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Title page

Contents

Abbreviations and Acronyms 6

Foreword 7

Report Team 8

Preface: Why this report? 9

Unlocking the power of healthy longevity: Key messages of this report 10

Executive Summary 14

CHAPTER 1. Introduction: Better health throughout the life course is achievable 20

1.1. Demographic shifts affecting life-course health 21

1.2. Falling fertility, reduced mortality, and cohort effects shape the future population 22

1.3. Implications of future demographic change 24

1.4. Progress in reducing mortality 26

1.5. The epidemiological shifts reshaping life-course health 28

1.6. The economic value of avoidable mortality 33

CHAPTER 2. Healthy longevity, NCDs, and human capital: Levers for action across the life course 39

2.1. Impact pathways of NCDs on human capital and productivity 39

2.2. NCD interventions are needed throughout the life course 43

2.3. Health and wellbeing benefits of a life-course approach to NCDs 45

2.4. The role of innovation in the life-course 46

2.5. Poverty and inequality impacts of NCDs 46

2.6. Tackling NCDs is crucial for gender equality 48

CHAPTER 3. Advancing healthy longevity now: What countries can do 51

3.1. Tackle NCDs with cost-effective, pro-poor interventions 51

3.2. Clinical interventions will lower NCD burdens and improve lives 56

3.3. Leverage social protection, jobs, and long-term care for productive longer lives with dignity 60

3.4. Leverage the power of data for healthy longevity 66

CHAPTER 4. Financing for healthy longevity: Country leadership and key supporting roles for development partners 69

4.1. Country-led financing for healthy longevity agendas 69

4.2. Support from external partners 72

4.3. Navigating the intersections of healthy longevity, climate change, and pandemic vulnerability 74

4.4. Accelerated development and uptake of global public goods for healthy longevity 76

CHAPTER 5. Conclusion: From knowledge to action 79

Appendix A: Data sources, methods, and analytic processes 81

Appendix B: Supplementary analytic materials 88

Appendix C: Acknowledgments 95

Appendix D: Background papers 97

Bibliography 98

Tables

TABLE 1.1. Average annual rate of reduction in mortality between 1990 and 2019 by age 28

TABLE 1.2. Projected deaths vs. avoidable deaths in hypothetical scenario and with accelerated performance throughout life course 35

TABLE 1.3. Economic value of avoidable mortality for 2050 as a percentage of annual income and in US$ trillion, by country income category 37

TABLE 1.4. Economic value of avoidable mortality in 2019 and 2050, globally and compared to the frontier mortality rates, as % of annual income by... 37

TABLE 3.1. Full list of recommended NCD interventions 52

TABLE 3.2. Estimated cost and impact of locally tailored, high-priority NCD package, by country income 59

TABLE 3.3. Estimated distribution of cost of NCD package, by level of health system 59

TABLE 3.4. Estimated increase in health care workers and facilities with HLI package 59

TABLE 5.1. Summary of the HLI agenda recommendations and their impact 79

Figures

FIGURE 1.1. Trends in global population change by age and dependency ratio, 1950 to 2050 21

FIGURE 1.2. Population and deaths by age in 1990 and 2023 and projections to 2050 22

FIGURE 1.3. Population size by age group in 1990, 2023, and 2050 and changes in total fertility rate, selected countries 24

FIGURE 1.4. Global distribution of climate vulnerability 26

FIGURE 1.5. Trends in probability of death at ages 0-79, 50-79, and 0-49 years from 1970 to 2019 by income region 27

FIGURE 1.6. Proportion of all deaths attributable to NCDs, by country income category, 2019 and 2040 28

FIGURE 1.7. Number of adults living with major NCDs in 2019 29

FIGURE 1.8. Contribution of mortality or disability for selected major causes of death in India at various ages, 2017 30

FIGURE 1.9. Number of people (aged 15+) with NCD risk factors in 2016 and trends in prevalence 31

FIGURE 1.10. Avoidable mortality as a percentage of total mortality, 2019 34

FIGURE 1.11. Projected mortality decline vs. mortality decline at the rate of top 20% of countries, Ethiopian men aged 50-69 35

FIGURE 1.12. Trends in the age distribution of avoidable mortality by sex in Colombia, 1990 and 2030 36

FIGURE 1.13. Levels in avoidable mortality, selected countries by age and sex in Latin America and Japan in 2020 36

FIGURE 2.1. Shares of total wealth, by asset type and income group, 2018 40

FIGURE 2.2. Conceptual framework to address NCDs, human capital, productivity, and wellbeing 41

FIGURE 2.3. Survival among British males in 1960, 2010, and with hypothetical ideal, including years lived with disability 45

FIGURE 2.4. Distribution of critical income values for LMICs in 2019, relative to reference 1990 global value 46

FIGURE 2.5. Incidence rates of major CVDs in selected countries by income region 47

FIGURE 2.6. Education levels and age-standardized death rates from cancers among adults aged 30-69 in India by sex, 2001-03 (left) and education levels... 48

FIGURE 3.1. Levels of excise and other taxes on cigarettes by country income group, 2020 55

FIGURE 3.2. Prioritization of HLI-recommended NCD clinical interventions, by country income 57

FIGURE 3.3. Coverage of contributory pension systems strongly depends on income level (left) and coverage levels in LMICs have changed little over 15 years (right) 63

FIGURE 3.4. Survival rates and pension coverage, by education in India 64

FIGURE 3.5. Sample HLI dashboards for India and Sierra Leone 68

FIGURE 4.1. Intersections of demographic change, NCDs, climate change, and pandemics 76

Boxes

BOX 3.1. Impacts of consumption and taxation of tobacco, alcohol, and SSBs 54

BOX 3.2. Tools from behavioral science can strengthen NCD prevention and control 55

BOX 3.3. Healthy longevity dashboards for India and Sierra Leone 68

BOX 4.1. Small island developing states 71

BOX 4.2. The relevance of multilateral development financing to healthy longevity 73

Appendix Tables

TABLE A1. List of diseases and conditions selected for studying rates of progress, classified by disease group 82

TABLE A2. Interventions considered in this analysis 85

TABLE A3. Key actions and related domains when developing a healthy longevity dashboard 87

TABLE B1. Population in 1990, 2023, and 2050 by country income category 89

TABLE B2. Average annual rate of reduction in mortality between 1990 and 2019 by age and income region 89

TABLE B3. Demographic changes, by age group from 1990 to 2050 92

TABLE B4. Median age at death, projections by country income category from 2022 to 2050 92

TABLE B5. Economic value of avoidable mortality as % of annual income and in US$, by income region for 2050 92

TABLE B6. Economic value globally of avoidable mortality as percentage of annual income, by disease 93

TABLE B7. Rates of progress in mortality decline 2000-19, by diseases and country income category 94

Appendix Figures

FIGURE B1. Country classification used in this report, based on the 2020 World Bank income classification 88

FIGURE B2. Population by selected age groups, 25 most populous countries and Colombia and Sierra Leone, 2023 and 2050 89

FIGURE B3. Annual rates of change in mortality rates, by country and age groups, 2000-2019 91

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