Advancing the understanding of what drives success in nations

How the last decade led to the improvement of people’s lived experiences

All regions saw progress in all pillars under Empowered People, other than MENA and Sub-Saharan Africa in Natural Environment and Latin America and the Caribbean in Health. Furthermore, less prosperous countries are converging with the more prosperous ones in Living Conditions, Health and Education (but not in Natural Environment).

How the health sector presents a success story despite Covid-19

The recent Covid-19 pandemic has reminded the world of the importance of health to personal and societal wellbeing. Nonetheless, while the last few years have been grim, looking at the past decade, health continues to improve and converge across all countries. The least prosperous countries in 2013 have been converging with the most prosperous ones for health. For instance, over the last 10 years, the weakest-performing region, Sub-Saharan Africa, has gained on Western Europe and North America, which are the best-performing regions.

In the last decade, the bottom 40 countries saw life expectancy at 60 increase from 76.1 to 77 years. Moreover, mortality rates have decreased across all life stages in the bottom 40.

One region where this has had a significant effect is Sub-Saharan Africa, where over 10 years maternal mortality has fallen from 608 to 514 deaths per 100,000 live births. Meanwhile the global average has decreased from 164 to 138 in the same period – a decrease that is almost four times smaller than that experienced in Sub-Saharan Africa.

Similarly, preventative interventions have improved during the decade, with some Sub-Saharan countries making particularly large jumps in vaccination levels. For example, Chad’s vaccination levels increased by 8% since 2019, amidst the pandemic causing a set-backs in other countries. Three factors allowed Chad to achieve this change: investing in cold-chain equipment, recruiting healthcare personnel and generating demand.

On the other hand, while preventative interventions saw an overall improvement, recently there have been some signs of deterioration. For example, while vaccination rates for measles improved from 81% in 2008 to 86% in 2018, they have been declining recently. For instance, overall, Sub-Saharan Africa has slowed in its rate of progress, particularly for measles and hepatitis immunisation.

There are multiple lessons that can be learnt from the successful decade in the health sector. First, basic improvements in health are achievable for virtually all countries. There are enough resources, international support and know-how to deliver basic interventions that increase life expectancy and improve the health of a population. Additionally, there is little political controversy and disagreement regarding basic health initiatives.

As the data for immunisations show, national problems, indifference, or international challenges (such as a pandemic) can undermine hard-earned progress achieved over many years. Hence, basic health interventions cannot be taken for granted and must be maintained.

How lower poverty and better services are leading to better lives

Looking at the past decade, it is evident that life has continued to improve for people around the world, with the bottom 40 countries seeing progress and convergence with the rest of the world on all aspects of Living Conditions.

People’s access to material resources continues to progress and severe poverty is dropping. The poverty rate for those living on $1.90 a day has fallen from 16.9% to 8.6% in the last decade with the largest decreases in Central and South Asia and East Asia and the Pacific. There has also been convergence in poverty levels and the bottom 40 countries in 2013 are much closer to the rest of the world in 2023.

The significant efforts made in the last decade to reduce extreme poverty have been successful. Looking at less-severe levels of poverty ($5.50 a day), the overall trend continues to improve as well. However, there has been considerable divergence. Although some countries have reduced less-severe poverty, the improvement of the worst-performing countries is not fast enough to catch up to the rest. While the countries that were at such poverty rates in 2013 have improved, they are even further behind today due to the rest of the countries improving even faster. The focus on poverty reduction, rather than building prosperity, has not brought the desired results.

Sub-Saharan Africa and Central and South Asia are far behind the rest of the world, while MENA has seen an increase in the percentage of people who live on less than $5.50 per day. Since many countries in MENA depend on Russia and Ukraine for wheat imports, the war in Ukraine has increased inflationary pressures in the region, which is already characterised by drought and conflict

Meanwhile, Basic Services such as access to electricity, water and sanitation have continued to improve, with Central and South Asia, Sub-Saharan Africa, and East Asia and the Pacific recording the largest increases. Access to basic sanitation services has increased from 45% to 71% over 10 years in Central and South Asia and from 77% to 91% in East Asia and the Pacific, leading to convergence.

In the last decade, African countries experienced significant increases in access to electricity. For example, in Uganda, access to electricity tripled from 12% in 2010 to 42% in 2020. Recently, the country launched a last-mile connectivity project, aimed at increasing rural electricity access, which according to the government has increased it to 57%.

The challenges ahead

It is important to note that there are multiple challenges that could prevent further progress.

  • While convergence between the bottom and top 40 groups is evident, the process is slow, and at this pace, it will take another century to see full convergence.
  • The effects of global crises such as Covid-19 and the war in Ukraine continue to persist in multiple elements, including mental health, where the full effects of these shocks are still unknown.
  • Current improvements are evident in technical and largely non-contentious areas, such as basic immunisations. Meanwhile, areas where real social change is required have not seen an equal improvement.
  • Evidence from the countries that have improved the most shows that progress is dependent on upstream change and government performance that is not always easy achieve.