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INTRODUCTION

Before focusing in-depth analysis on a small number of high-income countries, we begin by showing the 35 richest countries in terms of life expectancy at age 50 relative to gross domestic product (GDP) per capita. We then proceed to the main analysis, which is based on 10 countries selected by the committee as the most relevant for understanding the position of the United States.

In 2005, among the richest countries, we see a clear relation between e50 (both sexes) and the GDP per capita (Figure 2-1, right graph) (R2 = 0.60), which contrasts with the situation observed in 1960 (Figure 2-1, left graph) (R2 = 0.05). In between, major changes occurred in the field of public health. Until the middle of the 20th century, life expectancy was still strongly dependent on the fight against infectious diseases (even above age 50), which mainly relied on antibiotics and vaccines without much link to the GDP per capita, at least among rich countries. On the contrary, by 2005, e50 depends mostly on the success of the fight against degenerative diseases, including circulatory diseases.

Figure 2-1 shows some geographic clustering: among these countries at the top of the world income distribution, the group of countries in the lower left corner (lowest e50 and lowest GDP per capita) includes Russia and most of the countries in Central and Eastern Europe, and the countries in the rest of the world are clustered in the top half of the graph (with higher e50 and generally higher GDP per capita). However, the general correlation between GDP per capita and e50 appears to be rather strong.1 Yet under the diagonal on Figure 2-1, there are a few outliers: e50 in Denmark (DNK), Ireland (IRL), Russia (RUS), Singapore (SGP), and even more so Norway (NOR) and the United States (USA), are lower than one might expect given their income level. Specific explanations could certainly be given for each of these exceptions, but it seems that at least three of them were enriched rather suddenly in recent years, perhaps without sufficient time to realize the health benefits (Ireland, Norway, and Singapore). Denmark is well known for having encountered difficulties controlling some human-made diseases like tobacco-related conditions, and Russia is not a surprise at all but typical of the excess adult mortality in Eastern Europe. Above all, the United States is the most striking because e50 lags many other countries despite much higher levels of income, without any clear explanation. Indeed, when excluding the six exceptional cases, the correlation is even stronger (R2 = 0.75).

When looking at the trends in e50 over the period since 1955 among the 10 study countries, the strikingly unfavorable position of the United States

1

The difficulty of ensuring good and comparable income measurement is well known. This first graph is a rough indication that a few countries, including the United States, appear to be unusual.



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