Life expectancy and human development in the 21st century

Life expectancy is one of the best measures of human development.  In hunter-gather societies, on average, about 57-67% of children made it to 15 years. Then 79% of those 15 year-olds made it to 45 years.  Finally, those remaining at 45 years could expect to reach around 65-70 years. So we can see that life expectancy at birth in these societies was very low, given high child mortality. But some 40% did make it to about 65 years on average.  It seems to have been worse in the class-based feudal and slave societies.  The average medieval life expectancy for a peasant was only a mere 35 years of age at birth, but it was closer to 50 years on average for those who made it beyond 15 years. 

You can see that measuring life expectancy at birth is not a perfect guide to how long humans did live in pre-capitalist societies.  Nevertheless, there is no doubt that life expectancy on average rose sharply once science came to bear on hygiene, sewage, knowledge of the human body, better nutrition etc.  Of course, there were sharp inequalities in life expectancy in class societies between rich and poor.

If we accept that life expectancy is a good measure of human development, the latest data are revealing about capitalist societies in the 21st century.  Life expectancy fell in the US in 2021 to its lowest since 1996, the second year of a historic retreat, mainly due to COVID-19 deaths.  The decline from 2019 marked the largest two-year drop in life expectancy at birth in close to a century, the US Centers for Disease Control and Prevention (CDC) found.  Also, disparity in life expectancy between men and women widened last year to the highest in more than two decades, with American men now expected to live just 73.2 years, nearly six fewer years than women.

Deaths from COVID-19 contributed to over half of the overall decline in US life expectancy last year.  COVID-19 was associated with more than 460,000 U.S. deaths in 2021, according to the CDC. But COVID was not the only factor in the decline.  Drug overdoses and heart disease are also major contributors, the data showed.  Interestingly, deaths from suicide decreased in 2020 during COVID, but they were still the fifth-biggest contributor to the drop in overall life expectancy last year. Suicide-related deaths are the third-leading contributor to the decline in life expectancy for American men. 

While US life expectancy decreased from 78.6 years in 2019 to 76.9 years in 2020 and 76.1 years in 2021, a net loss of 2.4 years, in contrast, peer countries averaged a smaller decrease in life expectancy between 2019 and 2020 (0.55 years) and a 0.26-year increase between 2020 and 2021, widening the gap in life expectancy between the US and other advanced capitalist economies to more than five years. The decrease in US life expectancy was highly racialised: as the largest decreases in 2020 occurred among American Indian/Alaska natives, hispanics, black and Asian populations.  For native Americans and Alaska natives, life expectancy fell to 65, close to the national average during World War II.

This decline in life expectancy in rich US contrasts with the continued rise in China throughout the COVID pandemic – where the death rate from the virus was minimal compared to the US and Europe.  As a result, in 2021, China’s life expectancy at birth is now higher than that of the US!

This outcome is a stark and depressing condemnation of American capitalism in the 21st century. “The stagnation in life expectancy reflects deep societal challenges — not just in our health system but also in our economic and political systems,” said Dave Chokshi, a physician and former NYC health commissioner.

It was not just the pandemic. Americans of every age, at every income level, are unusually likely to die, from guns, drugs, cars, and disease.  American babies are more likely to die before they turn five; American teens are more likely to die before they turn 20; and American adults are more likely to die before they turn 65. Europe has better life outcomes than the US across the board, for white and black people, in high-poverty areas and low-poverty areas.

The US has more drug-overdose deaths than any other high-income country—both overall and on a per capita basis. Even before the pandemic, life expectancy in the U.S. declined for consecutive years in 2015 and 2016, largely because of the opioid epidemic and drug overdoses. The U.S. has a higher death rate from road accidents than Canada, Australia, Japan, South Korea, and the European Union. Even on a per-miles-driven basis, the US still has a higher death rate than much of Europe.

At 40 percent among adults, the US obesity rate is double the average of most European countries and eight times higher than Korea’s or Japan’s. Although the precise relationship between weight and health is contentious, the nonpartisan Commonwealth Fund has stated bluntly that America’s obesity levels are responsible for roughly one-fifth of deaths among American adults aged 40 to 85. 

The U.S. has fewer general practitioners per capita than most rich countries, in part because long and expensive medical education encourages doctors to become highly paid specialists. And along with this lack of affordable and accessible primary care, the US has the highest rate of avoidable deaths of any rich nation. (Examples of the OECD’s definition of “avoidable” mortality include deaths related to alcohol, shootings, accidents, and influenza.)

Life expectancy is an important measure of human development but it is not the only measure.  The UN has created a human development index (HDI) which measures not just life expectancy but also educational advancement and economic prosperity.  The HDI was launched in 1990.  In its latest Human Development Report (HDR) the data confirm that capitalism in the 21st century, if it ever was, is no longer progressive in the development of human well-being.  The report says that “decades of progress in terms of life expectancy, education and economic prosperity have begun unravelling since the pandemic.”  Over the past two years, nine out of ten countries have slid backwards on their HDI.

Switzerland sits at the top of the index with a life expectancy of 84 years, an average of 16.5 years spent in education and median salary of $66,000.  At the other end of the scale is South Sudan where life expectancy is 55, people spend just 5.5 years in school on average and earn $768 a year. But recent setbacks in a majority of the 191 countries included in the index, especially in life expectancy, have taken development levels back to those seen in 2016, reversing a 30-year trend.

Over the years since the index was introduced, many countries have faced crises and slid backwards, but the global trend consistently moved upwards. Last year was the first time the index declined overall since calculations began and this year’s results solidified that downward trend. And “the outlook for 2022 is grim,” says Achim Steiner, one of the HDR authors, who points out that more than 80 countries are facing problems paying off their national debt.  “Eighty countries being one step away from facing that kind of crisis is a very serious prospect,” he says. “We are seeing deep disruptions, the tail end of which will play out over a number of years.”

When we look at the league table of countries in the HDI, the usual richer advanced capitalist economies are at the top.  But the US is not in the top 20; it’s 21st, although it has by far the largest in population of these richer countries.  And if we compare the progress in human development in the top G7 economies using the HDI since 1990, we find, whereas the US was the highest of the G7 in 1990, it has slipped to fifth out of seven.  While Germany’s HDI rose 13.6% from 1990-2021, the US HDI rose only 5.6%.  And the US rose the least of the G7 in the 21st century.  Strangely, the UK rose the most from 1990, if from a lower start, and was the fastest riser in the 21st century to date.  This may be due to the higher than average spending on education in the 1990s and early 2000s.


Every G7 country did better than the US – another indicator of the relative decline of US imperialism.

The UN has also developed an inequality-adjusted HDI, where the degree of inequality of income is fed into the HDI to change the outcome.  Every country has a degree of inequality.  But some are much worse than others.  Among the G7 economies, the level of inequality in the US and Italy is so high that it reduces the HDI in those two countries by over 11% and knocks them even further down the HDI league. 

This is not surprising given the huge rise in inequality and poverty in the US since the HDI was started.  In January 2022, the U.S. Census Bureau reported that in 2020, there were 37.2 million people in poverty, approximately 3.3 million more than in 2019 – that’s an official poverty rate of 11.4 percent, up 1.0 percentage point from 10.5 percent in 2019.  The “poverty threshold” for a four-person family in 2020 was $26,496.  And the US Federal Reserve reports that in 1989 the top 1 percent controlled 23.5 percent of the nation’s wealth and, in 2022, its share had increased to 31.8 percent or $44.9 trillion.  The bottom 50% of wealth holders had 3.7% of household wealth in 1989; now they have 2.8%.

Inequality is even higher in many Global South countries, in particular, Brazil, South Africa and India have shocking inequality rates that knock their HDIs by over 25%.

If we look at the largest so-called emerging economies by population, including the BRICS (Brazil, Russia, India, China and South Africa), as you might expect, China achieved the greatest improvement in its HDI of all countries.  From a lowly 0.48 in 1990, China’s HDI reached 0.77 in 2021, a rise of 59%.  Compare that to India, which started pretty much at the same HDI as China but reached only 0.63 in 2021, a rise of 46% but still way less than China. 

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Whereas China was just 5pts higher in its HDI than India in 1990, now it is 14 pts higher.  In those three decades, China has come from behind to overtake Mexico, Brazil, South Africa and Indonesia – and close the gap with the US from 40pts behind to just 15 pts. 

For topical purposes, I also looked at Ukraine, Sri Lanka and Russia.  In 1990, when the Soviet bloc fell, Ukraine had a HDI of 0.73, virtually the same as Russia and ahead of tiny debt-ridden Sri Lanka.  By 2000, the ‘shock therapy’ of the return to capitalism lowered the HDI in Ukraine and Russia while all others in the list rose.  And 30 years later, Ukraine’s HDI has crawled up just 6% to 0.77, falling behind Sri Lanka and Russia, both of which did not do very well either.

Are the major economies of the global South catching up with the G7 countries of the global North?  If we exclude China and India, then the global South average (as defined above) was 18pts behind the G7 average in 1990.  In 2021, the gap was 14pts.  So hardly any progress in closing the gap in 30 years.  And the countries of Global South chosen here are mostly the best performers, not the poorest and weakest.

Returning to the measure of life expectancy, we find that as people have healthier and longer lives, they become more skilled and educated and so enable economies to grow and to raise incomes and livelihoods.  So public health measures are the most important lever for fostering economic development. 

The news that after 140 years, scientists at the University of Oxford have finally developed a vaccine that has 80% effectiveness against the deadly disease of malaria, which has killed millions and still kills nearly one child a minute.  The big pharma companies had avoided putting funds into malaria vaccines for decades, preferring to develop anti-depressants and cancer drugs that could sell well in the richer countries.  So it has taken 140 years to develop the malaria vaccine compared to just one year to find a vaccine for COVID.  The latter of course affected the Global North too.  Now the possible eradication of malaria that affects primarily the Global South would probably be the most significant boost to life expectancy and human development this century.

17 thoughts on “Life expectancy and human development in the 21st century

  1. Thanks. Great stuff. BTW, in the US there is a strong linear relationship between income and life expectancy. For more on this, see: “A Widening Gap in Life Expectancy Makes Raising Social Security’s Retirement Age a Particularly Bad Deal for Low-Wage Earners” - Presentation:

  2. The table shows the UK having the biggest improvement in HDI of all the G7 countries between 200 and 2021: real life experience would suggest this is false! I think this is a reflection of the way the HDI is calculated:

    Unlike life expectancy, which can be measured with a high degree of precision, the figures for HDI are derived from very “soft” data: “educational advancement” and “economic prosperity” cannot have very precisely-measured values (unlike life expectancy). Figures for HDI must therefore be read as having rather wide confidence intervals (again, unlike life expectancy where the figures are based on large numbers of fairly exact individual measurements). So, small percentage differences in HDI probably mean very little: it is only large differences, such as its rise in China, that can be confidently taken as meaningful (“statistically significant”).

    1. David – I think you are right. The education component of the HDI is somewhat dodgy. In the 1990s and early 2000s, the UK government widened entry to tertiary education so that measure rose in quantity but maybe not in quality. And as you say the differences in HDI between peer countries are very small and subject to volatility. But the trends for the US and China are still revealing.

  3. And the worst is to come. Now that the harvests are coming in, I have been pouring over the data. Losses up to 50% in Europe and North America. It is particularly high in the more vulnerable and nourishing crops such as fruits and vegetables. I wish there was a vaccine against hunger but there is not. If 2020 was associated with the pandemic, then 2023 will be associated with the great hunger. Capitalism has become a killer.

    You picked up on a point. Civilization was built on an agricultural surplus and that surplus was based on the most inferior of foods – grains (cultivated grasses) Such is the irony of history. A diet based on these grains not only reduced life span but the size of humans, because grains have anti-nutrients to reduce their consumption such as oxalic and phytic acids. So, the average human reduced from 6 foot in Africa to 4’6″ once their diet was composed mainly of grains. The lament in the Old Testament, of three score and ten, harked backed to the age of the hunter gatherer and greater longevity.

    Unless we get rid of capitalism, we too will soon be lamenting three score and ten.

      1. Here is an example. US rice planting in California down from 550,000 acres to 300,000 acres. Today’s Financial Times article Salad Days Are Over … expects 85% reduction in plantings.

        Or this report.

        The hard red winter wheat crop in the United States this year “was the smallest since 1963”. But in 1963, there were only 182 million people living in this nation. Today, our population has grown to 329 million.

        #2 It is being projected that the rice harvest in California will be “half what it would be in a normal year”.

        #3 The U.S. tomato harvest will come in at just 10.5 million tons in 2022. That is over a million tons lower than a normal year.

        #4 This will be the worst U.S. corn harvest in at least a decade.

        #5 Year-to-date shipments of carrots in the United States are down 45 percent.

        #6 Year-to-date shipments of sweet corn in the United States are down 20 percent.

        #7 Year-to-date shipments of sweet potatoes in the United States are down 13 percent.

        #8 Year-to-date shipments of celery in the United States are down 11 percent.

        #9 Total peach production in the U.S. is down 15 percent from last year.

        #10 Almost three-fourths of all U.S. farmers say that this year’s drought is hurting their harvests.

        #11 Thanks to the endless drought, the total number of cattle in Oregon is down 41 percent.

        #12 Thanks to the endless drought, the total number of cattle in New Mexico is down 43 percent.

        #13 Thanks to the endless drought, the total number of cattle in Texas is down 50 percent.

        #14 One beef producer in Oklahoma is now predicting that ground beef “could eventually top $50 per pound”.

        #15 At least 40 percent of the United States has been suffering from drought conditions for 101 consecutive weeks.

        #16 Overall, this is the worst multi-year megadrought in the United States in 1,200 years.

        #17 Europe is currently experiencing the worst drought that it has seen in 500 years. In some parts of central Europe, river levels have fallen so low that “hunger stones” are being revealed for the first time in centuries.

        #18 Corn production for the entire EU could be down by as much as one-fifth in 2022.

        #19 We are being warned that there will be crop losses in France of up to 35 percent.

        #20 It is being projected that crop losses in some areas of the UK could be as high as 50 percent.

        #21 It is being reported that there will be crop losses “of up to 50 percent” in some parts of Germany.

        #22 Some farmers in Italy have already lost “up to 80% of their harvest”.

        #23 Agricultural production in Somalia will be down about 80 percent this year.

        #24 In eastern Africa, the endless drought has already resulted in the deaths of at least seven million animals.

        #25 In China, they are facing the worst drought that they have ever experienced in recorded history.

        #26 India normally accounts for 40 percent of the global rice trade, but we are being warned that production in that country will be way down in 2022 due to “considerable rainfall deficits in key rice producing states”.

        #27 A third of the entire nation of Pakistan was under water after recent floods absolutely devastated that nation, and agricultural areas were hit particularly hard. As a result, the vast majority of the crops in the country have been “washed away”…

        It has also been estimated that roughly 65 per cent of the country’s food basket — particularly crops like rice, cotton, wheat and onion — have been washed away.

        Pakistan Foreign Minister Bilawal Bhutto-Zardari, in an interview to CGTN earlier this week, offered an even starker outlook by saying that “about 80 to 90 per cent” of the country’s crops have been damaged by the floods.

        #28 The prices of some fertilizers have tripled since 2021, while the prices of some other fertilizers have actually quadrupled.

        NEED I go on?

      2. If the remarkable list of losses in primary production (agricultural and livestock) provided by B. Green were not enough, take a look at the monitoring that the European Commission makes of European agricultural production in its bulletin Jrc Mars August 2022. Yes, it is the 2nd contradiction (the environmental contradiction) of the capitalist model. Ongoing and growing…

      3. UCBP– no, certainly not in that vein– I wanted sources for the claim that :” Losses up to 50% in Europe and North America. It is particularly high in the more vulnerable and nourishing crops such as fruits and vegetables.”
        Agriculture is facing a particular dismal year, but losses up to 50% in EU/US fruit and vegetable output are not predicted by the USDA ERS,

        Antonio: Here is the opening paragraph of the source you cite: “The exceptionally hot and dry weather conditions in much of Europe continued to substantially reduce yield outlooks for the EU’s summer crops. The crops most markedly affected are grain maize (-8.6% at EU level), sunflowers (-5.5%) and soybeans (-9.6%). Current yield forecasts for these crops are between 12% (sunflowers) and 16% (grain maize) below the 5-year average.”

        That’s deadly serious but not an apocalypse.

        A rich man can get through poor times better than a poor man.

      4. Actually my warning was predictive. It flattened the US stock markets yesterday when food prices drove up inflation. Anti-capital look into the individual food price rises found in the pdf version of the CPI release. They are very illuminating and reveal where the real shortages lie. That should settle this discussion and it is still early days. I am aware of the USDA 12th September release. I find the downward revisions over the last three months bewildering given that both Europe and North America have had the hottest summers since records began according to the Copernicus Institutes latest report. Driest I cant say but I am looking for the data.

        I will add that these hottest summers occurred despite Al Nina. The Sun is roaring. Solar 25 is accelerating projections on global warming. That is why I propose we focus on these issues. This is how revolutions are made.

    1. Diet of grains decrease life-span an size of people? Are you sure of this? The largest mammals are grain (grasses) eaters….

      ….In hormone-treated-cow-tortured-Burger-Land-USA, it’s true that people have grown very large (from anverage height for males in the 1950’s of 5 foot 8 to close to 6 feet today, but many of these people are obese and unhealthy. But maybe the industry’s use use of growth hormones is responsible for these effects and not beef eating per se. Wasn’t the average upper class Englishman ‘s height in the 16th century about 5 foot four?

      1. These grasses/grains are mainly carbohydrate. Cultivated grains also have a higher starch content. So wild rice for example has a protein content of 4 grams compared to less than 2 grams for cultivated brown rice. Sugar does not promote height; it only promotes fat, because the body has evolved to store excess sugar as fat.

        Refined carbohydrates and the denatured oils derived from grains (deodorized but rancid omega 6 oils) are the primary reason why Michael was able to describe the fall in longevity. These super-processed foods, the foundation of all inflammatory diets, are more lethal than cigarette smoke in my opinion having worked on both sides of the food industry.

  4. It may be the case that rising life expectancy is merely accidental in capitalism. If you analyze coldly, it was just a few, very punctual, technologies and and scientific discoveries that were responsible for the bulk of the rise of life expectancy in capitalism – and all of them only arose during 2nd Industrial Revolution capitalism, not the 350 years before.

    Marx noticed that, in the UK, child labor diminution and some protection to women were only slowly implemented after infant mortality reached alarming levels. We already know that, with industrialization, birth rates plummeted in relation to agrarian capitalism and before (already to circa 3 children per women) already during the 19th Century – probably a result of lower area per couple, which reduces the size of the families (cities have less space per person than farms). Also, pollutants and toxic substances, never imagined before, came into contact with humans for the first time in History thanks to the industrial processes, which essentially forced the capitalists to come with something that would not result in the immediate extinction of the species.

    All in all, we can essentially give credit to basic hygiene, basic sanitation, the accidental discovery of the first antibiotic (penicillin) and the desperate invention of vaccines (thanks to WWI) that were responsible for the bulk of the rise in life expectancy in capitalism. That’s just four inventions. If we take them out, we can see many capitalist inventions which actually lower life expectancy: processed foods, mass tobacco industry, drug-focused healthcare system, cancerous products etc. etc. etc. In this context, we can assume the healthcare industry – that keeps very old people alive – is a reaction, not a cause, to higher life expectancy and lower (negative) birth rates.

    So, we may argue that capitalism doesn’t depend on high life expectancy to survive as a system. On the contrary, we could argue there is an optimum life span for the average working class person for capitalism – one probably much lower than we would like (probably around 65 years old, which is the average retirement age in the advanced capitalist countries).

  5. Human development set back 5 years by Covid, other crises: UN

    The UN Development Program (UNDP) announced that for the first time since it was created over 30 years ago, the Human Development Index – a measure of countries’ life expectancies, education levels, and standards of living – has declined for two years straight, in 2020 and 2021, “erasing the gains of the preceding five years.”,%22erasing%20the%20gains%20of%20the%20preceding%20five%20years.%22

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