) (Figure 1). Healthy life expectancy has also increased since 2000, but not by as much as life expectancy, so more years are spent in less than full health. A person from the Americas could expect to live 77.2 years in 2019, with an average healthy life expectancy of 66.2 years, so that 11 years (or 14% of their expected life) would be spent in less than full health. A man from the Americas can expect to live for 74.5 years, with 64.8 years of healthy life and 9.7 years (or 13%) in less than full health. A woman from the Americas can expect to live for 79.8 years, with 67.5 years of healthy life and 12.3 years (or 15%) in less than full health.
Women have always lived longer than men, and in the Americas this gender gap has narrowed in recent years, from 6 extra years of life among women in 2000 to 5.4 extra years in 2019. Europe and the Eastern Mediterranean also experienced a narrowing of the gender gap, with the gap widening in other regions. This 2019 gender gap for the Americas was close to the global average of 5 extra years of life among women.
Between 2000 and 2019 the Americas had the smallest improvement in life expectancy, increasing by an average of 8 weeks per year, compared to 13 weeks in the Eastern Mediterranean, 14 weeks in the Western Pacific, 16 weeks in Europe, 22 weeks in South-East Asia, 32 weeks in Africa, and 18 weeks globally. People from the Americas in 2019 also spent a greater proportion of time in less than full health, compared with other world regions. Women and men from the Americas on average spent 14.2% of their lives in less than full health, compared to proportions ranging from 11.7% to 14.0% in other world regions, and a global average of 13.1%.
Among people reaching 60 years of age in the Americas, their years of remaining life increased from 21.1 years in 2000 to 22.7 years in 2019 – higher than any other world region.
Regional life expectancy and healthy life expectancy among adults aged 60
Among people reaching 60 years of age in the Americas, their years of remaining life increased from 21.1 years in 2000 to 22.7 years in 2019 – higher than any other world region for the full 20-year period (Figure 2). This improvement amounted to an average life expectancy increase of 4 weeks for every year between 2000 and 2019, lower than the global average of 6 weeks per year. Women reaching 60 years of age could expect to live a further 24 years in 2019, and men a further 21.2 years – and this gender gap of 2.8 years had reduced from 3.1 years in 2000. In 2019 women and men reaching 60 years of age could expect to spend around one-quarter of their remaining lives in less than full health (6.1 years, 26.9% of their remaining years), compared to a global average of 5.4 years (25.5% of remaining life).
Subregional inequalities in life expectancy
There was considerable variation in life expectancy and healthy life expectancy between the 33 countries covered in this report. In 2019, life expectancy at birth ranged from a high of 82.2 years (Canada) to a low of 64.1 years (Haiti), a difference of 18.2 years of life. Healthy life expectancy ranged from a high of 71.3 years (Canada again) to a low of 55.8 years (Haiti again), a difference of 15.4 healthy years of life (Figure 3, Table 1).
Looking at each subregion of the Americas separately, the life expectancy range was 3.7 years in North America (Canada had the higher life expectancy at 82.2 years, and the United States of America had the lower, at 78.5 years), 4.9 years among the Southern Cone countries, 7.8 years among the Andean countries, 8.9 years in Central America, 10.8 years in the non-Latin Caribbean, and 13.7 years in the Latin Caribbean (Table 1). The Caribbean subregions generally had lower life expectancies and also had a larger spread of life expectancy. These larger ranges in the Caribbean were due to two countries with life expectancy around 65 years: Haiti in the Latin Caribbean and Guyana in the non-Latin Caribbean. There were similar subregional patterns for healthy life expectancy. People living in all subregions lived around 10 years of their lives in less than full health. Although the differences were small, people from Barbados in the non-Latin Caribbean spent the lowest proportion of their lives in less than full health (11.9%), whereas people from the United States spent the largest proportion (15.8%).
Explanations for life expectancy inequalities between countries are multidimensional and include, for example, the risk factor profile and health system structure in each country. The World Bank classifies all countries of the world according to their income status (using the gross national income per capita).1 Countries are divided into low-, lower-middle-, upper-middle-, and high-income groups, and these broad groups can tell a lot about a country’s economic well-being. In the Americas in 2019, compared to countries classified as high-income (9 countries), people living in upper-middle-income countries (19 countries) lived for 2.6 years less, people living in lower-middle-income countries (4 countries) lived for 4.2 years less, and the single low-income country (Haiti) had 13.7 years less of life.
Measures of health system structure are reliably related to life expectancy. Health expenditure can be measured as the percentage of a country’s gross domestic product (GDP) that is spent on health care. Using this measure, each additional 1% spent on health increased a country’s life expectancy by 6 months. A country’s health workforce can be measured as the number of doctors and nurses per 10 000 population. Using this measure, increasing the health workforce by 10 workers for every 10 000 people improved a country’s life expectancy by 5 months (Figure 4).
Figure 4: Association of health staffing and health spending with life expectancy at birth among 33 countries in the Americas, stratified by (1 and 2) Pan American Health Organization subregion and (3 and 4) World Bank income group
Data source:World Health Organization. Mortality and global health estimates.
1.2 Major shifts in causes of death since 2000
In the past 20 years, the global population has increased from 6.1 billion to 7.7 billion. As national populations grow, the burden on healthcare systems increases, and a detailed understanding of illnesses and injuries can help health providers to plan their healthcare supply.2 Population growth has varied around the world. Africa has seen the fastest recent growth, from 660 million people in 2000 to 1.1 billion in 2019 – an increase of 65%. Other regions have seen population growth from 7% (in Europe) to 50% (in the Eastern Mediterranean) (Table 2).
Within the Region of the Americas, population growth has been between 12% and 19% in North America and the Caribbean, and between 21% and 37% in Central America and South America (Table 2).
Changes in the number of deaths since 2000
The number of deaths globally has risen from 51.3 million in 2000 to 55.4 million in 2019, a rise of 8%. The Americas has seen a larger percentage increase in the number of deaths than any other WHO region (a 31% increase). Deaths also increased in the Western Pacific (23%) and the Eastern Mediterranean (24%), and remained steady or fell slightly in South-East Asia, Europe, and Africa (Table 2). In the subregions of the Americas, the number of deaths increased by between 20% (in the Caribbean) and 55% (Mexico).
Globally, between 2000 and 2019, the share of deaths due to communicable, maternal, perinatal, and nutritional conditions (CMPN) fell from 31% to 18%, the importance of NCDs rose sharply, from 61% to 74%, and those due to injuries dropped a little, from 9% to 8%. In 2000, CMPN conditions killed almost three times more people in Africa and South-East Asia than all other WHO regions combined. This situation has been improving, with the many ongoing public health interventions helping to reduce the CMPN burden from 68% to 53% of all deaths in Africa and from 44% to 23% in South-East Asia (Figure 5). All regions reported a decrease in the share of deaths due to CMPN conditions. In contrast, the relative share of deaths from NCDs has increased steadily, up from 24% to 37% in Africa, from 52% to 66% in the Eastern Mediterranean, from 47% to 69% in South-East Asia, from 77% to 81% in the Americas, from 79% to 87% in the Western Pacific, and from 87% to 90% in Europe. Across all regions, injuries accounted for between 5% and 10% of all deaths. Important spikes from injuries were seen in 2004 in South-East Asia (earthquake and tsunami), in 2008 in South-East Asia (a combination of natural disasters, including the Sichuan earthquake in China and Cyclone Nargis in Myanmar), and in 2010 in the Americas (earthquake in Haiti).
Deaths across the life course since 2000
In the Americas there were 7.2 million deaths in 2019, with the number of deaths unsurprisingly increasing with age. There were 197 000 deaths among young children (aged 0–4 years), 98 000 among youth (aged 5–19 years), 445 000 among young adults (aged 20–39 years), 1.6 million among adults aged 40–64 years, and 4.8 million among adults aged 65 and older. Causes of death were strongly age-specific, with CMPN conditions dominating deaths in young children (62% of all deaths), injuries dominating deaths in youth and young adults (58% of youth deaths, 50% of young adult deaths), and with NCDs dominating thereafter (81% of adults aged 40–64, 88% of adults aged 65+) (Figure 6). The spike in deaths from injuries in 2010 was due to the earthquake in Haiti.
Regional mortality rates in 2019
Mortality rates are based on the number of deaths registered in a country in a standard period of time (usually a year) divided by the population. All rates in this report have been age-standardized to the WHO World Standard Population (2001) to remove variations arising from differences in age structures across subregions and over time. Age-standardized mortality rates in 2019 are presented in Table 3, separately for women and men, and for three main causes of deaths: CMPN conditions, NCDs, and injuries. Changes in these age-standardized mortality rates between 2000 and 2019 are presented in Figure 7.
Changes in regional mortality rates since 2000
Noncommunicable diseases
NCD mortality rates dominated throughout the Region of the Americas. Rates in 2019 ranged between 326 and 489 per 100 000 among women and between 404 and 604 per 100 000 among men. The lowest rates were seen in the Andean subregion and highest rates in the two subregions of the Caribbean. These NCD mortality rates have generally declined in the 20 years since 2000. Rates across the Americas dropped by 70 per 100 000 among women (a 17% improvement) and by 111 per 100 000 among men (a 19% improvement). There were different patterns of NCD mortality rate decline between the subregions, with strong declines seen in Brazil (27.0% decrease) and the Southern Cone subregion (20.6% decrease), moderate declines in the Andean subregion (17.9% decrease), in North America (16.5% decrease), and the non Latin Caribbean (12.8% decrease), and little change among the Central American countries (5.9% decrease), Mexico (1.7% decrease), and Latin Caribbean (0.8% increase).
Communicable, maternal, perinatal, and nutritional conditions
Rates due to CMPN conditions were generally far lower than for NCDs. Subregional rates in 2019 ranged between 25 and 117 per 100 000 among women and between 30 and 131 per 100 000 among men. Improvements in CMPN conditions rates between 2000 and 2019 were seen in all subregions, with the largest decrease seen in Central America (49.5% decrease) and the smallest seen in the Southern Cone subregion (5.0% decrease).
External causes
Subregional rates due to external causes in 2019 ranged between 20 and 44 per 100 000 among women and between 64 and 139 per 100 000 among men. Other than important decreases seen in the Andean subregion (31.6% decrease) and the Southern Cone subregion (20.1% decrease), rates were generally unchanged between 2000 and 2019. The spike in deaths from injuries in 2010 in the Latin Caribbean was due to the earthquake in Haiti.
Gender difference
Differences in mortality rates between women and men were smallest for the CMPN conditions (largest gender difference 30 per 100 000 in the non-Latin Caribbean, smallest gender difference 6 per 100 000 in North America). Differences in mortality rates between women and men were largest for NCD rates (largest gender difference 186 per 100 000 in the Southern Cone subregion, smallest gender difference 78 per 100 000 in the Andean countries).
Regional inequalities
Absolute differences in subregional mortality rates are presented in Figure 8 for the eight PAHO subregions of the Americas, and in Figure 9 for the same countries stratified into World Bank income groups. When looking at health inequalities, each subregion or income group is compared to the subregion or income group with the best health metric – in this case the lowest mortality rate. This comparison is called the excess mortality rate.
Communicable, maternal, perinatal, and nutritional diseases
The lowest mortality rates for CMPN conditions in 2019 were reported in North America, with 25 per 100 000 among women and 30 per 100 000 among men. The excess mortality rate ranged from 31 per 100 000 (Mexico) to 101 per 100 000 (Latin Caribbean) among men and between 18 (Mexico) and 92 (Latin Caribbean) among women. The high excess mortality rate in the Latin Caribbean was primarily because of the continuing high mortality rate from CMPN conditions in Haiti (222 per 100 000 among men and 215 per 100 000 among women). CMPN conditions were lowest among countries designated as high-income by the World Bank (28 per 100 000), with similar rates in women and men. Middle-income countries reported extra deaths compared to the high-income countries (upper-middle-income countries reported 47 excess deaths per 100 000, lower-middle-income countries reported 70 excess deaths). Haiti was the only low-income country in the Region in the 2019 World Bank classification.
Noncommunicable diseases
The lowest mortality rates for NCDs in 2019 were reported in the Andean subregion, with 326 per 100 000 among women and 404 per 100 000 among men. The excess mortality rates – which highlight differences in mortality rates between PAHO subregions – are noticeably higher for NCDs than they are for CMPN conditions or external causes. The highest excess mortality was in the Caribbean, with excess rates for women of 126 per 100 000 (non-Latin Caribbean) and 163 per 100 000 (Latin Caribbean) and excess rates for men of 175 (non-Latin Caribbean) and 199 (Latin Caribbean). NCDs were lowest among countries designated as high-income by the World Bank (394 per 100 000), with higher rates in men compared to women (461 per 100 000 among men, 335 among women). The excess mortality rates for upper-middle- and lower-middle-income countries were then 40 and 128 per 100 000 among men, and 19 and 160 per 100 000 among women. Haiti was the only low-income country in the region in the 2019 World Bank classification.
Figure 8: Excess mortality rates (per 100 000) in 2019 in subregions of the Americas, compared to the subregion with the lowest mortality rate, for communicable, maternal, perinatal, and nutritional (CMPN) conditions, noncommunicable diseases (NCDs), and deaths from external causes
External causes
Mortality rates from external causes in 2019 were rather different between women and men. Among men, the lowest rates were seen in North America (64 per 100 000) and the Southern Cone subregion (68 per 100 000). The remaining five subregions had excess mortality rates from 35 per 100 000 (Mexico) to 75 per 100 000 (Central America). Mortality rate differences among women were smaller. The lowest female mortality rate was in the Southern Cone subregion (20 per 100 000), with excess mortality rates between 2 per 100 000 (Mexico) and 24 per 100 000 (Latin Caribbean). Among men the lowest rate was among high-income countries (64 per 100 000). Excess mortality rates were then 46 per 100 000 (upper-middle-income) and 71 per 100 000 (lower-middle-income). Among women the lowest rate was in both high-income and upper-middle-income countries (24 per 100 000). The excess mortality rate was then 26 per 100 000 in lower-middle-income countries. Haiti was the only low-income country in the region in the 2019 World Bank classification.
Figure 9: Excess mortality rates (per 100 000 people) in 2019 in countries of the Americas classified by World Bank income groups, compared to the income group with the lowest mortality rate, for communicable, maternal, perinatal, and nutritional (CMPN) conditions, noncommunicable diseases (NCDs), and deaths from external causes
Data source:World Health Organization. Mortality and global health estimates.
1.3 Summary of key messages
Life expectancy
Mortality
Footnotes
1 In 2019, in the 33 countries of the Americas with available data from the Global Health Estimates, Haiti was categorized as a low-income economy (gross national income [GNI] USD 1035 or less), 4 countries were classified as lower-middle-income (USD 1036 to 4045; Bolivia [Plurinational State of], El Salvador, Honduras, Nicaragua), 9 countries were classified as high-income (GNI USD 12 536 or more; Antigua and Barbuda, Bahamas, Barbados, Canada, Chile, Panama, Trinidad and Tobago, United States of America, Uruguay). The remaining 19 were classified as upper-middle-income (GNI USD 4 046 to 12 535). See Appendix 1 for the full list of countries in the Americas used in this report.
2 The size and age-structure of a country’s population influence the amount and type of diseases and injuries. The many disease risks in a country also influence a country’s burden of disease. Population was mentioned briefly in the previous section on life expectancy. Population aging and preventable noncommunicable disease risks are considered further in Chapter 3.
