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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2
F I G U R E 3.6
Adult and child mortality in Sub-Saharan Africa
䊱
200
䊱
䊱 䊱 䢇
150
䊱
䊱
䊱
䊱 䢇 䢇 䢇
50
䢇
䢇 䢇 䊱
䊱 䢇
䢇
4,000
䊱
3,000
䢇
100
5,000
䢇
2,000 䊱 䢇
0
1,000
adult deaths per 100,000 adult population
under-5 mortality, deaths per 1,000 live births
6,000
0
1975–70
1980–84
1985–89
1990–94
1995–99
2000–04
period 䊱 non-Sub-Saharan Africa, under-5 䢇 non-Sub-Saharan Africa, adult 䊱 Sub-Saharan Africa, lower HIV, under-5 䢇 Sub-Saharan Africa, lower HIV, adult 䊱 Sub-Saharan Africa, higher HIV, under-5 䢇 Sub-Saharan Africa, higher HIV, adult
Source: de Walque and Filmer 2011. Adult mortality rates are based on sibling rosters from 83 Demographic and Health Surveys collected over time from 46 countries, and are estimated between 1975 and the most current period, typically 2000; they show the likelihood of dying in every five-year period of the data.
male and female mortality risks over time help make that point. Of every 1,000 adults between the ages of 15 and 60 in the rich countries, somewhere between 56 (Iceland) and 107 (United States) men and women will die each year.53 In India, that number rises to 213 (in China to 113). In Central and West Africa, adult mortality rates are higher, routinely exceeding 300 and in many countries 400. Compare that with conflict countries like Iraq (285) and Afghanistan (479). And in HIV/AIDS-affected countries, the numbers rise to between 481 (Malawi) and 772 (Zimbabwe). In their mortality risks, these countries are worse than Afghanistan (and far worse than Iraq or Pakistan). Comparisons over time highlight the dramatic difference between Sub-Saharan Africa and other regions of the world (figure 3.6). Here are the patterns54: • Infant and early childhood mortality (underfive mortality) has declined in both Sub-
Saharan Africa and other countries, although the rate of decline has been slower in the former. • Adult mortality rates in other countries have remained roughly stable over the past 25 years, but in Sub-Saharan Africa, they doubled between 1980 and 2000. • A large portion of this increase in SubSaharan Africa is attributable to HIV/AIDS, with adult mortality rates in high HIVprevalence countries reaching more than half the levels seen in the years of the genocides in Rwanda and Cambodia—but on a sustained and rising basis. • Particularly surprising is the fact that adult mortality did not decrease, and actually increased, in several countries in Sub-Saharan Africa with low HIV/AIDS prevalence, particularly those in Central and West Africa. Figure 3.7 uses World Health Organization (WHO) estimates for all countries between 1990 and 2008, to show how the relative rates of adult mortality for women and men have changed over this period. Countries below the solid maroon line saw a worsening of relative mortality risks for women, and those to the right of the dashed black line saw a worsening of adult mortality (so countries in the lower right quadrant, for instance, saw a worsening of both). Although the numbers are not strictly comparable to those in figure 3.6 (partly because of different time periods, and partly because of the measure of adult mortality), the broad story remains similar (also see box 3.1). In most countries, adult mortality risks declined. In the HIV-affected Sub-Saharan African countries (those with a prevalence above 5 percent in 2008), mortality risks are getting worse, and relatively more women are dying than men. Surprisingly, a large number of African countries saw very small improvements in mortality, with greater improvements for men; over this period, almost no country in Africa saw relative declines in mortality risks for women. In contrast, the majority of countries around the world experienced declines in adult mortality and relative improvements for women. Less surprisingly, the other main country grouping that stands out prominently in figure 3.7 consists of some Eastern Europe and Central Asian coun-