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OECD: Healthier lifestyles and better health policies drive life expectancy gains

Healthier lifestyles, higher incomes and better education have all contributed to boost life expectancy in recent decades. Better health care has also helped, according to a new OECD report.

Health at a Glance 2017 says that all OECD countries have seen life expectancy at birth increase by over 10 years since 1970 to reach an average of 80.6 years. Life expectancy at birth is highest in Japan (83.9 years), and Spain and Switzerland (83 years each), and lowest in Latvia (74.6) and Mexico (75).

New analysis in the report reveals that if smoking rates and alcohol consumption were halved, life expectancies would rise by 13 months. A 10% increase in health spending per capita in real terms would, on average, boost life expectancy by 3.5 months. However it is not just spending per se, but also how resources are used, that makes the difference in life expectancy. There is a large variation in the link between changes in health spending and in life expectancy: in the United States, for example, health spending has increased much more than in other countries since 1995, yet life expectancy gains have been smaller.

Health spending per capita has grown at around 1.4% annually since 2009, compared to 3.6% in the six years up to 2009. Average spending per capita has now reached about USD 4 000 per year. Spending is highest in the US, at USD 9 892 per person, and 17.2% of GDP. Health spending was also 11% or more of GDP in Switzerland, Germany, Sweden and France.

Reducing wasteful spending is key to maximise the impact of public resources on health outcomes, and Health at a Glance illustrates areas where spending could be more effective. For example:
# Increased use of generics in most OECD countries has generated cost-savings, accounting for more than 75% of the volume of pharmaceuticals sold in the US, Chile, Germany, New Zealand and the United Kingdom, but less than 25% in Luxembourg, Italy, Switzerland and Greece.
# Antibiotics should only be prescribed when absolutely necessary, yet antibiotic prescriptions varied more than three-fold across countries, with Greece and France reporting volumes much higher than the OECD average.
# The share of minor surgeries provided on a same-day (rather than inpatient) basis is now common in most OECD countries. For example, day surgery now accounts for 90% or more of all cataract surgeries in 20 of the 28 OECD countries with comparable data. However less than 60% of cataract surgeries are performed on a same-day basis in Poland, Turkey, Hungary and the Slovak Republic.

The report also shows that health care quality is improving:
– Over 80% of patients report positive experiences in terms of their time spent with a doctor, easy-to-understand explanations and involvement in treatment decisions.
– Avoidable hospital admissions for chronic conditions such as diabetes and asthma have fallen in most OECD countries, indicating an improving quality of primary care.
– Fewer people are dying following heart attack or stroke. Improvements are particularly striking among heart attack patients in Finland, and stroke patients in Australia.
– Across OECD countries, five-year survival rates for breast cancer were 85% and just over 60% for colon and rectal cancers, with survival rates improving in most countries over time.

While smoking rates continue to decline, there has been little success in tackling obesity and harmful alcohol use, and air pollution is often neglected:

Smoking rates have decreased in most OECD countries, but around one in five adults still smoke daily. Rates are highest in Turkey, Greece and Hungary and lowest in Mexico.
Across the OECD, alcohol consumption has declined since 2000. However, consumption has increased in 13 countries over the same period, most notably in Belgium, Iceland, Latvia and Poland. Moreover, one in five adults regularly binge drink across the OECD.
54% of adults in OECD countries today are overweight, including 19% who are obese. Obesity rates are higher than 30% in Hungary, New Zealand, Mexico and the United States.

The report, together with country notes and more information, is available at http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm.

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