Life and Death in South Asia


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In the film, Venus, an old and frail Peter O’Toole discovers the Greek goddess in the guise of his best friend’s niece. The ironic and good humored story explores the theme of the games played in a mutual seduction between the older man with experience, money and a nostalgic yearning for carnal desire and the young woman who soon finds out the power she wields and negotiates three kisses in return for a pair of earrings. In the final scene, wearing only one of his boots on a cold beach, O’Toole feels the caress of the sea’s salty foam with the sole of his foot and smiles. His face expresses the happiness of someone who knows the joys of being alive.

It is impossible to weigh up Peter O’Toole’s smile, measuring the degree of his happiness or comparing it to what you would feel if walking barefoot in the sand. But, the idea that his feelings can be measured as a metric has become fashionable, ever since the King of Bhutan decided that GDP fails to portray the well-being of his subjects and summoned a team to create the Gross National Happiness index.

A degree of skepticism guides my preference towards simpler measurements rather than more complicated ones. In comparing the well-being of two different countries, I like to take into account life expectancy at birth. I look with a grain of salt at international comparisons based on the percentage of the population who lives on “less than two dollars a day”. Why? Because I know how difficult it is to find an index of purchasing power parity that allows consumption measured in a local currency to be transformed into dollars. One simple change to this purchasing power parity index could turn, at the wave of a wand, millions of poor into nouveaux-riches.

In my opinion, where an acceptable Census of the population exists, life expectancy at birth is a first approach to measuring well being. The content of this indicator is enormously relevant, for life is the highest good and our capacity to survive depends on the society where we live: the quality of our food, our access to sanitation and health systems, as well as the absence of war and violence.

In the table below, you can see that women tend to live longer than men, but in Sri Lanka, that divergence is grossly exaggerated (seven years difference as opposed to two years difference on average for the other South Asian countries, except Afghanistan). It is conceivable that more men in Sri Lanka tend to die younger than women due to violent conflicts. The result is reflected in the disparity of the life expectancy between the two genders.

Life Expectancy at Birth (South Asia’s Countries, 2007) ,


  Male Female
Average in five countries
(Bangladesh, India, Nepal,
Maldives and Pakistan)
64 66
Sri Lanka 69 76

(Source: 2009 World Development Indicators)

Life expectancy at birth also reveals the poorest countries in the world. According to the UN, only 47 countries have a population with a life expectancy under 60 years, 42 of which are found in Africa. The five others are:  Afghanistan, Cambodia, Haiti, Laos and Papua New Guinea. It is estimated that the life expectancy in Afghanistan, in 2008, was less than 45 years.

The evolution of life expectancy also clarifies how developed a country is. The table below compares India and Japan. As the mortality rate for infants up to the age of 5 is high in India, a girl who manages to survive past this age has a much higher life expectancy than one who has just been born. In Japan, we see the opposite: where the probability of dying in the first few years of life is low, the life expectancy of a newborn is similar to that of a one year-old.

Life Expectancy and Child Mortality (India and Japan, 2007) 


  Life Expectancy at Birth
Infant Mortality Per 1,000 Births Under-5 Mortality Per 1,000
India 65 54 72
83 3 4

(Source: 2009 World Development Indicators)

To measure development in South Asia, I would like to know how many children reached the age of five because their families came to have access to basic health services and how many will reach maturity, because violence waned.  For, in order to walk barefoot on the beach and find happiness (as Peter O’Toole and his Venus did), one has to be alive.

Will South Asia choose life?



Eliana Cardoso

Former Acting Chief Economist

Join the Conversation

December 02, 2009

The quest for Immortality is an old age one.Truman Capote once remarked-"I am like a Condor in the sky.My victim is immortality."The case for this particular Economic Indicator has been aptly justified.NEVILLE BHASIN.

Charitha Ratwatte Snr.
December 02, 2009

The ten year difference in the life expectancy beween men and women in Sri lanka may not be completely explained away by violence alone. The collateral damage caused to non combatant civilians by civil conflicts which has plagued this nation does not discriminate by sex ! Probably the new life style diseases which men are prone to diabetes, high blood pressure, cancer , liver diseases also play a role . Diet, sedentary life, alchohol and cigarette smoking are the causes .

Eliana Cardoso
December 02, 2009

To Neville:
Great quote! Thank you.

Eliana Cardoso
December 02, 2009

To Charitha:
Thank you for your remarks. Yes, the hypothesis needs investigation to allow for adequate response.

Ravi P. Rannan-Eliya
December 02, 2009

Dear Eliana,

Your suggestion about violence being possibly responsible for the large male-female life expectancy difference in Sri Lanka is not borne out by the available facts.

The male-female difference in Sri Lanka is long-standing from at least the 1960s - long before any political violence occurred. This difference has been growing since at least that time, owing to stagnation in older adult male life expectancy, despite increasing female life expectancy. This is not a new observation - it was noted by the UN and Sri Lankan demographers as early as the 1970s, and is a rather old demographic observation. Intriguingly, this older male stagnation occurred even in the USA and many developed countries during the 1960s-70s, and was also noted in the 1970s in Malaysia.

This trend has persisted and the gap has widened. Sri Lanka is fortunately one of the few developing countries which does count most of its dead as well as most of the children who are born (the latter a universal right not met in most other countries). So we have good data. These data show, as we have recently done in ongoing AAA work for the Bank, that the stagnation is due to rising mortality in older adult males from non-communicable disease (NCDs), and more specifically heart disease.

In that respect, your concern about lack of health services is correct. To reduce NCD mortality in Sri Lanka will require substantially expanded healthcare for NCDs in older adults, particularly providing those cost-effective, cheap medical interventions (for the numbers, see the WB's own book on Disease Control Priorities (Ed. Jamison et al, 2004).

However, and this is perhaps the rub, this will require a reorientation in focus by policy makers in Sri Lanka and also in agencies such as World Bank away from those kids less than five years of age, to their older fathers and mothers who are dying far too early from cheaply preventable and treatable NCDs. It is no longer adequate for Sri Lanka and its friends to ask if kids reach the age of five - the better and more urgent question is to ask how many Sri Lankans will never live to be as old as Peter O'Toole (77 years old) because they die far too early from NCDs that would have been treated if only they lived in London or Washington DC, where public money is used to provide those treatments.

Just for the record, in a typical year in Sri Lanka less than 5,000 kids die before the age of 5, and less than 20,000 from violence, compared to more than 80,000 from NCDs, of which at least 20,000 are avoidable at minimal cost.

So yes - life is absolutely important, but real concern needs to focus on where in the life cycle life is really shortened, and we need to avoid generalizing problems across the whole region, especially when dealing with Sri Lanka and the Maldives. I hope that the Bank will join Sri Lankans in making that case and encouraging Sri Lankans and their government to invest the needed tax monies in better care for NCDs.

Regards, Ravi

Eliana Cardoso
December 02, 2009

To Ravi:
Thank you!!! I feel great when being corrected because I advanced a wrong hypothesis. This is the best way to learn.
Very important to know that in a typical year in Sri Lanka less than 5,000 kids die before the age of 5, and less than 20,000 from violence, compared to more than 80,000 from NCDs, of which at least 20,000 are avoidable at minimal cost.
Yes! Each country needs a different focus and seems the case that it would be worthwhile to encourage Sri Lankans to invest the needed tax monies in better care for NCDs.

Rachel Nugent
December 04, 2009

To all:

This is an interesting discussion about the dramatic changes in relative health care needs in developing countries that have taken place. Another example is in Bangladesh, where a recent study from DSS shows a 3500% increase in CVD deaths and an 86% decrease in age-adjusted mortality from diarrheal disease in one generation (Karrar et al 2009).

But an important reason for donor reluctance to shift their attention to the new mortality causes is that children are the victims of the traditional causes of death, while adults are the victims of the NCDs. What can we do to make the point that the health and welfare of children and adults are inter-connected? Parenthetically, perhaps it was simple wording in Eliana's last posting, but there are not 80,000 children dying of NCDs in Sri Lanka, are there?

Eliana Cardoso
December 04, 2009

80,000 people from NCDs (not kids), 20,000 people from violence (not kids).

Ravi Rannan-Eliya
December 07, 2009

Just to clarify. Now that I have checked the detailed numbers, the contrast if even more stark than suggested already.

In recent years, the total number of deaths in Sri Lanka have been slightly more than 110,000 per year.

Of these, the total annual deaths from ALL conditions in children aged less than 5 years, & ALL deaths due to any maternal or nutritional condition, & ALL injuries (including violence, accidents, suicide, etc) is less than 20,0000.

December 12, 2009

If we are going to talk about happiness we need to tie it to some more tangible measurement- hence a measure of eccological efficiency per unit happiness. It seems like it could be the basis of a great gain in our fruitfulness.

But in needs to be applied to individual entitites. I'd like to see cutting edge businesses like the new "Onlive" start to apply it to their way of being in the world and insist upon it in their negotiations with customers, investors and banks. If we must tollerate business then lets make it mindful, we might not even call it business after awhile, maybe it will become a play based ecollogy vice a toil based economy.

December 12, 2009

Since the GHI is based on eccology it would be good to get businesses to uses and insist upon it in all of their negotiations. This could change our very way of life.

January 29, 2019

Since the GHI is based on ecology it would be good to get businesses to uses and insist upon it in all of their negotiations. This could change our very way of life.