Life expectancy at birth continues to increase remarkably in OECD countries, reflecting sharp reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors including rising living standards, improved lifestyle and better education, and greater access to quality health services. Other factors such as better nutrition, sanitation and housing also play a role, particularly in countries with emerging economies (OECD, 2004a).

Premature mortality, measured in terms of potential years of life lost (PYLL) before the age of 70 years, focuses on deaths among younger age groups of the population. PYLL values are heavily influenced by infant mortality and deaths from diseases and injuries affecting children and younger adults: a death at five years of age represents 65 PYLL; one at 60 years of age only ten. Premature mortality can be influenced by advances in medical technology, especially in relation to infant mortality and deaths due to heart disease, and in prevention and control measures, reducing untimely or avoidable deaths from injuries and communicable diseases. A number of other variables, such as GDP per capita, occupational status, numbers of doctors and alcohol and tobacco consumption have also been associated with reduced premature mortality (Or, 2000; Joumard et al., 2008).

Cardiovascular diseases are the main cause of mortality in almost all OECD countries, and accounted for 35% of all deaths in 2009. They cover a range of diseases related to the circulatory system, including ischemic heart disease (known as IHD, or heart attack) and cerebrovascular disease (or stroke). Together, IHD and stroke comprise two-thirds of all cardiovascular deaths, and between them they caused almost one-quarter of all deaths in OECD countries in 2009.

Cancer is the second leading cause of mortality in OECD countries after diseases of the circulatory system, accounting for 28% of all deaths on average in 2009. In 2009, cancer mortality rates were the lowest in Mexico, Finland, Japan and Switzerland. They were the highest in central and eastern European countries (Hungary, Poland, Slovenia, the Czech and Slovak Republics) and Denmark (Figure 1.4.1).

Worldwide, an estimated 1.2 million people are killed in transport accidents each year, most of which are road traffic accidents, and as many as 50 million people are injured or disabled (WHO, 2009a). In OECD countries alone transport accidents were responsible for more than 120 000 deaths in 2009, occurring most often in the United States (45 000), Mexico (17 000), Korea and Japan (7 000 each). In addition, there were 38 000 deaths in the Russian Federation.

The intentional killing of oneself can be evidence not only of personal breakdown, but also of a deterioration of the social context in which an individual lives. Suicide may be the end-point of a number of different contributing factors. It is more likely to occur during crisis periods associated with upheavals in personal relationships, through alcohol and drug abuse, unemployment, clinical depression or other forms of mental illness. Because of this, suicide is often used as a proxy indicator of the mental health status of a population. However, the number of suicides in certain countries may be under-reported because of the stigma that is associated with the act, or because of data issues associated with reporting criteria (see “Definition and comparability”).

Infant mortality, the rate at which babies and children of less than one year of age die, reflects the effect of economic and social conditions on the health of mothers and newborns, as well as the effectiveness of health systems.

Low birth weight – defined as newborns weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004).

Most OECD countries conduct regular health surveys which allow respondents to report on different aspects of their health. A commonly-asked question relates to selfperceived health status, of the type: “How is your health in general?”. Despite the subjective nature of this question, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (for instance, see Miilunpalo et al., 1997).

Diabetes is a chronic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (Type 1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (Type 2 diabetes). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke if the disease is left undiagnosed or poorly controlled. They also have elevated risks for sight loss, foot and leg amputation due to damage to nerves and blood vessels, and renal failure requiring dialysis or transplantation.

In 2008, an estimated 5.2 million new cases of cancer were diagnosed in OECD countries, at an average of 261 per 100 000 population. Incidence rates varied substantially among countries, being comparatively high in Denmark, Ireland, Australia, Belgium and New Zealand at over 300 (Figure 1.11.1). In a number of OECD and emerging countries including India, Mexico, Indonesia and Turkey, rates were below 150.

The first cases of Acquired Immunodeficiency Syndrome (AIDS) were diagnosed 30 years ago. The onset of AIDS is normally caused as a result of HIV (human immunodeficiency virus) infection and can manifest itself as a number of different diseases, such as pneumonia and tuberculosis, as the immune system is no longer able to defend the body, leaving it susceptible to opportunistic infections and tumors. There is a time lag between HIV infection, AIDS diagnosis and death, which can be any number of years depending on the treatment administered. Despite worldwide research, there is no cure currently available.