Contributions of Declining Mortality, Overall and from HIV, TB, and Malaria, to Reduced Health Inequality and Inequity Across Countries.

The objective to reduce global health inequalities and inequities is integral to the global development agenda, from the Universal Declaration of Human Rights to the Sustainable Development Goals and the ongoing response to Covid-19. Yet summary measures of global health gains or of the cost-effectiveness of global health programs barely capture how well they improve the lives of the most disadvantaged populations. This paper instead explores the distribution of global health gains across countries, and the implications for health inequality and inequity (here referring to health disadvantages which reinforce economic disadvantage, and vice versa) across countries. Specifically, it studies the distribution of gains in life expectancy across countries (overall and owing to reduced mortality from HIV, TB, and malaria), using the Gini index and a concentration index ranking countries by GDP per capita as indicators of health inequality and inequity. By these counts, global inequality in life expectancy across countries declined by one-third between 2002 and 2019. Reduced mortality from HIV, TB, and malaria accounted for one-half of this decline. 15 countries in sub-Saharan Africa, containing 5 percent of the global population, accounted for 40 percent of the global decline in inequality, with nearly six-tenth of this contribution coming from HIV, TB, and malaria. Inequity in life expectancy across countries declined by nearly 37 percent, with a contribution from HIV, TB, and malaria of 39 percent of this gain. Our findings show how simple indicators on the distribution of health gains across countries usefully complement aggregate measures of global health gains and underscore their positive contribution to the global development agenda.