Health, like education, is an immediate goal of
development and a means to achieve the related goals of higher
labour productivity and total economic output. Life expectancy and
mortality rates are overall indicators of a population's health.
Life expectancy is the average number of years a newborn baby can
be expected to live if current age-specific mortality rates
continue. In developed countries, life expectancy has increased by
7 years, from 66 years in the early 1950s to 73 years in the late
1980s. In the developing countries as a whole, including China, it
has increased much more, from 41 to 60 years. China experienced the
most dramatic increase of 29 years, from 41 years in the early
1950s to 70 in the late 1980s. In the least developed countries,
the increase was only 13 years, from 36 years to 49. The increases
among the developing regions ranged from 13 years in sub-Saharan
Africa (from 35 to 48) to 20 years in Western Asia (from 43 to 63
years).
Women's life expectancy at birth is generally
several years longer than men's, especially in the developed
countries: 77 years for women versus 70 for men in the late 1980s;
in the developing countries, it is about 61 years for women and 59
for men. The only region with virtually equal life expectancy for
both sexes is South Asia, where the average is about 57 years for
both groups. In Sri Lanka, however, greater improvements in female
life expectancy in the past three decades have already resulted in
a more normal pattern in that country. In the region as a whole,
female life expectancy is projected to be about 63 years in the
year 2010, compared with 62 for men.
Maternal mortality rates also reliably indicate
the health situation and status of women of child-bearing age.
Maternal mortality (death of women caused by pregnancy or
child-birth) is the largest cause of death among women of
reproductive age in most developing countries. In less developed
regions, there were 450 deaths for 100,000 live births around 1983,
against 30 in the developed countries. Countries with high maternal
mortality rates also have high total mortality. These countries
should improve by the year 2010 as they follow the general downward
trends of total mortality. But the wide disparities among countries
are not likely to disappear, especially as the increase of life
expectancy is projected to be slower in Africa, for example, which
accounts for 30 per cent of maternal deaths, as against 18 per cent
of births
Five key factors contributing to the high
maternal mortality levels in the developing countries are
pregnancies in the earliest and latest years of the reproductive
period, maternal depletion through too closely spaced pregnancies,
high-parity births (i.e. births to women who already have had a
high number of pregnancies), lack of access to health services and
lack of trained birth attendants. Inadequate nutrition in childhood
and adolescence, as well as in adulthood, contributes to many
maternal deaths. Complications from poorly performed abortions also
cause a significant proportion of total maternal deaths, according
to a number of studies. Family planning and good primary health
care before and during pregnancy could greatly reduce the number of
deaths caused by all these factors. However, because a significant
proportion of these potentially fatal complications during
pregnancy cannot be predicted or prevented, speedy access to
emergency care is also of utmost importance. Not surprisingly then,
numerous maternal deaths among rural women in developing countries
are due to poor transportation networks.
In the past decade, there have been decreases in
the infant mortality rate in nearly all countries, but more than a
quarter representing 29 per cent of world population, still have a
rate above 100 per 1,000 live births, while the average in the
developed countries is about 18 or 15, excluding South Africa.
Continued reductions are projected for the 1990s, but the average
for the least developed countries is projected to remain above 100
during the period from 1995 to 2000, falling to 93 between the
years 2000 and 2005.
Challenges remain to lower worldwide mortality
rates and increase life expectancy. Reducing infant mortality rates
to below 120 per 1,000 live births by 1990, a goal set forth in the
International Development Strategy for the 1980s, has not been met
by 21 countries. Rates above the goal of 50 will still exist in 59
countries in the year 2000, including 41 in sub-Saharan Africa.
Similarly, 46 countries were projected not to meet the Strategy's
goal of increasing life expectancy to 60 years or more by the year
2000; 36 of these will be in sub-Saharan Africa and 31 will be
among the least developed countries.
At the turn of the 20th century, a new global
mortality factor has emerged: traffic accidents. Deaths due
to road accidents are now equivalent to those from AIDS.