eConcepts:
Open Data for Public Health Bodies

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How has cross-country life expectancy changed in the long-run?

The visualization summarises available life expectancy data over the last few centuries. The estimates from the UK – the country for which we have the longest time-series – show that life expectancy before 1800 was very low, but since then it has increased drastically. We can see that in less than 200 years the UK doubled life expectancy at birth. And the data shows that similarly remarkable improvements also took place in other European countries during the same period.

The chart also shows large historical changes in life expectancy estimates for other countries. Notice, for example, that a century ago life expectancy in India and South Korea was as low as 23 years – and a century later, life expectancy in India almost tripled, and in South Korea almost quadrupled.

In the long run the inequality in life expectancy within countries decreased hugely

The inequality in years of life between people within the same country can be measured in the same way that we measure, for example, the inequality in the distribution of incomes. The idea is to estimate the extent to which a small share of a country’s population concentrates a large ‘stock of health’, hence living much longer than most of the population in the same country.

The following visualization presents estimates of the inequality of lifetimes as measured by the Gini coefficient. A high Gini coefficient here means a very unequal distribution of years of life – that is, large within-country inequalities of the number of years that people live. These estimates are from Peltzman (2009)2, where you can find more details regarding the underlying sources and estimation methodology.

As can be seen in the chart, inequality in health outcomes has fallen strongly within many countries.

How has cross-country child mortality changed in the long-run?

The interactive time-series plot shows how child mortality has changed over the long run. As we can see, child mortality in industrialised countries today is below 5 per 1,000 live births – but these low mortality rates are a very recent development. In pre-modern countries child mortality rates were between 300 and 500 per 1,000 live births. In developing countries the health of children is quickly improving – but child mortality is still much higher than in developed countries.

A second interesting feature of the trends depicted in this chart is that there are many sharp ‘spikes’ in the 19th century. This is partly because the data quality is improving over time, but also because health crises were more frequent in pre-modern times. The decline of crises is an important aspect of improving ‘living standards’. In our entry on food price volatility you find empirical evidence of how frequent food crises were. In the following plot you can see what these and other crises – epidemics or wars, for example – meant for the health of the population.

Are developing countries catching up with low child mortality rates in developed countries?

The fact that developing countries have made particularly fast improvements to reduce child mortality in the last fifty years, has meant that cross-country gaps have been closing.

The following visualization shows child mortality estimates by income level of countries. We can see a clear downward trend across all groups. And since high-income countries have seen the slowest progress (due to their already high health outcomes) we can see that the gap between these countries and the rest of the world has been narrowing. Upper middle income countries are in fact close to catching up.

Nevertheless, the latest figures show the important challenges that remain: low-income countries have, on average, child mortality rates that are still more than ten times higher than in high-income countries. The remaining gap is still large.

The five most lethal infectious diseases over time

The chart focuses on the five most lethal infectious diseases. It shows the number of child deaths caused by these diseases from 1990 onwards.

Deaths caused by malaria and HIV/AIDS were rising over the 1990s. From 2005 onwards the deaths caused by each of these diseases is declining.

The most important disease referred to as ‘lower respiratory infections‘ in the visualization is pneumonia.

Maternal mortality reduced in the long run

The visualizations above highlight the drastic long-term improvements that countries have made to reduce child mortality. But have these health improvements also materialized for mothers?

The chart shows long-run maternal mortality estimates for a selection of mainly high income countries. We can see that a hundred years ago, out of 100,000 child birth, between 500 and 1,000 ended with the death of the mother. This means every 100th to 200th birth led to the mother’s death. Since women gave birth much more often than today, the death of the mother was a common tragedy. Today, these countries have maternal mortality rates close to 10 per 100,000 live births.

The same chart also shows that different countries have achieved progress in maternal mortality at different points in time. The decline of maternal mortality in Finland, for example, began in the middle of the 19th century and didn’t reach today’s low level until more than a century later. Malaysia in contrast achieved this progress in only a few decades.

The global distribution of the disease burden

This map shows DALYs per 100,000 people of the population. It is thereby measuring the distribution of the burden of both mortality and morbidity around the world.

We see that rates across the regions with the best health are below 20,000 DALYs per 100,000 individuals. In 2017 this is achieved in many European countries, but also in Canada, Israel, South Korea, Taiwan, Japan, Kuwait, the Maldives, and Australia.

In the worst-off regions, particularly in Sub-Saharan Africa, the rate is higher than 80,000 DALYs per 100,000.

Is the world making progress in its fight against HIV/AIDS?

The number of AIDS-related deaths increased throughout the 1990s and reached a peak in 2005, 2006 when in both years close to 2 million people died. Since then the annual number of deaths from AIDS declined as well and was since halved. 2017 was the first year since the peak in which fewer than 1 million people died from AIDS.

The chart also shows the continuing increase in the number of people living with HIV. The rate of increase has slowed down compared to the 1990s, but the absolute number is at the highest ever with more than 36 million people globally living with HIV.

How strong is the link between healthcare expenditure and life expectancy?

One of the most important inputs to health is healthcare. Here we study cross-country evidence of the link between aggregate healthcare consumption and production, and health outcomes.

One common way of measuring national healthcare consumption and production is to estimate aggregate expenditure on healthcare (typically expressed as a share of national income).

This visualization shows the cross-country relationship between life expectancy at birth and healthcare expenditure per capita.
The association between health spending and increasing life expectancy also holds for rich countries in Europe, Asia, and North America in the upper right corner of the chart. The US is an outlier that achieves only a comparatively short life expectancy considering the fact that the country has by far the highest health expenditure of any country in the world.

When did high-income countries start expanding their healthcare systems?

The earliest data on financing of healthcare dates back to the late 19th century – this is when many European countries began officially establishing healthcare systems through legislative acts. The visualization here presents estimates of government spending on healthcare as a percent of GDP for a selection of high-income countries using data from multiple sources.

How important is out-of-pocket spending around the world?

In many countries an important part of the private funding for healthcare takes the form of ‘out-of-pocket’ spending. This refers to direct outlays made by households, including gratuities and in-kind payments, to healthcare providers. The following visualization presents out-of-pocket expenditure on healthcare by country (as percent of total healthcare expenditure). As it can be seen, in high-income countries these outlays tend to account for only a small fraction of expenditure on healthcare (e.g. France, where the share was always below 8% in the entire series 1995-2013); while in low-income countries, they account for the majority of funding (e.g. Afghanistan, where the share of out-of-pocket expenditure reached 87.7% in 2002). Many countries have followed a clear path in the direction of reducing this type of expenditures (particularly in the developing world), yet some countries have moved in the opposite direction (Russia is a notable case in point, with a threefold increase in the share of out-of-pocket expenditure in the last decade).

Catastrophic health expenditures, latest available year of data

The following visualisation presents the percentage of the population facing catastrophic health expenditures, defined as greater than 10% of total household income or household consumption.

Global age-standardized alcohol-attributable cardiovascular disease death rates, 2016

Age-standardized suicide rates (per 100 000 population), both sexes, 2016

Prevalence of overweight, males 18+ age standardized: Maale, 2016

MPOWER policies – Smoke-free environments, 2014

Psychiatrists working in mental health per (100 000 population), 2011

National regulatory agency for medical devices, 2014

Maternal mortality ratio (per 100 000 live births) 2015

Prevalence of obesity, ages 18+, age standardized: Male, 2016

Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

Health status

The life expectancy of the Irish population has increased by nearly six years since 2000, the strongest gains among western European countries, and is now above the EU average. The increase was driven by sharp reductions in mortality from cardiovascular diseases, due in part to reductions in some risk factors like smoking but also to improvements in treatments.

Risk factors

In 2018, 17 % of adults in Ireland smoked tobacco every day, down from 27 % in 2002, and now slightly below the EU average. Nearly one-third of adults reported regular heavy alcohol intake in 2014, a rate well above the EU average. The obesity rate increased to 18 % in 2015, up from 15 % in 2007, and is now higher than the EU average.

Health system

Health spending in Ireland has increased at a moderate rate in recent years. At EUR 3 406 per person in 2017, it is around one-fifth higher than the EU average. Public funding accounts for 73 % of all health spending in Ireland, a lower share than the EU average (79 %). The remaining part is paid directly out of pocket by households (12 %) or through voluntary health insurance (13 %), which plays a much bigger role than in most other EU countries.

Effectiveness

Mortality from preventable and treatable causes in Ireland is lower than the EU average, signaling that public health policies and health care interventions are generally effective. Yet many other western European countries are more successful in avoiding premature deaths.

Life expectancy in Ireland has increased rapidly and is now above most EU countries

Life expectancy at birth reached 82.2 years in Ireland in 2017, up from 76.6 years in 2000. Since life expectancy in Ireland has grown more rapidly than in most other EU countries, it is now more than one year above the EU average (80.9 years) while it was still below the average in 2000. Although the gender gap in life expectancy in Ireland is narrowing, Irish men could still expect to live almost four years less than women (80.4 years compared to 84.0 years) in 2017. This gap is, however, less pronounced than in many EU countries.

Circulatory diseases and cancer are still the leading causes of death

The increase in life expectancy in Ireland since 2000 has mainly been driven by reductions in mortality rates from circulatory diseases, notably ischaemic heart disease. Despite this progress, circulatory diseases remain the leading cause of death in Ireland (30.1 % of all deaths) followed by cancer (29.9 %). Among the different types of cancer, lung, colorectal and breast cancer are the most frequent causes of death in Ireland.

Ireland has the highest share of the population that reports being in good health in the EU

About 83 % of Irish adults reported being in good health in 2017, the highest share among all EU countries and substantially above the EU average of 70 % (Figure 3). As in other countries, there are some disparities in self-rated health across income groups. Only 73 % of people in the lowest income quintile assess their health as good, compared to 93 % in the highest. These disparities already exist in children’s health: children from well-off parents are more likely to be in good health than those growing up in low-income households.

The Irish are living longer than before, but not all remain healthy as they age

The proportion of people aged over 65 in Ireland is currently relatively low, accounting for 13 % of the population. However, due to rising life expectancy and declining fertility rates, this share is projected to double to 26 % by 2050, which will lead to growing demands on health and long-term care systems.

Health expenditure is above the EU average on a per capita basis

In 2017, health spending per capita in Ireland stood at EUR 3 406 (adjusted for differences in purchasing power), around one-fifth above the EU average (Figure 7). This surprisingly high level – given the comparably young demographic – is mainly due to high health prices.

The use of both primary care and inpatient care is lower in Ireland than the EU average

The use of both primary care services (measured in terms of number of doctor consultations per person) and hospital care (measured in terms of number of admissions and discharges) is lower in Ireland than the EU average (Figure 8). Salaries in the health sector, in particular for specialists and for senior doctors and nurses, are above those of many other countries in western Europe.

Spending on inpatient care in Ireland is higher than in most other EU countries

For many health spending components, Ireland spends more than the EU average per capita (Figure 9). Spending on inpatient care is the fifth highest in the EU, around one-third above the EU average. For long-term care, per capita spending is more than 50 % above the EU average. On the other hand, per capita spending on pharmaceuticals and medical devices was below the EU average in 2017.

Ireland has a low number of doctors but a relatively high number of nurses

The number of doctors in Ireland has increased in recent years but remains relatively low, at 3.1 per 1 000 population in 2017 compared to the EU average of 3.6 (Figure 10). This is related partly to restrictions in the training capacity of new doctors. Despite having the highest number of medical graduates per capita in Europe, the limited internship opportunities for new graduates create a bottleneck for many of them to complete their training, and the country is increasingly dependent on foreign-trained doctors to respond to its needs (see Section 5.3). Conversely, the number of nurses is comparatively high, at 12.2 per 1 000 population in 2017 compared to the EU average of 8.5, but the number has decreased since 2010 and many nurses only work part time. There are growing issues over recruitment and retention that have led to severe shortages within the nursing workforce.

Preventable and treatable causes of mortality in Ireland are below the EU average

A first indication of how the Irish health system fares in terms of effectiveness is to look at mortality from preventable and treatable causes (Figure 11). Ireland is doing better than many other EU countries when it comes to preventable mortality, while mortality from treatable causes falls outside the top third of EU countries.

Vaccination rates in Ireland are around the EU average but vaccination hesitancy is growing

While childhood vaccination rates against many major infectious diseases are around the EU average and close to the WHO recommended target of 95 % (Figure 12), there has been a slow but notable decline in recent years. In 2017, vaccination rates against diphtheria, pertussis and tetanus, as well as measles, mumps and rubella, were all one percentage point below the rates seen in 2014 (Department of Health, 2018a). The decrease was even higher for influenza vaccination among older people (down by three percentage points compared with 2014).

Hospitalisation rates for ambulatory care-sensitive conditions are around the EU average

Hospital admissions for diseases such as diabetes, congestive heart failure or asthma and chronic obstructive pulmonary disease (COPD) are largely avoidable as patients with these conditions can be effectively treated in the community. Overall, hospitalisation rates in Ireland are around the EU average for these conditions (Figure 13). However, while there are fewer admissions for diabetes and chronic heart failure, Ireland records the second highest hospitalisation rate for asthma and COPD across EU countries after Hungary – around 50 % above the EU average. This signals untapped potential to improve the management of these chronic diseases in primary care.

The share of out-of-pocket spending in Ireland is below the EU average, but voluntary health insurance plays a bigger role

Despite the lack of comprehensive coverage for a substantial part of the population, the share of OOP spending in total health spending (12.3 %) was 3.5 percentage points below the EU average of 15.8 % in 2017 (Figure 14).

Many Irish people wait a long time for cataract surgery and hip replacement

Waiting times for diagnostics and medical treatments have historically been high in Ireland, and a number of different initiatives have tried to reduce them in the past (Siciliani, Borowitz and Moran, 2013). While in some cases improvements were achieved initially, a long-term solution to this issue has not yet been found. Long waiting times for services exist throughout the system (HSE, 2018). Within the community, for example, 23 % of people in need of occupational therapy had to wait for more than a year for assessment in 2017. For ophthalmological treatment, waiting times were longer than one year for nearly 40 % of patients.

Unmet needs for medical care in Ireland are slightly above the EU average

As a consequence of non-universal coverage and long waiting times for treatment, unmet needs for medical care in Ireland are above the EU average (Figure 16). In 2017, 2.8 % of the Irish adult population had foregone medical care due to costs, long waiting times or distance. As in other countries, people on low income in Ireland encounter greater barriers to access health services (4.9 % report unmet needs) than those on high income (1 %). Interestingly, because of the way public coverage is organised, the share of the population that report unmet needs because of costs is slightly lower for low-income groups than for middle-income groups. The largest income-related inequality in unmet needs is due to waiting times. While those on low incomes primarily rely on public care provision, those who can afford private health insurance may use private insurance coverage for quicker access.

The average length of stay in hospital has decreased and is lower than the EU average

About one-third of health spending in Ireland is allocated to inpatient care in hospitals. Some initiatives are underway to improve the efficient use of hospital resources; indeed, the average length of stay (ALOS) of patients has decreased over the past decade and is now about 25 % lower than across the EU (Figure 18). Still, there is further potential to get more value for money.

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