World Health Organization
Press Release WHO
Released in Washington, D.C. and Geneva, Switzerland
4 June 2000
Issues New Healthy Life Expectancy Rankings
Japan Number One in New ‘Healthy Life’ System
Japanese have the longest healthy life expectancy of 74.5 years among 191 countries, versus less than 26 years for the
lowest-ranking country of Sierra Leone, based on a new way to calculate healthy life expectancy developed by the World Health
Previously, life expectancy estimates were based on the overall length of life based on mortality data only.
For the first time, the WHO has calculated healthy life expectancy for babies born in 1999 based upon an indicator developed
by WHO scientists, Disability Adjusted Life Expectancy (DALE). DALE summarizes the expected number of years to be lived in
what might be termed the equivalent of "full health." To calculate DALE, the years of ill-health are weighted according to
severity and subtracted from the expected overall life expectancy to give the equivalent years of healthy life.
The WHO rankings show that years lost to disability are substantially higher in poorer countries because some limitations
-- injury, blindness, paralysis and the debilitating effects of several tropical diseases such as malaria -- strike children
and young adults. People in the healthiest regions lose some 9 percent of their lives to disability, versus 14 percent in
the worst-off countries.
In terms of DALE, the rest of the top 10 nations are Australia, 73.2 years; France, 73.1; Sweden, 73.0; Spain, 72.8;
Italy, 72.7; Greece, 72.5; Switzerland, 72.5; Monaco, 72.4; and Andorra, 72.3.
DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At
the other extreme are 32 countries where disability-adjusted life expectancy is estimated to be less than 40 years. Many of
these are countries with major epidemics of HIV/AIDS, among other causes.
The United States rated 24th under this system, or an average of 70.0 years of healthy life for babies born in
1999. The WHO also breaks down life expectancy by sex for each country. Under this system, U.S. female babies could expect
72.6 years of healthy life, versus just 67.5 years for male babies.
"The position of the United States is one of the major surprises of the new rating system," says Christopher
Murray, M.D., Ph.D., Director of WHO's Global Programme on Evidence for Health Policy. "Basically, you die earlier and spend
more time disabled if you’re an American rather than a member of most other advanced countries."
The WHO cites various causes for why the United States ranks relatively low among wealthy nations. These reasons
In the United States, some groups, such as Native Americans, rural African Americans and the inner city poor,
have extremely poor health, more characteristic of a poor developing country rather than a rich industrialized one.
HIV epidemic causes a higher proportion of death and disability to U.S. young and middle-aged than in most other advanced
countries. HIV-AIDS cut three months from the healthy life expectancy of male American babies born in 1999, and one month
from female lives;
The U.S. is one of the leading countries for cancers relating to tobacco, especially lung cancer Tobacco use
also causes chronic lung disease.
A high coronary heart disease rate, which has dropped in recent years but remains high;
Fairly high levels of violence, especially of homicides, when compared to other industrial countries. ....
Several factors go into making Japan number one in the rankings. One is the low rate of heart disease, associated with
the traditional low fat diet. The national diet is changing, with high fat foods such as red meat becoming common. The effect
of tobacco has also been mild until recently, with low lung cancer rates. These rates for men are expected to jump in coming
years as the long-term effects of the post-World War II smoking popularity begin to hit.
In Australia, smoking rates have dropped sharply from their earlier peaks, leading to lower lung cancer and heart problem
France registered high because of the health of its women, which pulled up the overall average.
French women never smoked in any large numbers until recently. Many young French women, however, have begun smoking,
which will lead to rapid increases in lung cancer rates and other diseases associated with tobacco in 10 to 20 years. French
men are already suffering from growing rates of these diseases from tobacco.
Sweden ranks high because of its health care system and because tobacco use is relatively low. ...
(Christopher Murray, M.D., Ph.D., Director of WHO's Global Programme on Evidence for Health Policy, is available for
telephone interviews on Thursday and Friday, June 1-2. Please call 703-820-2244 to schedule time.)