Life expectancy at birth has continued 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, as well as greater access to quality health services. Other factors, such as better nutrition, sanitation and housing also play a role, particularly in countries with developing economies (OECD, 2004c).

Life expectancy at age 65 has increased significantly among both women and men over the past several decades in all OECD countries. Some of the factors explaining the gains in life expectancy at age 65 include advances in medical care combined with greater access to health care, healthier lifestyles and improved living conditions before and after people reach age 65.

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. Declines in PYLL can be influenced by advances in medical technology, for example, 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, accounting for 36% of all deaths in 2006. They cover a range of diseases related to the circulatory system, including ischemic heart disease (known as IHD, or heart attack) and cerebro-vascular disease (or stroke). Together, IHD and stroke comprise two-thirds of all cardiovascular deaths, and caused one-quarter of all deaths in OECD countries in 2006.

Cancer is the second leading cause of mortality in OECD countries (after diseases of the circulatory system), accounting for 27% of all deaths on average in 2006. In 2006, cancer mortality rates were the lowest in Mexico, Finland, Switzerland and Japan. They were the highest in central and eastern European countries (Hungary, the Czech and Slovak Republics, Poland) and Denmark (Figure 1.5.1).

Worldwide, an estimated 1.2 million people are killed in road traffic accidents each year, and as many as 50 million people are injured or disabled (WHO, 2009c). In OECD countries alone, they were responsible for more than 125 000 deaths in 2006, occurring most often in the United States (46 000), Mexico (17 000) and Japan (9 000). Around 5 000-6 000 road accident deaths occurred in each of Italy, Poland and Germany in 2006.

The intentional killing of oneself is 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 divorce, alcohol and drug abuse, unemployment, clinical depression and 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-estimated because of the stigma that is associated with the act, or because of data issues associated with reporting criteria (see “Definition and deviations”).

Infant mortality, the rate at which babies 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 here 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.

Dental problems, mostly in the form of caries (tooth decay) and gum disease, are common in developed countries, affecting 60-90% of school children and the vast majority of adults (WHO, 2003). People with poor oral health may experience pain and discomfort, functional impairment, low self-esteem and dissatisfaction with their appearance. Dental and other oral diseases thus represent a major public health problem. Dental diseases are highly related to lifestyle factors, which include a high sugar diet, while also reflecting whether or not protective measures such as exposure to fluoride and good oral hygiene are present. Much of the burden of dental disease falls on disadvantaged and socially marginalised populations (WHO, 2003), and children are especially vulnerable. Treatment of dental disease in developed countries is often costly, although many countries offer free or subsidised dental care for children and adolescents (see also Indicator 6.6 “Inequalities in dentist consultations”).

Most OECD countries conduct regular health surveys which allow respondents to report on different aspects of their health. A commonly-asked question relates to self-perceived 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). For the purpose of international comparisons however, cross-country differences in perceived health status are difficult to interpret because responses may be affected by differences in the formulation of survey questions and responses, and by cultural factors.

Diabetes is a chronic metabolic 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 the nerves and blood vessels, and renal failure requiring dialysis or transplantation.

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