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442. The growing HIV epidemic reversed gains in life expectancy seen in many African countries in the 1970s, 338 with a greater impact on women. This is due in part to women’s higher AIDS-related mortality, which reflects women’s higher risk of contracting HIV sexually because of greater biological risk, as well as disempowerment in sexual relationships. 339 In certain countries in Africa men currently have greater life expectancy than women.337 443. Women have a marked advantage over men in life expectancy (10 years or more) in former Soviet republics, reinforced as male life expectancy declined in the late 1980s and the beginning of the 1990s. 340 Life expectancy among males increased marginally, but has since stagnated. The causes of men’s decline in life expectancy are debatable, but are attributed, in part, to increased stress, heart disease, and alcohol-related causes of death associated with political turmoil. These changes in life expectancy illustrate the influence of social and political context on health and longevity.337 444. In high-income, industrialized countries women have a higher life expectancy (4-7 years) than men. These gender differentials peaked in the 1970s, owing largely to men’s high rates of smoking in the preceding decades. The contraction of the gender gap seen in recent years is attributed, in part, to the decrease in smoking among males over the past 20 years. 341 445. Inequalities in life expectancy are dynamic — they change over time — both within and between populations, reflecting variable political, economic and epidemiological contexts. Because a central obligation of States is to respect, promote and protect the human rights of its people, life expectancy is an aggregate indicator of the extent to which States fulfil this obligation, and invest adequately in the capabilities, health, social protection and resilience of its citizens.
G.
Unfinished agenda of health system strengthening 446. Despite decades of unprecedented medical advances and innovations in health care, stark inequalities in the accessibility and quality of health systems persist across and within countries. Sub-Saharan Africa and, to a lesser extent, South Asia continue to have some of the least accessible and most fragile health systems, as measured by operations indicators such as health worker density, coverage of critical services, commodity stock-outs and record keeping, or by health outcomes.
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J. Adetunji and E. R. Bos, “Levels and trends in mortality in sub-Saharan Africa: an overview”, in Disease and Mortality in Sub-Saharan Africa, 2nd ed., D. T. Jamison and others, eds. (Washington, D.C., World Bank, 2006). J. A. Higgins, S. Hoffman and S. L. Dworkin, “Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS”, American Journal of Public Health, vol. 100, No. 3 (2010), pp. 435-445. V. Shkolnikov, M. McKee and D. A. Leon, “Changes in life expectancy in Russia in the mid-1990s”, The Lancet, vol. 357, No. 9260 (2001), pp. 917-921; D. A. Leon and others, “Huge variation in Russian mortality rates 1984-94: artefact, alcohol or what?”, The Lancet, vol. 350, No. 9075 (1997), pp. 383-388. F. C. Pampel, “Cigarette use and the narrowing sex differential in mortality”, Population and Development Review, vol. 28, No. 1 (2002), pp. 77-104; “Sex differentials in life expectancy and mortality in developed countries: an analysis by age group and causes of death from recent and historical data”, Population Bulletin of the United Nations, No. 25 (United Nations publication, Sales No. E.88.XIII.6); Geronimus and Snow, “The mutability of women’s health with age: the sometimes rapid and often enduring, health consequences of injustice”.
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