It was Amartya Sen who championed the idea that human development could be measured by increases in human life span. The basic idea is that a life cut short is a great injustice – perhaps the greatest injustice of all – and that being able to live a long life is a critical measure of development. Martha Nussbaum further underscored the value of a long life by making it the first of her “Ten Central Capabilities”: Life. Being able to live to the end of a human life of normal length; not dying prematurely or before one’s life is so reduced as to be not worth living.

Life expectancy at birth is also the first of three measures included in the Human Development Index, which was created to emphasize that people and their capabilities should be the ultimate criteria for assessing the development of a country, not just measures of economic growth.

In recent decades, many nations have been able to extend the life of their citizens. Life expectancy at birth rose from 65 in 1990 to 71 in 2021, according to the United Nations. Increases in some low- and middle-income countries (e.g., China) were more than twice as fast as high-income countries over comparable periods.

But this global progress masks deep regional inequalities. Today, average life expectancy is 60 years in Sub-Saharan Africa, 68 years in South Asia, 73 in the Middle East and North Africa, 72 in Latin America and the Caribbean, 77 in Europe and Central Asia and 77 in North America. All 15 of the countries with life expectancy at birth below 60 years are in Sub-Saharan Africa.

There are also differences within Africa, where life expectancy ranges from 53 (Chad, Nigeria, Lesotho) to 74 in Cabo Verde. Further, as life expectancy remains below 60 in many of the HIV/AIDS-affected countries (e.g., Lesotho and Eswatini) but rises into the high 60’s in several countries in the east, the gaps in Africa are widening.

The highest performing country in the world and the “frontier” for life expectancy is Japan, where the average citizen lives to 84 years.

An outstanding analysis of the contribution of increasing life expectancy to economic growth and development, Global Health 2035, found that annual increases in life expectancy added 1.8% to annual GDP for all low- and middle-income countries between 2000 and 2011.

Reductions in early death trigger a range of positive development forces, including declining fertility (as more children survive, parents have fewer children), growing working-age populations (and greater productivity), rising savings rates (as people plan for longer lives), increasing foreign investment and falling healthcare costs (as populations thrive, at least in the short term before the costs of aging set in).

Global Health 2035 concludes that “this new understanding of the economic value of health improvements provides a strong rationale for improved resource allocation across sectors.”  Their conclusion is clear. Nations should be investing more in health relative to other sectors and investing in ways that increase life span.

Many of the 13 million early deaths are preventable with low cost, high impact interventions including contraception, vaccination, devices (e.g., condoms, malaria bed nets, rapid diagnostic tests, pulse oximetry etc.), therapeutic foods and supplements, and medicines (e.g., antiretrovirals, artemisinin-based combination therapies, oral rehydration salts/zinc tablets, antibiotics and oxygen). Others require higher-cost interventions, especially diagnosing and treating heart disease, preventing newborn deaths and suicide.

Substantial behavior changes relating to diet, alcohol and tobacco use, sexual practices and cooking norms are required to reduce the risks of early death. Reducing the risks of air pollution will ultimately require changes to industrial, agricultural, transport and urban policies and practices, and are likely to be very challenging in economies that are transitioning from low- to middle-income status. Deaths from road injuries are projected to increase rapidly in countries with weak road infrastructure and limited transport safety policies.

The evidence suggests that where investments in health interventions are made alongside investments to improve the education of girls and women of reproductive age, large gains are possible. Fully half of the reduction in child deaths since 1970 has been due to increases in the education of women of reproductive age, according to a study by Chris Murray and colleagues. Women’s education was also found to be critical to child mortality declines, alongside access to clean water and sanitation, poverty reduction, and economic growth, according to a World Health Organization study.

Accordingly, all countries should make reducing early deaths (<50 years) the focus of their national health goals by maintaining early deaths at <20% of all deaths by 2025 and <15% by 2030. For countries already at these levels, targets of <15% and <7% should be set with Japan’s rate of 3% as the ultimate goal. This focus on reducing early deaths is supported by a recent Lancet study which concluded that “reducing premature deaths is a flexible target that can be pursued in different ways in different countries, according to their mortality patterns and resources,” and by the Copenhagen Consensus, which has consistently argued that investing in increasing lifespans is the most cost-effective development investment in the world today.

National health plans and programs should target the leading causes of early death in their respective countries and invest in the most cost-effective solutions targeted to the most vulnerable populations. In many low- and middle-income countries infectious diseases, newborn deaths, and road injuries will dominate the causes of early death, while in higher-income countries non-communicable diseases, injuries, and self-harm will dominate. In countries where stillbirths and sex selection are major challenges, reductions in pregnancy termination related to sex selection and preventing stillbirth should be national health priorities.

In addition to investing to improve the diagnosis and treatment of the leading causes of early death, governments and other stakeholders should invest heavily in prevention by reducing population exposure to the major risk factors, especially low birth weight, short gestation, child wasting, unsafe sex, alcohol use, smoking, high blood pressure, air pollution, and poor diet.

Finally, we need to invest in solutions that go beyond a single disease or intervention to better integrate the financing and delivery of the products and services with the greatest impact on reducing risk and death among the populations where early deaths are concentrated.

We need to aim for the vision outlined by Jim Kim, Paul Farmer and Michael Porter in “Redefining Global Health Care Delivery”, where the creation of “patient value” is the endgame because this is ultimately what will drive people to seek healthcare enabling population-wide health improvements and the achievement of global health goals.

Solutions also need also to address the underlying political, economic, and social causes of early death. As the majority of early deaths occur in countries where people struggle on low incomes, where governments are often dysfunctional, where markets are not strong, and where women are disempowered, specific health interventions need to be delivered in the context of broader reforms to encourage economic growth and rising incomes, to build stronger democracies and markets, and to empower women.