Does a longer life mean a healthy life?

While we all hope to live as long as possible, we equally hope to live our years in the best health possible. — Filepic

The Sustainable Development Goals (SDGs) were agreed to by the members of the United Nations (UN), including Malaysia, in 2015.

They are a set of 17 interconnected goals, which collectively provide a roadmap to a better future for humanity by 2030.

The SDGs address societal challenges that include poverty, inequality, climate change, peace and justice.

SDG 3, which specifically aims to “ensure healthy lives and promote well-being for all at all ages”, has a direct relationship to life expectancy.

Our life expectancy

Life expectancy is the average number of years that a newborn could expect to live, if he or she were subject to the age-specific mortality (death) rates of a given period of time.

It is an indicator of mortality conditions and is a proxy of a nation’s overall health and well-being.

Life expectancy was historically short for humans, but human lifespan increased markedly in the second half of the last century due to medical and technological advances; improved nutrition, housing and sanitation; and public health policies.

The Statistics Department has provided the life expectancy data of Malaysians since 1957, as well as the SDGs’ data.

The long-term target for our life expectancy is 83 years.

The Statistics Department has an online dashboard with the time trends of specific data for males, females, different demographic groups and states.

The World Health Organization (WHO) provides national health data for the SDGs.

Malaysia is a member of the WHO and is considered part of the Western Pacific region.

This region has a population of 1.9 billion, and comprises 37 other countries, including Brunei, Cambodia, Laos, the Philippines, Singapore, Australia, China, Japan, New Zealand, South Korea and the Pacific Islands.

The WHO defines healthy life expectancy (HALE) as the “average number of years that a person can expect to live in ‘full health’ by taking into account years lived in less than full health due to disease and/or injury”.

HALE calculations are estimated as the years lost due to disability (YLD) rate per capita, adjusted for independent comorbidity (concurrent illness) by age, sex and country.

The WHO stated: “In Western Pacific, healthy life expectancy at birth (years) has improved by 4.35 years from 63.8 [63.1-64.6] years in 2000 to 68.2 [67.6-69] years in 2021.”

It added: “In Malaysia, healthy life expectancy at birth (years) has worsened by 0.183 years from 64.1 [63.5-64.7] years in 2000 to 63.9 [63.4-64.6] years in 2021.”

Source: WHO

Years spent ill

Prior to the Covid-19 pandemic, life expectancy had increased globally.

In the WHO Western Pacific region specifically, it had gone up by about six years between 2000 and 2020.

Although the global HALE had increased by about 9% from 2000 to 2020, this was primarily due to declining death rates, rather than reduced years lived with disability.

In other words, the increase in HALE had not kept pace with the increase in life expectancy globally.

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The Covid-19 pandemic reversed about a decade of global gains in both life expectancy and HALE at birth.

In 2020, both global life expectancy and HALE returned to 2016 levels (72.5 years and 62.8 years respectively).

There were further declines in 2021, with both retreating to 2012 levels (71.4 years and 61.9 years respectively).

It was no different in Malaysia; in fact, it was worse.

Malaysia had the highest Covid-19 death rate per capita in all of Asean and the second highest in Asia.

The maternal mortality rate (MMR) in Malaysia in 2021 was 68.2 maternal deaths per 100,000 life births, compared to 24.9 maternal deaths per 100,000 life births in 2020.

In fact, the last occasion that Malaysia had such a high MMR was in the mid-1980s, more than three decades ago.

The MMR, which reflects the number of women who die due to pregnancy or childbirth, is often used as an indirect measure of a country’s healthcare system.

In 2021, the gap between Malaysia’s life expectancy (72.8 years) and HALE (63.9 years) at birth was 8.9 years.

This means that a Malaysian could expect to spend an average of 8.9 years in ill health.

This was lower than the average gap in the WHO Western Pacific region, but higher than the global number.

The broad causes of death in Malaysia in 2021 were:

• Non-communicable diseases (NCDs, 65.1%)
• Communicable, maternal, perinatal and nutritional conditions (25.6%)
• Injuries (5.6%), and
• Other Covid-19 related outcomes (3.7%).

Source: WHO

Will we be HALE?

Three in 10 Malaysians have high blood pressure, with about 12% unaware of their condition and less than half of those aware of their condition having good control of their blood pressure.

One in six adults have diabetes, with two in five unaware of their condition, and similarly, less than half of those aware of their condition having good control of their blood glucose (sugar) levels.

One in three Malaysians have high cholesterol, with one in two unaware of their condition.

The prevalence of overweight and obesity in Malaysia is more than half the population, which is the highest rate in Asean.

It has been estimated that more than half a million Malaysians have four NCDs (i.e. high blood pressure, diabetes, high cholesterol and obesity), and about 2.3 million have three NCDs (typically, three of the four listed).

Will Malaysia’s HALE improve by 2030? Or is it mission impossible?

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.