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Life expectancy and health: current social security determinants

Life expectancy and health: current social security determinants

Introduction

Signed during the mid-20th century, the Universal Declaration of Human Rights and the International Labour Organization’s Convention Nº 102 on Social Security[1] mandated that society provide social security in order to “ensure that individuals and households have access to medical care, and minimum social-protection floors especially vis-à-vis old age, unemployment, illness, disability, workplace accidents, maternity or the loss of the family breadwinner”.  ILO Convention Nº 102 establishes that social security right holders have a right to the following:

  1. Medical care
  2. In-cash, illness benefits
  3. Unemployment benefits
  4. Old age benefits
  5. Employment injury
  6. Family benefits
  7. Maternity benefits
  8. Disability benefits
  9. Survivor benefits

With the exception of unemployment benefits, all of the coverage is addressed the biological needs of the human being, which represent the economic and social vulnerabilities that individuals face given the reduction in their capacity to generate income or maintain subsistence levels due to the loss of their ability to remain productive.

As a result, the Inter-American Social Protection Observatory 2016 (ISPO 2016) has focused its analysis on the functional capacity of individuals and the life expectancy rate, factors which are directly related to health, which is defined by the World Health Organization as the “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

The ISPO 2016 analysis is presented on the basis of hemisphere, sub region and nation.  The Observatory is also comprised of database indicators which are disaggregated by age group, gender, risk-factor prevalence and cause of death in accordance with the mandate issued at the IV Extraordinary General Assembly of the Inter-American Conference on Social Security held in São Paulo, Brazil.

Whereas social security is mandated in all of the CISS member-States, each national social security sector involves differences in terms of coverage, organizational structures and organizational maturity in terms of service delivery which are the result of a variety of national economic, social and political factors.  While sorting data by sub region provides an opportunity to further analyze these factors, as well as identify major trends within the sector, it does not constitute a satisfactory substitute for country-by-country analysis.

Analyzing life expectancy and health as social-security determinants involved the entire population of the nations in question which, under optimal conditions, possessed some type of social security coverage.

The ISPO 2016 included Mexico within the Central America sub region whereas it’s demographic and epidemiological characteristics, as well as the type of preventable risk factors by sex and by age, are more in line with populations within this region than with North America.  This strategy was also employed during the research and studies carried out on the burden of disease and risk factors.

The CISS region is comprised of 37 nations within the Americas which are grouped into six Sub regions.

When broken down by sub region, 39.6% of the Hemisphere’s population is in North America, 30% in the Southern Cone, 18% in Central America, 11.7% in the Andean sub region and 0.1% in the Caribbean.

It should be noted that 82% of the population within the Americas is limited to six nations: the US, Brazil, Mexico, Colombia, Argentina and Canada.  The remaining 18% of the population is distributed throughout the remaining 31 nations.

Another important factor is the CISS region’s life expectancy, which is the highest in the world at 77 years.  The Americas are followed by Europe and the Western Pacific at 76 years.  According to the World Health Organization, Africa possesses the lowest life expectancy in the world, which currently averages 58 years.

With the exception of Haiti and Bolivia, which average 63 and 68 years respectively, life expectancy rates within the Americas are on par with those of medium-high and high income nations.  This indicator may be reasonably interpreted as the result of the social protection and social security policies carried out within the Hemisphere.  However, the improvements in life expectancy rates have also produced new challenges for social security systems.

[1] Article 22 of the Universal Declaration of Human Rights states that “Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality”.  ILO Convention 102; Convention concerning Minimum Standards of Social Security (adopted in 1952, entered into force in 1955).

Map 1

Socioeconomic indicators by CISS region and sub region

The life course and social security

An individual’s life is determined by biological conditions and the impact upon same by their respective economic, political, social and cultural environments.  As a result, the life trajectory is comprised of a variety of independent spheres or domains (schooling, training, employment, reproduction, labor mobility and retirement) in which social security plays an important role in terms of an individual’s ability to enjoy living conditions which tend towards optimal development (Elder and Shanahan, 2006).

Figure 1

Life course in social security

Apart from any institutional inputs, social security currently involves two determinants:  population’s life expectancy and the functional capacity of an individual’s body, in terms of their biological characteristics.

 

Life expectancy at birth

Life expectancy is a synthesized indicator which is directly related to factors such as income, healthcare services, labor categories, social security coverage.  It demonstrates the current gap between individuals in terms of gender, economic strata, nationality and quality-of-life levels.

Life expectancy is not a static concept.   It has evolved throughout human history primarily upon the basis of improvements in the health of individuals and reductions in the overall death rate.  During the Middle Ages, the Life Expectancy was 35 years.  By the 18th century, it had risen to 40.  Thanks to advances such as penicillin, vaccination and improvements in living conditions during the second half of the 20th century, it rose to between 50 and 65 years.  This period of history also saw the evolution of social security measures which established coverage and benefits criteria based on the life expectancy rates of the time.  However, as of 2010, the international life expectancy rate is currently averaging 71 years.  In fact, in nations such as Japan, it has reached 83 years.

The current life expectancy at birth (LEB) rates throughout the CISS region demonstrate significant differences between its respective sub regions.  The LEB for North America is 79.3 years, while in the Andean sub region it is 76.4.  The Southern Cone averages 75.4, Central America 74.7, and the Caribbean 72.2 years.

Figure 2

Life expectancy at birth

Healthy Life Expectancy

Due to the importance of accurate quality-of-life measurements for healthcare and social security systems, especially in terms of the over-60 population and its increasing relevance vis-à-vis higher life expectancy rates, a healthy life expectancy indicator was created.  The health adjusted life expectancy indicator, or HALE, measures a population’s health by taking into account mortality and morbidity. It adjusts overall life expectancy by the amount of time lived in less than perfect health.

An individual’s quality of life level drops significantly in correlation to the years of healthy life lost due to illness, disability or premature death.  The current international average of years of healthy life lost is nine years, while within the Americas it is 10 years.  However, in relative terms, the indicator very least throughout the Hemisphere.  The Caribbean currently has the highest percentage of healthy life lost, at 15.8% of LEB.  The Andean sub region averages 13.4%, while the remaining three sub regions vary between 12 and 12.6%.

Table 1

Healthy life expectancy

Population aging

Population aging within the Americas is an important factor in terms of social security and the sustainability of its economies in the coming decades.

The average median age within the Hemisphere is currently 32 years.  However, 40% of the nations which comprise the CISS region currently possess a median age which is above 32 years, which only serves to underline the speed with which their respective populations are aging.  Additionally, whereas developed nations underwent population aging over a period of between 100 and 150 years, the developing world is undergoing this demographic shift four times faster; a factor which severely impedes a nation’s ability to employ mechanisms designed to cushion this impact, as well as provide the economic subsidies required to meet increases in demand.

Figure 3

Median age, by nation

Within the Americas, 10 nations are already well within the parameters of what is termed advanced or highly-advanced population aging.

Table 2

Stages of population aging

Life expectancy at 60

Increasing life expectancy combined with drops in the birth rate and rapidly aging populations, has become a major challenge to measures designed to ensure sustainable social security and social protection in the coming years.

In addition to being a patently biological indicator, population aging is extremely relevant in terms of sociodemographic, economic, political, cultural and subjective issues.  Each of these factor types complicate attempts to analyze population aging and demonstrate the multifaceted nature of the issue itself.

Within the Americas, the population aged 60 and over will increase from 133 million in 2013 to 285 million in 2050.  This is to say, this age group will increase from 14.1% of the total population, as a 2013, to over 25% of the Americas by the year 2050.

The current life expectancy at 60 within the hemisphere is 23.5 years; i.e., individuals have a high possibility of living to 83 years of age or beyond.  However, it is highly probable that these individuals will live out their last 10 years battling age-related disabilities or chronic degenerative diseases brought on by unhealthy lifestyles or age.

Figure 4

Life expectancy at 60

On average, life expectancy at 60 rates throughout the Americas vary little despite differences in terms of development.  This dynamic represents a major challenge for the Hemisphere’s less developed economies.

 

Functional capacity of the body and preventable risk factors

The biological nature of humans makes them vulnerable throughout the entire lifecycle, from birth to old age.  All societies are comprised of communities, groups of individuals, families or individuals who possess higher possibilities of facing disease, accidents and premature death.  In terms of reducing the vulnerability of the aforementioned groups and individuals, social security has played an important role in reducing risk levels.

Biological, environmental (physical or psychosocial) and economic risk factors have undergone paradigm shifts throughout history.  In recent history, non-communicable diseases and their concomitant risk factors have become increasingly relevant given their magnitude, as well as the impact they have on individual quality-of-life levels and the overall sustainability of social security systems within the medium term.

Among high income nations, non-communicable diseases caused 83.2% of deaths, while injuries cost 9.2% and communicable disease 7.2%.

Within the Americas, causes of death follow along the same trajectories as upper-middle income nations.  Non-communicable disease accounting for 78.3% of deaths, followed by injuries at 11.1%, and communicable disease at 10.6%.

Although communicable disease plays a fairly significant role in the Andean sub region (17.1%), Southern Cone (13.0%) and Central America (12.7%), these diseases possess a high correlation to national development levels.

Additionally, nations within the Andean sub region and Central America at the highest levels of death due to injury (intentional and non-intentional).

Figure 5

Deaths categorized by disease type, (%)

Impact of health on social security systems

Health is a fundamental resource which permits individuals to live productively in terms of their personal, social and economic lives.

Healthcare coverage a pillar of social security which requires ever-increasing outlays of human and economic resources within public health systems, primarily due to increases in life expectancy and shifts in the epidemiological paradigm.

The difference in life expectancy rates of men and women is an important factor for social security.  While the life expectancy of men is currently 74 years, women currently possess a rate of 80 years.  This difference of five years exacerbates the fact that women comprise the more vulnerable population due to lower labor market participation rates and/or higher dependency levels.

The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.  Within the Americas, this indicator has undergone two major shifts during the last two decades.  Years of life lost due to premature death have decreased substantially, even as years of life lost due to disability have increased significantly.  This dynamic has resulted in lower early-death rates and increases in the demand for medical care and health care coverage.

Table 3

Years of healthy life lost, 2010 versus 1999

Impact of non-communicable disease on social security

Historically, high-income nations were the logical primary targets of non-communicable disease.  However, middle-income nations such as those which comprise the majority of the Americas now report non-communicable disease as the leading cause of death and disability due to the economic growth, epidemiological shifts and population aging which they have undergone, in addition to improvements made to their respective public health and medical care systems.  By the year 2050, it is expected that the burden of non-communicable disease will increase especially rapidly due to the growth of older adult populations.

The majority of non-communicable diseases are chronic in nature.  In consequence, they require costly treatment regimens and prolonged individual medical care by increasingly specialized healthcare professionals.  This has a direct impact on national income, economic development and growth, and individual quality-of-life levels due to drops in productivity, long-term disability and increased public outlays on healthcare and social security.

Social security systems are facing considerable increases in costs and in terms of service delivery primarily due to three non-communicable diseases: cardiovascular disease, cancer and diabetes.  Due to the magnitude involved, these diseases are considered epidemics.  Given the high cost of treating these individuals and the impact they have on individual quality of life levels, they merit special attention within society.

It is important to note that aging, in and of itself, is not a direct cause of these diseases.  However, as an individual ages they are less able to combat their onset.

A small proportion of individuals suffering from these diseases do so because of a genetic predisposition for same during their life cycle.  But the majority develop these conditions due to unhealthy lifestyle decision-making.

Risk factors such as high blood pressure, overweight and obesity, and high blood glucose levels are both controllable and avoidable.  An individual’s ability to counteract them will significantly reduce their probability of developing any or all of these three conditions within the middle term.

Cardiovascular disease is the leading cause of death involving preventable risk factors.  The Caribbean currently leads the Americas in terms of this non-communicable disease.

Figure 6

Cardiovascular disease, by sub region and age group

(Prevalence rate per 100,000 deaths in 2013)

Table 4

Cardiovascular disease, by sub region and age group

(Prevalence rate per 100,000 deaths in 2013)

Cancer is the second-leading cause of death due to preventable risk factors.   The Caribbean, North America and the Southern Cone lead the Americas in terms of prevalence.

Figure 7

Cancer, by sub region and age group

(Prevalence rate per 100,000 deaths in 2013)

Table 5

Cánceres

Cancer, by sub region and age group

(Prevalence rate per 100,000 deaths in 2013)

Diabetes is the third-leading cause of death due to preventable risk factors.  Although prevalence rates are fairly similar throughout the Americas, growth rates differ by sub region.

Figure  8

Diabetes, by sub region and age group

(Prevalence rate per 100,000 deaths in 2013)

Table 6

Diabetes

Diabetes, by sub region and age group

(Prevalence rate per 100,000 deaths in 2013)

All things being equal, early diagnosis aimed at conserving the functional capacity of an individual’s body and increasing healthy life expectancy may serve to increase the short-term as well as middle-term viability and sustainability of social security systems.

Analysis by sub region provides an opportunity to evaluate the general trends which exist among the causes and effects of social security determinants.  However, this approach in no way constitutes an adequate substitute for country-by-country analysis, whereas each nation – given its unique economic, social, political, cultural and organizational characteristics, as well as its respective development trajectory – possesses a unique set of behaviors in terms of the indicators involved.

In the section of the Inter-American Social Protection Observatory entitled Preventable risk factors, by gender, age and nation, readers will find a database which provides an opportunity to analyze issues in terms of a specific nation and/or perform comparative analyses on the basis of sub region or the Americas as a whole.

 

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