Global Health and Human Development

By

Shikha H. Kakkar

Suborna Bhattacharjee

Juan Landeros

Nicole Francine Celera

Human Development Index

HDI (Human Development Index) is a strategic tool used to measure a country’s social and

economic development. The HDI was created to lay emphasis on people and their capabilities as

criteria for assessing the development of a country rather than the economic growth alone. HDI

can be used to question national policies and also can be used to compare health care trends

amongst two different countries with similar gross national income.The HDI is a summary

measure for assessing long-term progress in three basic dimensions of human development, a

long and healthy life, access to knowledge and a decent standard of living. A country scores

higher HDI with a longer life expectancy at birth, longer education period and the income per

capita is high. This is used to determine whether a country is developed, developing or

underdeveloped.

Figure 1: Main Factors of HDI (Source- http://hdr.undp.org)

Analysis of the HDI ranking of the United States of America

The United States’ HDI value for 2017 is 0.924, which put the country in the very high human

development category positioning it at 13 out of 189 countries and territories. Between 1990 and

2017, United States’ HDI value increased from 0.860 to 0.924, an increase of 7.4 percent.
However, HDI rank decreased from 2 to 13 which shows some other countries have performed

better than USA in these years. The results of HDI are reported annually by the United Nations

Development program.The top countries are grouped into a category called “Very High Human

Development” and are considered developed based on the HDI. The countries which performed

better than USA in HDI ranking 2017 are Norway, Switzerland, Australia, Ireland, Germany,

Iceland, Hong Kong, Sweden, Singapore, Netherlands, Denmark, Canada. Among them, Norway

achieved 0.953 HDI which is significantly higher than 0.924 achieved by USA.

Table 1: The United States HDI trends based on consistent time series data

Year Life expectancy at Expected years Mean years GNI per capita HDI HDI
birth of schooling of schooling (2011 PPP$) Value Rank
1990 75.3 15.3 12.3 37,370 0.860 2
2000 76.8 15.5 12.7 46,267 0.885 5
2010 78.5 16.6 13.2 50,178 0.914 5
2015 79.2 16.5 13.3 53,741 0.920 12
2016 79.4 16.5 13.4 54,104 0.922 12
2017 79.4 16.5 13.4 54,941 0.924 13

Table-1 reviews United States’ progress in each of the HDI indicators Between 1990 and 2017,

United States’ life expectancy at birth increased by 4.2 years, mean years of schooling increased

by 1.1 years and expected years of schooling increased by 1.2 years. United States’ GNI per

capita increased by about 47.0 percent between 1990 and 2017.

Life Expectancy Analysis

Life expectancy is the number of years a newborn could expect to live. The life expectancy at

birth in the United States is at 79.5 years in 2017. The average life expectancy in the US has

improved over the years from 75.2 years in 1990. United States now ranks at 31 in comparison to

other countries in terms of longer life expectancy. Male life expectancy is lower at 77.6 years
when compared to the Female life expectancy of 81.8 years in the United States. Figure-2

compares Male and Female life expectancy of USA with two countries (e.g., Australia, Canada)

and two groups (e.g., OECD and Very High HDI). Organisation for Economic Co-operation and

Development (OECD) is an intergovernmental economic organisation with 36 member counties

and Very high HDI refers to 58 countries with HDI more than 0.8. From Figure.2, we observe

that United States performs worse than Australia, Canada and OECD in both Male and Female

life expectancy. Compared to Very High HDI group, USA performed worse in Male life

expectancy and performed better in Female life expectancy.

Maternal Mortality & Infant Mortality Rate

Maternal Mortality Rate: The Maternal mortality rate (MMR) is the annual number of female

deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its

management, excluding accidental or incidental causes .

The maternal death rate in United States (U.S) is consistently expanded from 7.2 deaths per

100,000 live births in 1987 to 18.8 deaths per 100,000 live births in 2016 (CDC, Pregnancy

Mortality Surveillance System). The graph below show trend of maternal mortality rate in the

U.S from 1987 to 2016.

The U.S has highest maternal mortality rate in comparison to other developed nations. The

leading causes of maternal deaths in the United States overlap with the main global causes are

hemorrhage, pregnancy-related hypertensive disorders and infection. The causes for steadily

increase in mortality rate in U.S. is lack of integration of care between maternity care and

primary care. A lot of women lack access to primary care to prevent chronic medical conditions

such as obesity, hypertension, diabetes, that aggravate the risk to pregnancy which contribute to

maternal death.

Infant Mortality Rate: The infant mortality rate (IMR) is the number of infant deaths for every

1,000 live births. In 2016, the infant mortality rate in the United States was 5.9 deaths per 1,000
live births. In the United States IMR has improved, declining 15% from 6.86 infant deaths per

1,000 live births in 2005—a recent high—to 5.82 in 2014 (CDC, Mortality Surveillance System).

The United States has higher infant mortality rate than other wealthy countries. The causes are

poor access to quality health care to mother and to child after birth. Hence, Maternal and infant

mortality corresponds to overall health and wellness, which includes maternal health during

pregnancy as well as access to health and basic care after birth.

US pay per capita for healthcare and how does that compare to other nations

UNDP has reported that 6.9 trillion USD is spent on health globally in 2011. Unfortunately,

around 20-40% of that spending is wasted (UNDP). Human Development Index is a summative

statistic that measures the average of being knowledgeable, a decent standard of living, and a

long and healthy life (UNDP). United States of America is a country that is considered a very

high human development area. UNDP ranked United States thirteenth in HDI in 2017 and ranked

United States fifth in expenditure on health total. In 2012, United States spent 2,809 billion USD
on healthcare. In 2014, the total expenditure on health in the United States was 9,403 USD per

capita (WHO).

Source - (WHO)

Compared to other countries, other very high human development countries in Australia

and Europe, such as Norway, which is the country with the highest total spending per person on

health per person 9,908 USD as well as the country with highest government spending per

person 8,436 USD (UNDP). Norway is considered a very high human development country.

UNDP ranked Norway first in HDI in both 2013 and 2017 and it was ranked first in expenditure

on health total. Eritrea is a low human development country with lowest total spending per

person on health with 12 USD. UNDP ranked Eritrea 179th in HDI and it was ranked 182nd in

expenditure on health total. Myanmar is the country with lowest government spending per person

on with 3 USD (WHO). Myanmar is considered a medium human development country. UNDP

ranked Myanmar 137th in HDI and 150th in expenditure on health total.

Does spending correlate with good health outcomes?

According to the UNDP, the United States spends 17.9% of its total GDP on health care

spending. This compares to the 12.2% of GDP that countries with very high HDI are spending on

health care. It would be expected that this significant amount of spending in health care would in

turn lead to better health outcomes, longer life expectancy, and lower mortality rate. When

compared to other countries considered to have very high HDI, we see a different story.

As this chart illustrates (UNDP 2018), the United States spend substantially more on

health care spending, but that spending is not reflected in the health outcomes of its population.

Other very high HDI countries spent over 6% less of their GDP on health care spending and are

achieving life expectancies of around 3 years more. More drastically, the mortality rates in the

united states for men and women are near double than that seen in Norway, Switzerland and

Australia. This disconnect in amount of money spent on healthcare and health outcomes clearly

illustrates that, in the United States, we are spending much more money and achieving worse

health than other comparable countries. When comparing these very high HDI countries we do

see a correlation between health outcomes in countries other than the united states, with all three

comparison countries having similar GDP percentage spent on healthcare, and similar life

expectancy and mortality rates. This does present a correlation between healthcare spending and
health outcomes, with the United States being an outlier. These countries serve as an example of

efficient health care spending leading to better health outcomes, with the United States being an

example of not only diminishing returns, but also inefficient spending having a negative effect

on the overall health of its population.

Conclusion:

The drastic difference between spending and health outcomes of very high HDI countries and the

united states is something that was surprising. I would expect that our health outcomes would be

much closer to countries like Norway and Australia, even though we are spending so much more

on healthcare. It seems that these countries are not only spending on healthcare more efficiently,

but also achieving much better healthcare outcomes with less cost. The United States seems to be

the outlier amongst other very high HDI countries in more ways than one, many of the very high

HDI countries have some form of single payer healthcare system, or at the very least make health

insurance mandatory. This amount of regulation allows for controlling the cost of healthcare,

while also ensuring access. If this example is followed by the United States, it is possible to see

their healthcare spending reduce, and the health outcomes of their populations improve.
 References

1. UNDP (n.d.). Human Development Reports: Trends. Retrieved November 18, 2018, from

http://hdr.undp.org/en/composite/trends

2. UNDP (n.d.). Human Development Reports: Expenditure on health, total (% of gdp).

Retrieved November 18, 2018, from http://hdr.undp.org/en/content/expenditure-health-total-gdp

3. UNDP (n.d.). Human Development Reports. Retrieved November 18, 2018, from

http://hdr.undp.org/en/composite/HDI

4. WHO (n.d.). Spending on health: A global overview. Retrieved November 18, 2018, from

http://www.who.int/news-room/fact-sheets/detail/spending-on-health-a-global-overview

5. WHO (n.d.). United States of America. Retrieved November 18, 2018, from

http://www.who.int/countries/usa/en/

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accounts/atlas2014.pdf

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8. CDC. Pregnancy Mortality Surveillance System,Retrieved August 7, 2018

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-

system.htm