Healthy Ageing and Prevention Index

• Our data offers a glimpse of the time period pre- and post- pandemic. This graph allows us to see the distribution of COVID-19 vaccination coverage as it corresponds to the Healthy Ageing and Prevention Index. 
• As of 2023, the global COVID-19 vaccination coverage was 56%. 
• On average, countries with a higher Index ranking and higher proportion of older adults also had a higher vaccination rate. 

Notes:
A completed vaccination course refers to having received the recommended number of doses of a COVID-19 vaccine corresponding to that product’s primary series, in the country where it was administered.

The number of doses constituting a primary series varies by product and by country. For most vaccine products in most countries, a completed vaccination course consists of two doses.

Source
COVID-19 vaccines | WHO COVID-19 dashboard

• The variation in the percentage of GDP spent on health care has increased over time. 
• In countries ranked 1st-50th, the percentage has increased from 6.5% in 2000 to 9% in 2020. 
• Countries ranked 51st-100th have seen a smaller increase of 1.3%, (from 5% to 6.3%).
• Lower ranked countries have increased spending by 1.2% (from 4.1% to 5.3%).
• Spending levelled out post-2009, likely as a result of the financial crisis. There was another spike in spending in 2020, which is because of the COVID-19 pandemic.
• Reasons for these changes include the increased cost of health care reflected in the cost of inputs, such as training of staff, research and the adoption of new technologies. Rises may also partly reflect a rise in an ageing population which, on average, consumes more health care resources than younger generations. 

Source
Global Health Expenditure Database (who.int)

• This graph looks at OECD member states’ adult flu vaccination coverage, based on the 2021/22 flu season. 
• Just over one in two older adults in the OECD are vaccinated against influenza.  
• The take up of adult flu vaccination is the highest in non-EU countries (64%), followed by western EU member countries (60%) and lastly eastern EU member countries (20%). 
• The top three countries for flu vaccination uptake include the UK, (81%), South Korea (80%) and Ireland (75%). 
• The bottom countries include Turkey (5.9%), Latvia (8%) and Poland (10%).
• Low average uptake rates along with stark variation between the top and bottom countries demonstrate the urgent need to strengthen vaccination programmes across the globe.

Source
Health care use – Influenza vaccination rates – OECD Data

• Canada and the United States are outliers, with Canada spending relatively more on preventative healthcare than curative healthcare.
• In contrast, the US spends much more on healthcare than any other country in the Index but far more of it goes on curative care than on prevention.
• Canada spends approximately 6% of its health budget on prevention. As a result it has seen an increase in life expectancy from 79.1 to 82.2 years between 2000 and 2019. This compares with a smaller increase in US life expectancy from 76.7 years to 78.5 years over the same period.

Source
Global Health Expenditure Database (who.int)

• Higher ranked countries spend significantly more on prevention than lower ranked countries.
• While higher ranked countries still spend more on immunisation than lower ranked countries, comparatively, immunisation programmes make up a very small proportion of overall prevention spend.
• For instance, for countries ranked 1-10 on the Index, per capita immunisation spend is only $21.30 compared with $174.48 for prevention. For those ranked 11-20, it is $13.91 and $184.85 respectively.

Source
Global Health Expenditure Database (who.int)

• The chart shows that countries in Central and Eastern Europe, including former East bloc countries, have considerably lower rates of vaccination than Western European countries and effectively form a distinct group.
• The top vaccinated country of those included is Denmark (rank 9 on the Index) with 75% and the bottom vaccinated country with only 5.8% is Bulgaria (rank 56).
• Other countries in Western Europe include: Belgium, Finland, France, and the UK, all of which have high adult flu vaccine uptake.
• Other Eastern Europe countries with low uptake include: Hungary, Poland and Turkey.

Notes
Data for flu vaccination against influenza in the population aged 65 and over using latest data for each of the 31 European countries versus the Global Index up to 2020.

Western and Eastern European countries have been predominantly grouped based on geographical location, with Central European countries grouped with Eastern Europe. Greece is an outlier, where due to political reasons, has been grouped with Western Europe.

Source
Database – Eurostat (europa.eu)

• The difference between life expectancy at birth compared with the first year or so of life is normally positive in a well performing health economy. But in less well performing countries, life expectancy at birth may be negative when compared with childhood life expectancy .
• For instance, you tend to see lower life expectancy at birth in countries with high infant mortality. This is because the high infant mortality rate has a negative effect on overall life expectancy.
• Where the difference between life expectancy at birth and 1-4 year-olds is negative, potential months of life are lost to overall life expectancy. We call this negative life expectancy. Where life expectancy is higher at birth (typically in countries with low infant mortality rates) we call this positive life expectancy.
• The chart shows wide differences using this measure. Countries that spend more per capita on immunisation not only gain more years in life expectancy but also perform better on the Index.
• This suggests that immunisation plays a critical role in improving life expectancy outcomes, leading to a higher Index ranking.
• The chart further suggests that vaccination programmes may, in general, be underfunded in around half of all counties and need to be strengthened.

Source
Global Health Expenditure Database (who.int)

• Across the world, we’ve seen a 5-year increase in life span from 66 years to 71 years between 2000 and 2020.
• The biggest increases were between 2000-2010 where we saw individuals, on average, living an additional 3.4 years.
• In recent years, life span has slowed but the differences between high and low ranked countries have shrunk by 3.5 years suggesting a reduction in inequalities on this measure.

Source
World Population Prospects – Population Division – United Nations

• Of the 153 countries on our Index, 118 have introduced the vaccine to date and 35 haven’t.
• For 16 countries that had introduced the vaccine to date there were no data.
• Higher ranked countries were more likely to rollout the HPV vaccination programme earlier than lower ranked countries. 
• On average, countries ranked in the top 10 introduced the vaccine into their national immunisation programmes in 2009. This includes countries like Switzerland, Sweden and Australia. For those ranked 60 or lower, the average year of introduction was 2019. 
• As of 2023, the rollout is not yet complete with 35 out of 153 countries yet to implement it into their vaccine schedules. The majority of these are LMICs including China and India. 
• Cervical cancer is the most common female cancer but it is almost completely preventable. However, about 90% of cases and deaths from cervical cancer occur in LMICs. Swift action is needed to ensure global rollout of the vaccine.

Source
Microsoft Power BI

• The age-standardised prevalence of tobacco use has been declining among high (1-50), medium (51-100) and low-ranking countries (101-153).
• More rapid declines are observed in high- and low-ranking countries than in medium ranked countries.
• Between 2000 and 2020, high ranked countries have seen a decrease of 11% from 32% of over-15s smoking to 21.5%. Medium ranked countries saw a decline of 8.1% from 28.1 to 20.2 over the same time period. Finally, low ranked countries saw a decline of 8.7% from 27.6% to 18.9%. 
• Since 2018 the rate of decline has flattened out at around 20% regardless of rank, a trend which should be cause for concern as smoking is strongly correlated with deaths from non-communicable diseases.

Source
UNSDG

• The chart demonstrates a 40% increase in UHC coverage between 2000 and 2019, with the biggest improvements coming from lower ranked countries. This good news highlights a significant reduction in inequity of access to healthcare.
• For instance, those ranked 91-100 saw an above average increase of 102.8%. Countries ranked 101-110 saw a 90% increase in UHC, consisting mainly of African countries, but also India. Conversely, countries in the top 20, on average saw a 14.1% increase.
• Nevertheless, we still find that countries that have greater UHC coverage perform better on the Index.

Notes
About Universal Health Coverage: Universal health coverage means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care.

UHC is measured on a unitless scale of 0-100, which is computed as the geometric mean of 14 tracer indicators of health service coverage. The tracer indicators are as follows, organised by four components of service coverage: 1. Reproductive, maternal, newborn and child health 2. Infectious diseases 3. Noncommunicable diseases 4. Service capacity and access. UHC is tracked by the WHO and World Bank.

Source
UHC Service Coverage Index (SDG 3.8.1) (who.int)

• Higher ranked countries have a greater obesity burden than lower ranked countries.
• Conversely, lower ranked countries have a greater undernourishment burden than higher ranked countries.
• Levels of obesity and undernourishment tend to be more or less equal in countries ranked between 71 and 80 on the Index.
• Unhealthy diets and poor nutrition are likely hampering progress for many countries:
  • Globally, 88% of countries worldwide experience more than one form of malnutrition.
  • Avoidable deaths due to poor diet have grown by 15% since 2010 and are now responsible for a quarter of all adult deaths.

Source
UNSDG
2021 Global Nutrition Report | Foreword – Global Nutrition Report

• High ranked countries have the most medical doctors with over 40 per 10,000 population. Countries ranked between 11 and 40 have around 35 per 10,000.
• Countries ranked 70 or worse fall to an average of only five per 10,000.
• According to the WHO and World Bank, at least half of the world’s population cannot obtain essential health services.

Source
UNSDG
World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses

• Countries in the top 20 have comparable death rates from NCDs like heart disease and cancer but in countries ranked lower than 20, the number of deaths increase and life expectancy falls.
• It means that better ranked countries have greater access to life-saving treatment and preventative interventions that support healthier lifestyles, including access to medicines that can prolong and/or better manage chronic conditions.
• It is estimated that 80% of NCDs are preventable, mainly driven by modifiable risk factors including, tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol and air pollution.
• There is a small dip in death rates from NCDs in countries with an index ranking in the range of 90-110, even though life expectancy continues to decline. A probable reason is that deaths from communicable diseases are more common and strike at younger ages, reducing exposure to NCDs in their cases.

Source
UNSDG
Sachs, J., Schmidt-Traub, G., Kroll, C., Lafortune, G., Fuller, G. (2018): SDG Index and Dashboards Report 2018.
Non Communicable Diseases | NCD Alliance