5. Health

Newborns in more than two-thirds of OECD countries can expect to live beyond 80 years (80.5 years on average for the OECD as a whole), and up to 84.2 in Japan (Figure 5.2). Life expectancy has increased in all OECD countries over the last few decades and was over ten years higher in 2017 than it was in 1970 (OECD, 2019[1]). Compared to 2010, average life expectancy has increased by about 1 year and 2 months (1.5%). Yet growth has slowed in some countries: for Iceland, Germany, Greece and the United Kingdom, life expectancy is plateauing, with gains of less than 9 months between 2010 and 2017. In the United States, already below the OECD average at 78.6 years, net gains in life expectancy over this time have been nil, after a temporary decrease over 2014-17. The causes of the slowdown in life expectancy gains are multifaceted: Improvements in heart disease and stroke have slowed as populations age and levels of obesity and diabetes rise, a comparatively large number of people died from influenza and pneumonia in the recent decade, and drug-related accidental poisoning rose in some countries in the context of the opioid crisis (OECD, 2019[1]; Raleigh, 2019[2]). But there is also good news: many countries with comparatively lower levels of life expectancy are converging towards the OECD average. For example, life expectancy has risen by more than 2 years since 2010 in Chile, Estonia, Korea and Lithuania.

On average, between 6 and 7 out of 10 people in OECD countries say their health is in good shape (Figure 5.3). However, there are notable country differences: in Asian and eastern European OECD members, as well as in Portugal, fewer than 60% of adults view their health as good. By contrast, more than 80% in Australia, Canada, Ireland, New Zealand, Switzerland and the United States do so (though differences in the way survey questions are phrased in some of these countries might bias results upwards). While the OECD average has remained relatively stable, trends since 2010 have diverged between countries. Perceived health has improved most in Slovenia (5.7 percentage points), and declined most in Lithuania (-6.5) and Korea (-8.1).

Fatalities from suicide, acute alcohol abuse and drug overdose have recently been coined as “deaths of despair” (Case and Deaton, 2017[3]). On average, 14.8 people per 100 000 in OECD countries die from such causes, which is only a small share (1.8%) of overall deaths (Figure 5.4). Nevertheless, these deaths represent an important measure of severe mental illness and addiction among the population (OECD, 2019[4]). Slovenia, Lithuania and Latvia, as well as Korea and Denmark, record the highest death rates from suicide and substance abuse in the OECD, above 20 per 100 000 population. Among these, deaths of despair are mainly from suicide in Korea and Lithuania, whereas fatalities from acute alcohol abuse represent at least a third of overall deaths of despair in Latvia, Denmark and Slovenia (Figure 5.4). By contrast, overall rates are very low in Turkey (2.6), Greece (4.2) and Colombia (5.2). Yet these estimates should be interpreted with some caution, since death registries are likely to underrepresent the phenomena due to different reporting practices and stigma (Box 5.1).

Since 2010, deaths from suicide (the most common form of deaths of despair, Figure 5.5) and substance abuse have fallen in a third of OECD countries, driven mainly by reductions in suicides. Some of the countries with the greatest challenges have made the most progress: Hungary, Japan and Korea reduced these fatalities by over 25%, Estonia by 23% and Lithuania by 15%. The situation worsened elsewhere: since 2010, deaths of despair increased by 16% in the United States, 18% in Slovenia (with the highest level in the OECD) and 30% in the Netherlands. In these three countries, deaths from both acute alcohol abuse and drug overdose rose substantially.

Data on self-reported depressive symptoms are available only for European OECD countries, where, on average, 6% of adults experienced a range of depressive symptoms in the past two weeks (e.g. having little interest in doing things, feeling tired, overeating or having no appetite) (Figure 5.6). Slightly more people, 8% on average, self-report having suffered from chronic depression (the most common mental disorder after anxiety disorder in the EU) in the past year (OECD/EU, 2018[5]).

Life expectancy at birth is higher for women (83.2 years, on average) than for men (77.9 years) in all OECD countries. Conversely, 70% of men report their health to be good, but only 66% of women do, on average. These gender gaps vary in size across countries, but the direction remains consistent in almost all cases (Figure 5.7). Eastern European countries are furthest from gender parity on both measures.

Throughout OECD countries, men are much more likely to die from suicide, acute alcohol abuse or a drug overdose – on average, almost 4 men for every woman (Figure 5.8). This gender gap is largest in Poland, at 8.2. Even in the country with the smallest gender gap (Luxembourg), the rate of deaths among men is double the rate for women.

The size of the gender gap in deaths of despair has narrowed in 20 OECD countries since 2010. In more than half of these, this has been driven by a higher or stagnant female death rate alongside fewer male deaths. Overall, female deaths from suicide or substance abuse increased in more than one-third of OECD countries (14) since 2010. Nevertheless, in two of the most unequal countries (Iceland, Lithuania), the gap between the sexes widened further, as deaths among women decreased at a faster pace than those for men.

In the European OECD countries where data are available, more women (8%) than men (5%) have experienced recent depressive symptoms (OECD/EU, 2018[5]).

There are marked inequalities in life expectancy and self-reported health that are related to differences in education and income. In the 18 OECD countries for which data are available, the average gap in life expectancy at age 25 between high- and low-educated people is 7.6 years for men and 4.8 years for women (Figure 5.9). At age 65, these gaps are 3.6 and 2.6 years, respectively (Murtin et al., 2017[6]). Similarly, across all OECD countries, better educated people experience better physical and mental health: on average, 78% of those with a tertiary education say their health is good, compared to 65% of people with a secondary degree (OECD Health Status database). In European OECD countries, 4% of people with tertiary degrees versus 6% with secondary degrees have experienced recent depressive symptoms (OECD/EU, 2018[5]).

Without exception, people with higher income also report better health. On average, 79% of those in the top income quintile in OECD countries say their health is good, compared to only 60% in the bottom quintile (Figure 5.10). Eastern European countries show the largest income-related differences, with gaps in perceived health exceeding 25 percentage points. In the Czech Republic, Latvia and Estonia, income-related differences in self-reported health also widened by more than 10 percentage points since 2010.


[3] Case, A. and A. Deaton (2017), “Mortality and Morbidity in the 21st Century”, Brookings Papers on Economic Activity, http://brookings.edu/wp-content/uploads/2017/08/casetextsp17bpea.pdf (accessed on 26 September 2019).

[6] Murtin, F. et al. (2017), “Inequalities in longevity by education in OECD countries: Insights from new OECD estimates”, OECD Statistics Working Papers, No. 2017/2, OECD Publishing, Paris, https://dx.doi.org/10.1787/6b64d9cf-en.

[4] OECD (2019), Addressing Problematic Opioid Use in OECD Countries, OECD Health Policy Studies, OECD Publishing, Paris, https://dx.doi.org/10.1787/a18286f0-en.

[1] OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://dx.doi.org/10.1787/4dd50c09-en.

[8] OECD (2019), OECD Mental Health Performance Framework, http://oecd.org/health/health-systems/OECD-Mental-Health-Performance-Framework-2019.pdf (accessed on 14 January 2020).

[5] OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris/European Union, Brussels, https://dx.doi.org/10.1787/health_glance_eur-2018-en.

[7] Patel, V. et al. (2018), “The Lancet Commission on global mental health and sustainable development””, The Lancet Commissions, Vol. 392/10157, pp. 1553-1598, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31612-X/fulltext.

[2] Raleigh, V. (2019), “Trends in life expectancy in EU and other OECD countries : Why are improvements slowing?”, OECD Health Working Papers, No. 108, OECD Publishing, Paris, https://dx.doi.org/10.1787/223159ab-en.

[10] United Nations (2005), Budapest Initiative Task Force on Measurement of Health Status: Survey module for measuring health state, https://digitallibrary.un.org/record/747214 (accessed on 16 September 2019).

[9] Washington Group on Disability Statistics (2016), The Washington Group Short Set on Functioning (WG-SS), http://washingtongroup-disability.com (accessed on 16 September 2019).

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