Health News from Cuba

Life expectancy: Cuba leads Latin America

By José A. de la Osa

Disability Adjusted Life Expectancy (DALE), a new indicator developed by the World Health Organization (WHO) to measure the health status of populations, shows Cuba-- with 68.4 years-- - leading Latin America, "very near U.S. levels".

Cuba is followed in the region by Uruguay (67 years), Argentina and Costa Rica (66,7). Brazil is divided, with a DALE higher in the southern regions than in the north, showing a overall average of 59.1.

Christopher Murray, WHO Program Director for Health Policy Evidence, is the author of the report, which was made public simultaneously in Geneva, Washington, D. C., and London. Dr. Murray is a physician and health economist, and serves as Associate Professor of the School of International Health Economics, Harvard University.

In his report, Murray notes that the old system measured total life expectancy in each country based on the average number of years both men and women could expect to live. Nevertheless, people do not live all their years in perfect health, since at some point in their lives they may suffer some degree of disability.

The DALE indicator takes into consideration the years lived with a disability, including its severity, in order to estimate the total equivalent of healthy years lost. The healthy years lost from disability are subtracted from the total life expectancy to obtain the healthy life expectancy.

Japan, with a DALE of 74,5 years, leads the 191 nations where this new indicator has been applied, followed by Australia, 73.2; France, 73.1; Sweden, 73; Spain, 72.8; Italy, 72.7; Greece, 72.5; Switzerland, 72.5; Monaco, 72.4; and Andorra, 72.3. A total of 24 countries present a DALE of 70 or more years, and over half of WHO member countries register a DALE of 60 years.

Dr. Murray considers "surprising" the fact that the United States is in 24^th place, with a DALE of 70 years. "The position of the United States is one of the biggest surprises in the new life expectancy system", he says. "Basically you die earlier and spend more time with a disability if you are from the United States, as compared to the other developed countries." The report mentions several reasons for this, including the fact that in the U.S., some minorities such as Native Americans and Afro-Americans from rural areas and poor urban neighborhoods, live in conditions of poverty similar to those in developing countries. It notes that the AIDS epidemic in the U.S. accounts for a greater proportion of deaths and disabilities among young and middle-aged people than in the majority of developed countries. The United States, says the WHO report, exhibits one of the highest incidences of cancer associated with smoking, especially lung cancer, and high death rates from heart disease, which remain high despite recent decreases. The report also mentions the high levels of violence, especially homicides, in comparison with other industrialized countries.

At the other extreme of the list are 32 countries, with a DALE of less than 40 years. The last 10 are in Sub-Saharan Africa, where ,according to the report, the AIDS epidemic is decimating the population. From the bottom of the list up are: Sierra Leona, with 25,9 years; Niger, 29.1; Malawi, 29.4; Zambia, 30.3; Botswana, 32.3; Uganda, 32.7; Rwanda, 32.8; Zimbabwe, 32.9; and Ethiopia, 33.5.