Halving premature death and improving quality of life at all ages: cross-country analyses of past trends and future directions

Abstract

Background: Although death in old age is unavoidable, premature death-defined here as death before age 70 years-is not. To assess whether halving premature mortality by 2050 is feasible, we examined the large variation in premature death rates before age 70 years and trends over the past 50 years (1970-2019), covering ten world regions and the 30 most-populous nations. This analysis was undertaken in conjunction with the third report of The Lancet Commission on Investing in Health: Global Health 2050: the path to halving premature death by mid-century.

Methods: In this cross-country analysis of past mortality trends and future directions, all analyses on the probability of premature death (PPD) were conducted using life tables from the UN World Population Prospects 2024. For each sex, country, and year, probability of death was calculated from these life tables with 1-year age-specific mortality rates.

Findings: Globally, PPD decreased from 56% in 1970 to 31% in 2019, although some countries saw reversals because of conflict, social instability, or HIV and AIDS. Child mortality has decreased faster than adult mortality. Among all countries, 34 halved their PPD over three decades between 1970 and 2019. Among the 30 most-populous countries, seven countries, with varying levels of baseline PPD and income, halved their PPD in the past half century. Seven of the most-populous countries had average annual rates of improvement in the period 2010-19 that, if sustained, could lead to a halving of PPD by 2050, including Korea (3·9%), Bangladesh (2·8%), Russia (2·7%), Ethiopia (2·4%), Iran (2·4%), South Africa (2·4%), and Türkiye (2·3%).

Interpretation: Halving premature death by 2050 is feasible, although substantial investments in child and adult health are needed to sustain or accelerate the rate of improvement for high-performing and medium-performing countries. Particular attention must be paid to countries with very low or a worsening rate of improvement in PPD. By reducing premature mortality, more people will live longer and more healthy lives. However, as people live longer, the absolute number of years lived with chronic disease will increase and investments in services reducing chronic disease morbidity are needed.

Funding: The Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and a Norwegian Research Council Centre of Excellence grant.

Figure 1

Progress in probability of PPD by CIH3 region for both sexes, 1970–2023 The horizontal dashed line and black dot show PPD for the world in 2019. The red dot indicates halved region-specific PPD in year 2050 compared to 2019 (the baseline year). The north Atlantic region includes western Europe and Canada. For China, the graph shows data for 1970–2020. CIH3=third commission on investing in health. PPD=probability of premature death.

Figure 2

Age-specific mortality trends for both sexes in 1970–2019, for the 30 most populous countries Probability of a live-born infant dying between ages 0 years and 14 years (A). Probability of dying between ages 15 years and 49 years, conditional on being alive at 15 years (B). Probability of dying between ages 50 years and 69 years, conditional on being alive at 50 years (C). Probability of premature death (ie, dying between ages 0 years and 69 years (D). The probability of dying over a particular age range in one particular calendar year is determined by the average of the separate age-specific mortality rates within that age range in that 1 year. Hence, a sudden but transient mortality shock caused by a war, natural disaster, or epidemic produces a transient high value that shows what would happen if, purely hypothetically, the age-specific mortality rates in that one calendar year were to persist indefinitely. Countries are ranked by probability of premature death (PPD) at the mortality rates of 2019.

Figure 3

Rate of decline in PPD in the period 2010–19 by sex, for the 30 most populous countries

Figure 4

Country progress in PPD and average rates of improvement for USA versus Germany and the UK, 1970–2019, by decade