Narrowing health gap between the richest and poorest countries

Geneva – The world has made dramatic progress in improving health in the poorest countries and narrowing the gaps between countries with the best and worst health status in the past two decades, according to the World Health Statistics 2013.

The WHO annual statistics report highlights how efforts to meet the Millennium Development Goals (MDGs) have reduced health gaps between the most-advantaged and least-advantaged countries.

Progress towards Millennium Development Goals measured

As the Millennium Development Goals (MDGs) approach the 2015 deadline, this year’s World Health Statistics shows the considerable progress made in reducing child and maternal deaths, improving nutrition and reducing deaths and illness from HIV infection, tuberculosis and malaria.

“Intensive efforts to achieve the MDGs have clearly improved health for people all over the world,” says Dr Margaret Chan, Director-General of WHO. “But with less than 1000 days to go to reach the MDG deadline, it is timely to ask if these efforts have made a difference in reducing the unacceptable inequities between the richest and poorest countries.”

This year, the World Health Statistics compares progress made by countries with the best health status and those with least-favourable health status at the MDG baseline year of 1990 and again two decades later.

Impressive health progress for countries in lowest health status category

It shows that, in absolute terms, countries in the lowest 25% category of health status have made impressive health progress.

For example, the absolute gap in child mortality between the top and bottom countries was reduced from 171 deaths per 1000 live births in 1990 to 107 deaths per 1000 live births in 2011. Some countries that were among those with the world’s highest child mortality rates in 1990 – including Bangladesh, Bhutan, Lao People’s Democratic Republic, Madagascar, Nepal, Rwanda, Senegal and Timor-Leste – have improved child survival to such an extent that they no longer belong to that group.

However, despite the fact that 27 countries have reached the MDG target already, the current rates of progress will not be sufficient to reach the global target of a two-thirds reduction in 1990 levels of child mortality by 2015.

In 1990, countries with the highest rates of women dying in pregnancy and childbirth had on average 915 more maternal deaths per 100 000 live births than countries with the lowest rates. By 2010, this gap had narrowed to 512 maternal deaths per 100 000 live births. Unfortunately the global rate of decline (of 3%) will need to double to achieve the MDG target of reducing maternal mortality ratio by three quarters.

The gap between countries with the highest and lowest rates of new HIV infections narrowed from 360 to 261 people per 100 000 population between 1990 and 2011. While new HIV infections increased six-fold for countries with the lowest rates, the group of countries with the highest rates have cut new HIV infections by 27%.

Key trends outlined in the report

Globally, tuberculosis (TB) deaths have decreased by more than 40% since 1990 and the trend indicates that this will reach 50% by 2015. The gap has narrowed between the top and bottom groups of countries from 62 TB deaths in 1990 to 41 deaths per 100 000 population in 2011. Progress in reducing TB deaths however has not been even, with just 34% reduction in countries with the highest TB death rates compared to 70% in countries with the lowest rates.

“Our statistics show that overall the gaps are closing between the most-advantaged and least-advantaged countries of the world,” says Dr Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. “However, the situation is far from satisfactory as progress is uneven and large gaps persist between and within countries. ”

Other key trends in this year’s report include:
•Preterm births: Every year around 15 million babies are born preterm (before 37 weeks of pregnancy) and one million of them die. Preterm birth is the world’s leading killer of newborn babies and the second most important cause of death (after pneumonia) in all children aged less than 5 years.
•Diabetes: Almost 10% of the world’s adult population has diabetes, measured by elevated fasting blood glucose (≥126mg/dl). People with diabetes have increased risk of stroke and are 10 times more likely to need a lower limb amputation than people who do not have diabetes.
•Access to medicines: Many low- and middle-income countries face a scarcity of medicines in the public sector, forcing people to the private sector where prices can be up to 16 times higher. In these countries, an average of only 57% (and as little as 3%) of selected generic medicines are available in the public sector.

About the World Health Statistics

Published annually by WHO, the World Health Statistics is the most comprehensive publication of health-related global statistics available. It contains data from 194 countries on a range of mortality, disease and health system indicators including life expectancy, illnesses and deaths from key diseases, health services and treatments, financial investment in health, as well as risk factors and behaviours that affect health.