The World Health Organization has published its latest comprehensive set of World Health Statistics to 2020, the first year of the COVID-19 pandemic – which led to an estimated 4.5 million excess deaths in that year.
The statistics reveal the extent to which the pandemic has been affecting health systems worldwide, in some cases severely curtailing access to vital services. These disruptions are likely to set back global progress on both life expectancy and healthy life expectancy made in the first 20 years of the century.
Global life expectancy at birth had increased from 66.8 years in 2000 to 73.3 years in 2019, and healthy life expectancy increased from 58.3 years to 63.7 years. This was largely due to gains in maternal and child health, and to major investments and improvements in communicable disease programmes, such as HIV, tuberculosis and malaria. But the 2020 data shows how service disruptions contributed to an increase in deaths from tuberculosis and malaria between 2019 and 2020.
Prior to the pandemic, there had also been encouraging trends globally in the reduction of child stunting, alcohol consumption and tobacco use, as well as in increased access to safely managed drinking water, safely managed sanitation, basic hygiene, and clean fuels and technologies for cooking.
These advances had been partly underpinned by a doubling in global spending on health between 2000 and 2019, reaching 9.8% of global gross domestic product. But approximately 80% of that spending occurred in high-income countries, the bulk of it (about 70%) coming from government budgets. In low-income countries, out-of-pocket spending was the main source of health expenditure (44%), followed by external aid (29%).
While service coverage has improved in the last 20 years, catastrophic health expenditure has worsened. With the current global economic recession and health systems struggling to provide continuity of health services, the COVID-19 pandemic is likely to halt the progress made in service coverage and further worsen financial protection globally. This is because some people are unable to access care at all because they cannot afford it. In addition, among those who do seek and obtain services, there is a greater risk of facing financial hardship because of out-of-pocket health spending than before the pandemic.
At the same time, a chronic failure to acknowledge the central role of primary healthcare, and to adequately fund key elements such as the health workforce, both slowed the effectiveness of the response to COVID-19 and triggered disruptions to routine care which threaten to further jeopardize countries’ abilities to reach the 2030 Sustainable Development Goals for health.