Muhammad Hammad

1. CHANGE AND INEQUALITY IN HEALTHY LONGEVITY

Globally, the 5.4-year increase in Healthy Life Expectancy (HALE) between 2000 and 2019 was driven mainly by declining mortality (96%) rather than reduced morbidity (4%). Key contributors included reductions in communicable diseases like HIV/AIDS, tuberculosis, and lower respiratory infections, especially in Africa and South-East Asia, and NCDs like stroke and ischaemic heart disease in regions like the Americas and Europe. However, rising diabetes morbidity and dementia mortality partially offset gains, highlighting ongoing health challenges

Change in HALE during the COVID-19 Pandemic in 2019–2021

The COVID-19 pandemic led to a 1.54-year global drop in Healthy Life Expectancy (HALE) between 2019 and 2021, with mortality and pandemic-related outcomes causing 1.29-year and 0.28-year losses, respectively. The impact was most severe among adults aged 30+ years. Regions like the Americas and Southeast Asia saw significant HALE losses (2.72 years and 2.5 years, respectively), mainly due to COVID-19 mortality. Increased morbidity from COVID-19, anxiety disorders, and depressive disorders also contributed to HALE declines, offsetting pre-pandemic gains.

Gap in HALE between Males and Females in 2019 and 2021

Globally, women live about 5.1 years longer than men, but when accounting for disability, the gap narrows to 2.3 years due to higher female morbidity. Key contributors to female HALE advantage include lower mortality from NCDs like ischaemic heart disease and stroke, and injuries like road incidents. However, female morbidity from conditions like back pain, gynaecological diseases, and depression offsets some of this advantage. The COVID-19 pandemic slightly widened the female HALE lead, with lower female mortality from COVID-19 contributing 0.72 years to the gap.

Gap in HALE between High-income and Other Income Groups in 2019 and 2021

High-income countries faced setbacks in health outcomes despite overall advantages. Factors like higher mortality from lung cancers, drug use disorders, and morbidity from injuries/NCDs (e.g., falls, back pain) reduced their Healthy Life Expectancy (HALE) lead. However, lower COVID-19 impacts boosted HALE in high-income countries vs. others (e.g., +0.25 years vs. low-income, +1.39 years vs. lower-middle-income countries)

Progress in Premature Mortality Reduction

Global premature mortality (deaths under 70 years) declined pre-pandemic but slowed post-2015, with a 1.1% annual reduction rate (ARR) in 2015-2019 vs 1.7% in 2000-2015. COVID-19 increased premature mortality by 15% in 2019-2021, hitting the Americas and South-East Asia hardest. By 2050, a 24.2% decline in premature mortality is projected, indicating a slowdown vs 2000-2019. To halve premature mortality by 2050, a 1.4x acceleration is needed; regions like Africa and low-income countries require 2.5-3x acceleration

2. HEALTH-RELATED SUSTAINABLE DEVELOPMENT GOALS

Mortality-related Sustainable Development Goal Indicators

Global maternal mortality declined 40% from 2000 to 2023, with 260,000 deaths in 2023 (MMR: 197/100,000 live births). Progress slowed post-2016 (1.6% ARR), and achieving the SDG target (MMR <70) by 2030 requires a 14.8% ARR. Under-five mortality dropped 52% (2000-2023), but 60 countries won’t meet SDG targets without acceleration. Neonatal deaths declined more slowly (45%), with 2.3 million deaths in 2023.

Globally, 18 million people under 70 died from non-communicable diseases (NCDs) in 2021, accounting for over half of deaths in this age group. The risk of premature NCD death (30-70 years) declined from 22.5% in 2000 to 18% in 2019, but progress slowed (0.5% ARR in 2015-2019 vs 1.3% in 2000-2015), falling short of the 2.7% ARR needed to meet SDG targets. The Eastern Mediterranean and South-East Asia Regions had the highest risks in 2019.

Mortality due to injuries remains significant: 1.18 million died from road injuries (2021), 727,000 from suicide, and 484,000 from homicide. Males face higher risks for road injuries (3x female rate), suicide (2x), and homicide (4x). Air pollution caused 6.7 million deaths in 2019, disproportionately affecting low-income countries.

Infectious Diseases

Global infectious disease progress is mixed: HIV incidence dropped 48% (2010-2023), but new infections remain 3 times the 2025 target; TB cases rose to 10.8 million (2023), missing End TB targets; malaria cases increased to 263 million (2023), with 94% in Africa. Hepatitis B caused 1.1 million deaths (2022), with 63% of new infections in Africa. NTDs affected 1.495 billion (2023), 32% down from 2010. Antimicrobial resistance is rising, with E. coli and MRSA resistance at 45.5% and 32.2% (2022).

Risk Factors for Health

Global risk factors for health show mixed progress: child stunting prevalence remains high at 23.2% (2024), wasting affects 6.6% of children under 5, and anaemia impacts 30.7% of women (2023).

Tobacco use declined 21% (2010-2022) but misses 2025 targets; alcohol consumption dropped 12% (2010-2022). Access to safe water/sanitation rose but progress is slow.

Air pollution remains severe, with 2.1 billion using polluting cooking fuels (2023). Adolescent birth rates fell 17% (2015-2024).

Universal Health Coverage and Health Systems

Universal Health Coverage (UHC) progress is uneven, with slowed gains in service coverage. NCD treatment lags (hypertension 42%, diabetes 40%), and vaccination rates stagnate. Health workforce shortages persist, especially in Africa. Financial protection is weak, with 13.5% of people facing catastrophic health spending (2019). Domestic funding prioritization declined in 2022, but international aid supports low-income countries.

3. PROGRESS IN ACHIEVING THE TRIPLE BILLION TARGETS

The Triple Billion targets show uneven progress: 500 million more people will have affordable health care by 2025 (half the target), 697 million will be better protected from health emergencies (30% short), and 1.5 billion will experience healthier lives (surpassing the target). Progress is driven by reduced tobacco use, improved air quality, and better water/sanitation access.

Current trends fall short of 2030 goals. Meeting SDG targets could add 5.6 billion healthier people, 2.1 billion with UHC, and 1 billion protected from emergencies. Reducing regional disparities could boost progress dramatically, e.g., +30.6% emergency protection in the Americas and +28% in Africa.

4. INEQUALITY IN IMMUNIZATION

Vaccines save 3.5-5 million lives annually, but global inequalities persist. Low-income countries struggle with vaccine access due to limited resources, logistics, and inequities. Within countries, gaps exist based on economic status, education, and urban/rural location.

Diphtheria, Tetanus, and Pertussis coverage shows economic (10.4% gap) and education-related (18.7% gap) inequalities. Zero-dose children rose to 14.5 million (2023) due to COVID-19 disruptions.

Targeted efforts and data strengthening are crucial to address barriers in poor urban areas, conflict zones, and gender-related inequities.