Guyanese have the highest probability in the Americas of dying from certain diseases

Dear Editor,

In my letter of May 18, I addressed the twin issues of life expectancy (LE) and healthy life expectancy (HLE) at birth only cursorily. This letter fills the gap. LE at birth, say 2015, is the average remaining years of life a child born in that year can expect to live on the basis of the current mortality rates for the population. Healthy life expectancy (HLE) is a population health measure that combines mortality data with morbidity or health status data to estimate expected years of life in good health for persons at a given age. HLE accounts for both the quantity and quality of life, and can be used to describe and monitor the health status of populations. HLE estimates may also be used for predicting future health service needs, evaluating health programs, and identifying trends and inequalities.

Globally, life expectancy has been improving at a rate of more than 3 years per decade since 1950, with the exception of the 1990s.  During the latter period, progress on life expectancy stalled in Africa because of the rising HIV epidemic; and in Europe because of increased mortality in many ex-Soviet countries following the collapse of the Soviet Union. Life expectancy increases accelerated in most regions from 2000 onwards, and overall there was a global increase of 5.0 years in life expectancy between 2000 and 2015, with an even larger increase of 9.4 years in the WHO African Region. In 2015, global life expectancy was 71.4 years. Twenty-nine countries have an average life expectancy of 80 years or higher. Life expectancy exceeds 82 years in 12 countries. At the lower end, there are still 22 countries with life expectancies below 60 years, all of them in Sub-Saharan Africa.

On average, women live longer than men in every country of the world. Overall, female life expectancy is 73.8 years and male life expectancy is 69.1 years (in 2015). Globally, female life expectancy at birth passed male life expectancy at birth in the 1970s and the difference reached 4.6 years in 2015. Among high-income OECD countries, the male-female gap peaked at 6.9 years in the 1990s and has been declining since to reach 5.2 years in 2015.

Worldwide, HLE in 2015 is estimated at 63.1 years for both sexes combined. In general, HLE varies between countries in line with life expectancy, but is on average 11.7 per cent shorter than life expectancy (ranging from 9.3 per cent to 14.7 per cent between countries).  The gap between LE and HLE are the equivalent healthy years lost through morbidity and disability. The main contributors are musculoskeletal disorders (with back and neck pain being a major contributor), mental and substance-use disorders, neurological disorders, vision and hearing loss, cardiovascular diseases and diabetes. The prevalence of most of these conditions rises with age, and, for most conditions, the age-standardized rates are not declining. As life expectancy increases, the proportion of the lifespan spent with these conditions increases, which means that HLE increases more slowly than LE.

Life expectancy at birth in Guyana increased from 31.1 years in 1911 to 54.8 years in 1952.  Males born in that year were expected to live 53.2 years; females 56.3 years.  Eight years later, LE reached 60.3 years. The 50 years towards the end of colonialism, 1911 to 1960, witnessed a huge increase in LE: 29.2 years or about 5.8 years per decade.  The increase during next decade pales in comparison, when longevity expanded by only quarter as much (a paltry 1.5 years). A child born when Guyana became independent in 1966 could have expected to live to 61.4 years; one born in 2015 to 66.2 years.  That is, during the 50 years as a free country LE expanded by a mere 4.8 years, or only 16.4 per cent as much as the previous fifty years.

Yearly gains in LE began to decline in 1965, and during the long downswing, from 1977 to 1990, the annual rise was half of what it was at the time the country became independent. GDP slumped from US$710.7 million in 1977 to US$494.0 million in 1990 (at constant 2005 prices); a whopping contraction of 30.5 per cent.  It was not until 1996 that GDP became larger than what it was in 1977. Income per person in 1990 was 25 per cent lower than in 1977.  During these seventeen years, LE expanded by a paltry 1.1 years.  Another 1.5 years was added from 1990 to 2000, 1.1 years more in the next decade, and by a miserable 0.16 years in the next five years. Mostly interestingly, the LE gain during the PNC regime (1964-1990) was 2.5 years; that during the PPP regime (1990-2015), 2.7 years.  Of course, gains become more difficult as longevity rises, but Guyana has not reached this point as yet. LE in Guyana is about 15 years shorter than in Hong Kong, China (SAR), where it is 84.0 years, the highest in the world.

Guyanese are clearly at a ‘life’ disadvantage – a deficit of 5.2 years and 10.8 years compared to, respectively, the global mean and the average for the Americas.  For the Americas, LE is highest in Canada (82.3 years) and lowest in Haiti (63.5 years), but Guyana is just behind Haiti (66.2 years).

Between 1966 and 2015, female LE rose by 4.6 year; that of males by 5.0; and that of both sexes by 4.8 years.  A female child born in 1996 could expect to live 63.9 years, and a male child to 58.9 years; the figures for a female and male child born in 2015 are 68.8 years and 64.2 years, respectively. In 1960, females lived 5.2 years longer than males, a figure that remained relatively stable until 1973.  The female-male gap began to widen from then on and peaked at 7.2 years during 1988-90, three straight years when the economy contracted. A gradual decline of the gap then commenced and in 2015 females in Guyana were expected to live 4.6 years longer than males.

How does Guyana score on healthy life expectancy? For countries in the Americas, the loss in HLE ranges from a low of 7.3 years in Guyana to a high of 11.1 years in Nicaragua, with the loss in most countries clustering around 9 years; that is, 11 per cent of life expectancy in Guyana is expected to be spent with debilitating health problems that reduce mobility. So while LE at birth in 2015 was 66.2 years, HLE was 58.9 years.  On both counts, we are just above Haiti. In the Americas, life expectancy and healthy life expectancy at birth are lowest in these two countries.

The difference between LE and HLE is primarily a function of factors affecting the human condition, including stagnant economic growth, surging inequality, a sedentary lifestyle, consumption of energy-dense food, tobacco consumption, the harmful use of alcohol and the demographic transition, and, of course, a poor system of health care.  The probability of dying from cardiovascular disease, cancer, diabetes and chronic respiratory disease between age 30 and 70 is highest in Guyana (28.4 per cent); higher than Haiti (23.9 per cent), which occupies the second place.  No other country in the world has a higher suicide rate than Guyana.

The letter raises four major issues: (i) life expectancy and healthy life expectancy at birth in Guyana are the second lowest in the Americas, just behind Haiti; (ii) gains in life expectancy during the PNC regime were only marginally smaller than those under the PPP regime; (iii) the female-male life expectancy gap is narrowing; and (iii) there is a growing epidemic in Guyana: in the entire Americas, Guyanese have the highest probability of dying from certain illnesses, including cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes. Our health system is in a deplorable state, and needs urgent attention. Investment in nutrition and health is an investment in the country’s future.

Yours faithfully,

Ramesh Gampat

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