How are we going to be in 2040?

The ranking of life expectancy of countries offers new information on their health status.

For example, China, with an average life expectancy of 76.3 years in 2016, ranked 68th out of 195 countries. However, if health trends continue in recent years, it could reach 39th in 2040 with an average life expectancy of 81.9 years, an increase of 5.6 years.

In 2016, the United States ranked 43rd with an average life of 78.7 years. In 2040, life expectancy is expected to increase by only 1.1 years to reach 79.8 years, but to fall to 64th place. In comparison, the United Kingdom had a life of 80.8 years in 2016 and is expected to increase to 83.3 years, from 26th to 23rd in 2040.

In addition, the study, published today in the international medical journal The lancet, predicts a significant increase in deaths from noncommunicable diseases (NCDs), including diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease and lung cancer, as well as worsening health problems related to obesity.

However, there is "great potential to change the downward trajectory of health" by tackling key risk factors, education levels, and per capita income, the authors say.

"The future of health in the world is not pre-ordered and there is a wide range of plausible trajectories," said Dr. Kyle Foreman, director of data science at the University of Toronto. Institute of Metrology and Health Assessment (IHME) of the University of Washington. and lead author of the study. "But if we see significant progress or stagnation depends on whether or not health systems are able to take into account the key factors of health."

High blood pressure, high body mass index, hyperglycemia, smoking and alcohol largely explain the future trajectory of premature mortality. Air pollution ranked sixth.

In addition to China, several other countries are expected to significantly improve their rankings in terms of life expectancy in 2040, including:

• Syria is expected to reach the highest rank in the world – from 137th in 2016 to 80th in 2040 – according to the authors, presumably because of a conservative conflict model;
• Nigeria from 157th to 123rd; and
• Indonesia from the 117th to the 100th

By contrast, Palestine is expected to experience the largest decline in life expectancy from 114th in 2016 to 152nd in 2040. In addition, several high-income countries are expected to experience a significant drop in their rankings, including:

• The United States, which recorded the largest decline in high-income countries, dropped from 43rd in 2016 to 64th in 2040;
• Canada from 17 to 27;
• Norway from the 12th to the 20th;
• Taiwan (Province of China) from 35th to 42nd;
• Belgium from the 21st to the 28th;
• Netherlands from the 15th to the 21st;

The ranking also reveals that Spain is expected to rank first in the world in 2040 (average life of 85.8 years), up from fourth place in 2016 (average life of 82.9 years ). Japan, ranked first in 2016 (average life of 83.7 years), will move to second place in 2040 (average life of 85.7 years).

To complete the top 10 in 2040, we find:

1. Singapore (average life of 85.4 years) ranked third, compared with 83.3 in 2016 and also ranked third
2. Switzerland (average life of 85.2 years), compared to 83.3 years in 2016 and second ranking
3. Portugal (average life of 84.5 years), compared to 81.0 years in 2016 and 23rd place
4. Italy (average life of 84.5 years), compared with 82.3 years in 2016 and seventh
5. Israel (average life of 84.4 years), compared to 82.1 years in 2016 and 13th rank
6. France (average life of 84.3 years), compared to 82.3 years in 2016 and eighth
7. Luxembourg (average life of 84.1 years) against 82.2 years in 2016 and 10th place
8. Australia (average life of 84.1 years), compared to 82.5 years in 2016 and fifth.

Among the top 10 countries, even the "worst" scenarios envisaged in 2040 remain above 80 years. In contrast, the least ranked countries, namely Lesotho, Swaziland, Central African Republic and South Africa, the "best" and "worst case" scenarios in 2040 are going from a peak of 75.3 years in South Africa ("best" scenario) to 45.3 years in Lesotho ("worst case scenario"), a difference of 30 years.

"Inequalities will continue to be important," said IHME's director, Christopher Murray. "The gap between the" better "and" worst "scenarios will diminish, but will remain important: in many countries too many people will continue to earn relatively low incomes, remain poorly educated and die prematurely. helping people cope with major risks, including smoking and unhealthy eating

In a "worst case" scenario, life expectancy declines in nearly half of the countries in the next generation. Specifically, 87 countries will experience a decline and another 57 will see an increase of one year or more. By contrast, in the "best" scenario, 158 countries will see life expectancy gains of at least five years, while 46 countries will see gains of 10 years or more.

The growing trend towards an increase in premature mortality due to noncommunicable diseases and injuries, as well as the abandonment of communicable diseases, is clear from the changing proportions of the top 10 causes of premature death.

In 2016, four of the top 10 causes of premature mortality were NCDs or injuries; on the other hand, in 2040, this number increases to eight. The top eight noncommunicable diseases or injuries among the top ten in 2040 should be ischemic heart disease, stroke, COPD, chronic kidney disease, Alzheimer's disease, diabetes, road accidents and lung cancer.

The study has unprecedented reach, says Foreman, and provides more robust statistical modeling and more comprehensive and detailed estimates of risk factors and diseases than previous predictions from the United Nations and other research institutes on the subject. population.

IHME researchers have used data from the Global Burden of Disease (GBD) study to develop "better" and "worse" alternative forecasts and scenarios for life expectancy and mortality. mortality by 250 causes of death in 195 countries and territories.

Researchers made predictions of health-independent factors, including sociodemographic measures of fertility, per capita income, and years of education, as well as 79 independent factors such as smoking, mass index high body, lack of clean water and sanitation. They then used information on how each of these independent drivers assigns specific causes of death to develop mortality forecasts.

"The range of" best "and" worst "scenarios allows stakeholders to examine potential changes to improve health systems locally, nationally and globally," Murray said. "These scenarios offer new perspectives and help frame health planning, particularly with regard to the long timeframe between initial investments and their impacts, as in drug research and development."

In addition to attracting attention to the growing importance of noncommunicable diseases, the analysis reveals a significant risk of rebounding mortality from HIV / AIDS, which could negate gains life expectancy recently recorded by several countries in sub-Saharan Africa.

In addition, while NCDs are expected to increase in many low-income countries, communicable, maternal, neonatal and nutritional diseases will likely remain one of the leading causes of premature death, creating a "double burden" of the disease. .

The study is entitled "Predicting Life Expectancy, Years of Life Lost and All-Cause Mortality by Cause for 250 Causes of Death: Baseline and Alternative Scenarios for 2016-" 40 for 195 countries and territories ".

The study is available at http://www.healthdata.org.

Accompanying documents, including complete listings and data to support the ranking of all countries, are available under embargo at https://cloud.ihme.washington.edu /index.php/s/AkAfRKXFaKwLpFr.

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More information:
Kyle J Foreman et al, Prediction of life expectancy, years of life lost and all-cause and cause-specific mortality for 250 causes of death: baseline and alternative scenarios for 2016-2040 for 195 countries and territories The lancet (2018). DOI: 10.1016 / S0140-6736 (18) 31694-5