"It is the most interesting book I have ever read and inspires me to do something immediate to save our civilization." —Hanh Lien, translator for the Vietnamese edition of World on the Edge
Chapter 5. Our Socially Divided World: Life Expectancy: A Seminal Indicator
Life expectancy is in many ways the best single measure of economic and social progress. Although income per person is widely used, this measures only average wealth, whereas life expectancy also tells us how widely the benefits of progress are distributed. If these benefits are concentrated in a few hands, life expectancy will be short; if they are broadly distributed, life expectancy will be much longer.
After World War II, life expectancy climbed rapidly throughout the world with advances in public health, vaccines, antibiotics, and food production. But as the twentieth century drew to an end, life expectancy was no longer rising everywhere. The HIV epidemic sharply reduced it in sub-Saharan Africa. Without AIDS, sub-Saharan Africa's 700 million people could expect to live to the age of 62, but in fact their life expectancy has dropped to 47 years. And millions of infants born with the virus are likely to die by the age of 5.5
In Botswana and Swaziland, 39 percent of all adults are HIV-positive and the infection is continuing to spread. In Botswana, life expectancy was expected to reach 70 years by now but instead is projected to drop to 40 years by 2005. In Zimbabwe, where 34 percent of the adult population was HIV-positive at the end of 2001, life expectancy is projected to drop to 33 years by 2005—half what it would have been without AIDS. For South Africa, where the epidemic started later, 20 percent of the adult population is now HIV-positive. Life expectancy, which would have been 68 years by 2010, instead will be 42 years.6
The decline in life expectancy witnessed thus far in Africa is the beginning, not the end, of the epidemic. A combination of the spread of the virus itself, the deterioration of basic health care as AIDS victims overwhelm the health care system, and the associated fall in food production are combining to further reduce life expectancy. For the first time in history, we see an epidemic that claims primarily able-bodied adults, thus creating a situation where disease begets famine and famine begets disease. The result is a life expectancy more akin to those of the Dark Ages than what we envisaged for the twenty-first century.
5. United Nations, World Population Prospects: The 2002 Revision (New York: February 2003); Joint United Nations Programme on HIV/AIDS (UNAIDS), Report on the Global HIV/AIDS Epidemic 2002 (Geneva: July 2002), pp. 44-46.
6. HIV prevalence from UNAIDS, op. cit. note 5, pp. 189-202; Swaziland update by the Ministry of Health cited in "Swaziland: The World's Worst HIV Infection Rate," U.N. Integrated Regional Information Networks, 31 December 2002; life expectancies from United Nations, op. cit. note 5, pp. 10-14.
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