Life Expectancy Is Up
Areas of the Americas Differ, but Infant Mortality Is Down
By David Brown
Washington Post Staff Writer
Tuesday, September 29, 1998; Page Z09
Life expectancy in the Americas has risen nearly four years to 72.5 years of age since the early 1980s, a trend driven by a steady decline in infant mortality and, to a lesser extent, by myriad improvements in the health of adults, according to a new report by the Pan American Health Organization (PAHO).
The improved life expectancy for North America, Latin America and the Caribbean, however, masks significant differences between regions, and even bigger gaps between individual countries. In North America, for example, life expectancy is 77 years, while in Latin America it is 70. A nearly 25-year difference divides Haiti (54.5 years) and Canada (79 years.)
Infant mortality, defined as death before the age of 1, is currently 27 per 1,000 births. Major improvements have occurred in Latin America and the Caribbean, which together have a rate of 35 deaths per 1,000 births, down from 59 early last decade. In the United States, infant mortality is 8 per 1,000 births. Life expectancy is the most potent measure of a population's health, and declines in deaths during childhood have the largest impact on it.
The statistics are contained in a two-volume report entitled "Health in the Americas," released last week as health ministers from PAHO's member countries gathered at the organization's Washington headquarters for a four-day meeting. Founded in 1902 as the Pan American Sanitary Bureau, PAHO is the oldest international health agency in the world. It functions as the Western Hemisphere's branch of the World Health Organization. The report contains health reviews of the 45 nations or territories in the Americas, as well as discussions of subjects ranging from individual diseases, the water supply and the effects of El Nino to the hemisphere's patterns of immigration, laboratory capabilities and methods of financing medical care.
A major force in the improvement of health in Latin America and the Caribbean in recent years has been the expanding access to clean water. About 78 percent of people now get drinking water from household connections or a source nearby. About 70 percent of the population drinks treated water, compared with only 20 percent a decade ago. Plumbing is available to 69 percent of the population, although only 10 percent of wastewater is treated in some way before disposal.
About 3.4 million people ages 15 to 49 were infected with the human immunodeficiency virus that causes AIDS in 1994, according to the report, and 800,000 cases of AIDS were counted last year. Public health officials, however, believe the number of AIDS cases may be double the number reported.
The incidence of tuberculosis, a disease in resurgence in parts of Africa and Eastern Europe, is steady in the Americas. The number of new cases each year per 100,000 people is 32. This rate, however, varies greatly country to country. It is highest in Peru, where the incidence of 174 cases per 100,000 is more than three times that of Latin America as a whole.
An epidemic of cholera that began eight years ago has subsided. The number of cases reported last year was only 5 percent of the number reported in 1991, when the infection reappeared after being virtually unseen for a century. An epidemic of dengue, an occasionally fatal disease transmitted by mosquitoes, appears to have peaked in 1995 and is in slow decline.
The last case of polio in the Americas occurred in Peru in 1991, and a campaign to eradicate measles from the hemisphere is underway. In 1996 there were slightly more than 2,000 confirmed cases of measles in the Americas, compared to more than 600,000 a year in the early 1960s.
Progress has been made in the reduction of minor health problems as well. During the past two decades, the amount of dental caries -- tooth decay -- in children has fallen by 20 to 80 percent in nearly all Latin American and Caribbean countries, largely as a result of programs to add fluoride to the water or, in some places, salt.
As in most places in the world, the biggest health threats in the future will come from noncommunicable diseases, not infections. Deaths from chronic and degenerative diseases will outnumber those from infectious and parasitic diseases by a ratio of 10-to-1 in the year 2000, according to the report. The number of people with diabetes in the Americas is expected to rise from 28 million in 1994 to 40 million in 2010. The number in Central America is expected to double during that period.
Perhaps the greatest measure of inequity in the region is the amount of money spent per capita on health care. For the Americas as a whole, the average is $240, but the range extends from $9 in Haiti, the hemisphere's poorest country, to $3,858 in the United States, the richest.
Nevertheless, at a press conference unveiling the report, George A.O.
Alleyne, PAHO's director, emphasized the region's shared interests as much
as its stark differences. "We never use the term donor country in PAHO," he
said. "All countries give, all countries receive." He specifically mentioned
the hemisphere-wide benefit of the eradication of polio and the
near-elimination of
measles. In Latin America, inter-country cooperation has helped advance
everything from a safer blood supply, to more judicious use of pesticides,
to better ethical review of clinical research protocols, he said.
(c) Copyright 1998 The Washington Post Company