Download HIV/AIDS, Mobilizing and Spending: Current Purposes and Problems

HIV/AIDS, Mobilizing and Spending: Current Purposes and Problems
By Tony Barnett1 and Alan Whiteside2
Paper prepared for the high-level meeting on trans-Atlantic collaboration organized
by the Center for Strategic and International Studies (CSIS) and Ministère des
Affaires Etrangères, France , Paris, 12-13 March 2006.
Confidential. Not for distribution beyond the meeting with out the permission of the
authors
We were asked to write on ‘the trends on spending within a global concept and the evolving
epidemic’. We present these thoughts (a short paper with a long appendix) with an
expectation that it will spur discussion. It is based on our experience of working in the field
intensively for more than 15 years independently and collaboratively.
We believe there is a paradox: there has never been as much or as little money available for
the epidemic as there is today. This statement requires some elaboration. A lot of money is
nominally available inasmuch as it has been publicly allocated; some of it may be available in
fact; some of it may be diverted from other sources; some of it while “available” does not and
cannot be converted into effective on-the-ground expenditure.
The world, most notably in the form of statements from the United Nations General
Assembly; the establishment of the GFATM and in proclaimed fund allocations by the US
(PEPFAR - $15 billion) and DFID (£5 billion) has woken up to the scale of the epidemic.
However, the amount of money allocated falls far below what is estimated to be needed, and
is probably far more than can actually be spent, another paradox.
In early 2005, there was an irate reaction to the presentation by UNAIDS of their estimate of
the amount of money needed for a comprehensive response to HIV/AIDS. The activist
community roasted the “donors” for not asking for enough from the funders. As a result of
this in mid-2005 UNAIDS reworked its figures and estimated what a comprehensive response
to the epidemic would cost. Table 1 summarizes these costs.
Table 1: AIDS Resource Needs
US$ Billion
Prevention
Treatment and Care
OVC
Programme Costs
Human Resources
Total
2006
8.4
3.0
1.6
1.5
0.4
14.9
2007
10.0
4.0
2.1
1.4
0.6
18.1
2008
11.4
5.3
2.7
1.8
0.9
22.1
2006-08
29.8
12.3
6.4
4.6
1.9
55.1
Source: UNAIDS (2005)
1
2
London School of Economics
HEARD, University of KwaZulu Natal
1
1. How much money has been raised?
Exact figures tracking resource allocation to HIV/AIDS are extremely difficult to put
assemble, particularly given the time lags between commitment and disbursement of funds.
Nonetheless, external financing for HIV/AIDS has shown an upward trend in the last few
years. Figure 1 shows those trends in some African countries
Figure 1: Trends External Funding Commitments for HIV/AIDS for Select African
Countries 2000-04 (US$ Millions)
Source: Lewis (2005)
This marked increase in disbursements is encouraging. However, on their own these figures
tell us little about where or how the funds are being used and their impacts,
Monitoring and evaluation processes are rent by dissent and politics – for example how to
count a patient on ARVs or how to count an orphan and, perhaps most of all, how to count a
“programme effect1”.. The total cost to tackle AIDS as estimated by the UN is $55 billion
over the period 2006-08 (Table 1), and $18.1 billion for 2007. The resources raised however,
are far below what is required. UNAIDS projects that US$ 10 billion will be available for
2007, a $6.1 billion shortfall from what is required. As an aside a meeting in Beijing in
January called for $1.2 billion to combat avian flu - and $1.9 billion was pledged.
2
Figure 2: Projection of Available Resources for AIDS from all Sources 2005-07
Source: UNAIDS (2005)
Appendix I provides more detailed information regarding investment and spending on
HIV/AIDS past decades.
2. The big issues with regard to money flows
A number of important issues need to be addressed with regard to financial flows:
a) Where are the resources going?
What is the balance between prevention, treatment and impact mitigation? Commonsense and
basic public health tells us that ounce of prevention is worth a pound of cure and prevention
is not working. Most funding is allocated to treatment, specifically to the procurement of
ARV drugs. For example, as shown below, PEPFAR allocated 42% of its total funding to
drugs and only 20% to prevention. This bias in policy is only natural since drugs are an
incredible financial burden on developing country health budgets.
Prevention must be (re) emphasized . But we do not know what works and why and this issue
has been muddied through inclusion of moral as well as technical agendas. This issue needs
to be clarified and confronted at the meeting.
3
Figure 3: Distribution of PEPFAR Funding for HIV/AIDS 2003-08
ART care
13%
Palliative Care
15%
ART drugs
42%
Prevention
20%
children and
orphans
10%
Source: www.avert.org
b) Is money what is needed?
Many developing countries do not have the capacity to absorb the increased aid. The
bottleneck for HIV/AIDS is often not finance but health staff/ health systems (although, there
have been several instances where budgets for HIV/AIDS have fallen short e.g. Swaziland).
The deterioration of the health system due to HIV/AIDS impacts the ability to treat and care
for people with the disease. For instance, in Swaziland, staff attrition rate was 7.9%, a third of
which was due to HIV/AIDS deaths (HDA and JTK Associates, 2005). The weak health
systems of developing countries require additional long-term assistance. Unfortunately, this
does not sit well with donor imperative – as public spending on wages and human resources
is generally thought of as being inflationary (even though there is no evidence for this claim
with regards to health spending).
c) Is the money reaching the people who need it?
There are two big questions here – first is the money actually leaving the donor countries or
is it being consumed by national suppliers and the second is do the systems allow money to
flow to the households and clinics that need it. These are not new questions and have applied
to aid flows for decades but HIV puts them under the spotlight.
d) Are we planning for the long term?
Long term planning around HIV/AIDS requires predicting the trajectory of the epidemic and
medical advances (both with regards to cost of drugs as well as the invention of new
treatment regimes). There is a good deal of uncertainty regarding both. Since it is difficult to
estimate the cost of providing treatment in the long run (in fact costs change on a monthly
basis), it is difficult to predict what the cost of treatment will be in the future in view of
changing drug prices, capacity constraints, new drug regimes, increased number of people on
treatment and so on. The case of Brazil shows that while the number of patients on ART had
increased between 1997 and 2005, the average treatment cost per patient declined rapidly as
drug prices declined. However, the cost of treatment rose again in 2003-04 owing to the
4
introduction of new drugs and the fact that many patients were no longer able to survive on
the first line therapies..
Figure 4: ART Patient and Cost Trends in Brazil (1997-2005)
PATIENTS ON ANTI-RETROVIRAL
THERAPY IN BRAZIL, 1997 - 2005*
jul/05
jan/05
jul/04
jan/04
jul/03
jan/03
jul/02
jan/02
jul/01
jul/00
jan/01
jan/00
jul/99
jan/99
jul/98
jan/98
jul/97
jan/97
170.000
Average cost of ARV per patient/year
(US$)
7000
6240
6000
5486
5000
Introduction of
expensive
new ARVs
Thousands (US$)
4603
4000
3464
3000
• Prices of second-line, patented
drugs have stopped falling
substantially
• Number of people using them
has increased dramatically
2000
1000
2500
2210
1500
1359
1336
0
1997
1998
1999
2000
2001
2002
2003
2004
2005*
Year
Source: slides presented and made available to author
e) The time scale and magnitude of support needed.
The AIDS epidemic is a long wave disaster. If a person is put on ARVs they will need them
for the rest of their life. A child orphaned today at 2 years of age today will need support until
they are 18, that is 2020 – assuming there are economic opportunities for them after that!.
Furthermore, the current HIV infections have yet to turn into AIDS cases. The scale of need
5
will increase. It is clear the impact of the epidemic will be felt for generations to come and
needs to be planned for.
4. Viral resistance
Are we taking sufficient account of the development of acquired and possibly transmitted
viral resistance in resource poor settings? If either or both of these is/are likely to be problems
(and we believe that acquired resistance is certainly going to be a problem, and the future of
transmitted resistance is receiving insufficient attention), then we need to be looking at four
issues:
- Development, pricing and access to new generations of ARVs
- A review of prevention issues in readiness for a possible new epidemic of resistant
virus
- A review of impact mitigation responses to a new wave of epidemic effects.
- A particular potential problem – the possibility that widespread ART will have
adverse effects on mitochondrial DNA.
5. AIDS exceptionalism.
We believe that AIDS is exceptional but we need to do more than say this we need to explain
why this is the case. For example:
“Health workers do not die of malaria in the same numbers that they die for AIDS’
Malaria does not alter demographic structures in the same way that AIDS does
We also need to be clear that while AIDS exceptionalism may be an important advocacy tool,
it also has dangers, as for example when it is linked to the “security” or otherwise used as a
scare factor.
6. The Questions we should be asking
a) How much has HIV/AIDS cost so far?
Looking at the cost of the HIV/AIDS epidemic from two perspectives, we can conclude that
the total cost from the beginning of the epidemic is in the region of $20bn. This round figure
does not adequately take into account the costs that have arisen in the non-formal economy
and in the realm of social reproduction. These costs represent global resources, which in the
absence of the epidemic could have been used for other purposes.
b) The Cost of HIV/AIDS
Estimation of the cost of the HIV/AIDS epidemic is complex and we can only arrive at orders
of magnitude. We can look at the question in four ways:
1. Costs as reflected by total expenditure on engaging with the epidemic globally $23.889bn
2. Costs as reflected in estimated losses in economic performance in the worst affected
countries
3. Costs as reflected in losses associated with non-quantifiable or hard to quantify longterm effects.
4. Cost considered against simple epidemiological assumptions.
These 4 approaches are further explored in appendix II.
c) Cost of HIV/AIDS to the affected
While HIV/AIDS is an enormous cost to the state, the private sector, and the international
donor community, it also financially burdens affected individuals and communities. The costs
can be broadly categorized as direct and indirect costs.
6
1. Direct costs: Direct costs due HIV/AIDS are those related to medical expenditure and
funerals. For example, in rural Tanzania, the mean direct health costs in households
experiencing an AIDS death was approximately US$ 70 dollars, roughly 24 per cent of
the total per capita income (Ngalua et al., 2002). Such an expenditure shock could well
trap a family into poverty for generations.
2. Indirect costs: These include change in labour supply, change in patterns of agriculture,
change in wages and so on.
Patient and community level costs have often been neglected in discussions around funding.
It is important to realize that these seemingly small patient level costs can have enormous
implications for the effectiveness of programmes tackling AIDS. For instance, there is
evidence that increased transport costs for patients lowers the level of adherence to ART,
which lowers effectiveness of treatment and breeds resistant strains of the virus. Approaches
to provision of treatment must try and include these costs in their estimates and plan for them.
7. . Conclusion: three big questions
Twenty five years into the epidemic we are uncertain as to the next steps. There has been a
marked increase in funding for HIV/AIDS, it is in no capacity sufficient to tackle the
epidemic. Moreover, providing funding is not sufficient as many countries lack the human
and physical capacity to absorb the funds and tackle the disease effectively.
This leads us to the biggest questions of all:
1. What do we really know about confronting prevention, care and impact mitigation?
2. How can big money and big organization engage with local needs and variability?
3. What are the “deep policy stakes2” which unite and divide the US and the EU in
relation to Global Health Policy?
4. and thus, what should this meeting strive to achieve in order to contribute to the
global public good!
7
APPENDIX I - SPENDING AND INVESTMENT ON HIV
1. Vaccine R&D: $3201m (2000-2005)
Table 1: Annual Investment in preventative HIV vaccine
(current US$)
2000
2001
2002
2003
US
272
314
376
463
Rope
23
32
39
44
+
Other
10
12
21
24
Multilaterals
2
2
2
2
Philanthropic
Sector
20
7
112
15
Pharmaceutical
companies
57
Biotechnology
companies
42
TOTAL
327
367
649
548
R&D between 2000 and 2005
2004
516
57
28
2
2005
568
39
8
2
2000-2005
2509
234
103
12
12
10
176
59
-
116
9
683
627
51
3201
+
Includes all national public sector funding apart from funding from the US and Europe
Note: The 2005 estimates represent actual disbursements and firm commitments made as of May 2005
Source: Tracking Funding for Preventive HIV Vaccine Research and Development: Estimates of Annual
Investments and Expenditures 2000 to 2005, The HIV Vaccines and Microbicides Resource Tracking Working
Group) (AVAC, Alliance for Microbicide Development, IAVI, UNAIDS) 2005
2. Microbicide R&D: $649.1m (1997-2005)
Table 2: Annual Investment in microbicide R&D by public and philanthropic sectors between
1997 and 2005 (current US$ million).
US
Europe
Other
Multilaterals
Philanthropic Sector
TOTAL
1997-1999
84.4
9.8
94.2
2000
34.6
0.7
0.3
0.1
29.4
65.1
2001
61.3
0.4
0.1
0.3
3.4
65.4
2002
75.3
5.1
0.2
0.4
24.8
105.8
2003
78.8
10.6
0.9
0.1
16.9
107.1
2004
92
29.9
2
0.2
18.1
142.3
2005
99.3
37.8
5
0.2
21.1
163.4
20002005
525.7
84.5
8.5
1.3
123.5
743.3
Note: The 2005 estimates represent actual disbursements and firm commitments made as of May 2005
Source: Tracking Funding for Preventive HIV Vaccine Research and Development: Estimates of Annual
Investments and Expenditures 2000 to 2005, The HIV Vaccines and Microbicides Resource Tracking Working
Group (AVAC, Alliance for Microbicide Development, IAVI, UNAIDS) 2005.
8
3. Treatment of Individuals - ARVs (2005)
Table 3: Estimated Number of people on ARVS in June 2005 by Region
Estimated no. of people receiving
Geographical Region
ARVs, June 2005
Cost (no. of people x 16k)
Sub-Saharan Africa
500,000
8,000m
Latin America and the
Caribbean
290,000
4,640m
East, South and South East
Asia
155,000
2,480m
Europe and Central Asia
20,000
320m
North Africa and the
Middle East
4000
64m
TOTAL
970,000
15,504m (=US$27,073m)
Source: Progress on Global Access to HIV Antiretroviral Therapy, UNAIDS/WHO,2005.
4. Major Corporate Donors
(a) Glaxosmithkline spends on average £1.3 billion each year and has 9300
employees in R&D (Source: VSO). Up to 1991 Glaxosmithkline had invested
approx. $50 million in its HIV programme
(b) Bristol-Myers Squibb Since mid 1999, BMS has committed $37 million in grants
for HIV/AIDS activities. Through its “Secure the Future” initiative the company
pledged an additional $15 million on top of a previously committed $100 to help
prevent and treat HIV/AIDS
Source: Global spending on HIV/AIDS: Tracking public and private investments in AIDS prevention, care and
research, Progressive Health Partners & the IDS Research Institute, UCSF 2001.
5. Major Foundations
(a) Ford Foundation: Since 1987 the Ford Foundation has awarded approx. $70
million in HIV/AIDS related grants
(b) Bill and Melinda Gates Foundation: The Gates Foundation has committed over
$350 million to HIV/AIDS prevention
(c) Henry J. Kaiser Family Foundation: The Kaiser Foundation has committed in
excess of $100 million to AIDS programmes in the US and South Africa
(d) Rockfeller Foundation: In 2000, the Foundation made grants totalling $1.5
million to HIV/AIDS. In 2001 the Foundation committed a further $30 million to
HIV/AIDS
Source: Global spending on HIV/AIDS: Tracking public and private investments in AIDS prevention, care and
research, Progressive Health Partners & the IDS Research Institute, UCSF 2001
Total: $551.5million
9
6. UNAIDS Budget
Table 4: UNAIDS Budget 1996-2003
UNAID
Year
(millions)
2003
$350
2002
$150
2001
$70
2000
$70
1999
$60
1998
$60
1997
$60
1996
$60
budget
TOTAL 1996-2003 $880
Source: UNAIDS
7. WHO Global Programme on AIDS
WHO estimates that the total spending of GPA plus the Special Programme on AIDS (SPA)
(1986 to 1995) was approx $750 million to $1500 million.
Table 5: WHO Budget 1996-2005
Year
WHO budget (millions)
2004-2005
$218.1
2002-2003
$59
2001-2000
$50
1998-1999
$39
1996-1997
$28
TOTAL
$394.1
Source: WHO
8. USAID Budget
Table 6: USAID Budget 1986-2003
Year
USAID budget (millions)
2005
$540
2004
$550
2003
$795.0
2002
$510.0
2001
$433.0
2000
$200.0
1999
$139.1
1998
$125.4
1997
$118.9
1996
$137.5
1995
$151.9
1994
$112.8
10
1993
1992
1991
1990
1989
1988
1987
1986
TOTAL
2003
$124.5
$95.7
$78.4
$48.5
$47.1
$34.7
$5.0
$1.1
1986$4248.6
Source: USAID
9. Total US funding for global HIV/AIDS (includes USAID funding, State Department
funding, research etc)
Table 7: US Funding for HIV/AIDS 1986-2005
Year
US FUNDING (millions)
2005
$2,701
2004
$2,253
2003
$1,490
2002
$1,196
2001
$712
2000
$360
1999
$215
1998
$179
1997
$170
1996
$163
1995
$170
1994
$161
1993
$153
1992
$128
1991
$112
1990
$100
1989
$62
1988
$45
1987
$12
1986
$1
TOTAL 1986-2005 $10,383m
10. DFID Budget
Table 8: DFID Budget for HIV/AIDS 1997-2005
Year
2004/05
2003/04
2002/03
HIV/AIDS budget in millions (£)
No data available
£297m
£274m
11
2001/02
2000/01
1999/00
1998/99
1997/98
TOTAL 1997-2004
£217m
£191m
£76m
£45m
£38m
£1138m
Note: in 2004 DFID stated that over the next 3 years the UK government would spend at least £1.5 billion on
HIV/AIDS related work. DFID also pledged £36 m to UNAIDS in 2004.
Source: DFID
12
APPENDIX II - COST OF HIV/AIDS
This appendix presents the cost of the epidemic depending on the approach taken. Ideally a
comprehensive estimate of total cost will include all these measures:
1. Costs as reflected by total recent expenditure on engaging with the epidemic
globally3:
Table 1: Various HIV/AIDS related Expenditures
Vaccine R&D (2000-2005)
Microbicide R&D (1997-2005)
Donations by philanthropic Foundations
UNAIDS budget (1996-2003)
WHO budget for HIV/AIDS (1986-2005)
USAID budget for HIV/AIDS (1986-2003)
Total US funding related to HIV/AIDS (1986-2005)
DFID budget for HIV/AIDS (1997-2004)
World Bank budget for HIV/AIDS
TOTAL EXPENDITURE:
$3201m
$743.3m
$551.5m
$880m
$1894m (upper estimate)
$4248.6m
$10,383m
$1,987m
$1.7 billion.
$23.889bn
2. Costs as reflected in estimated losses in economic performance in the worst affected
countries
These costs have been approached by means of a range or more or less sophisticated
economic modeling exercises. The results of these are summarized in the following table.
The general conclusion that may be drawn is that economic performance as measured by
GDP growth falls by about 1 per cent per year in affected countries over the duration of the
epidemic. This is a very significant figure, particularly when it is considered that many of
these countries already have negative GDP growth rates to begin with.
3
The detailed estimates for each of these heads of expenditure are contained in Appendix 1
13
Table 2: Comparisons of macro-economic studies – Impact of HIV/AIDS on Growth
Country/region
Predicted impact
Author
Forecast dates
Africa and sub- Annual GDP growth 0.56–1.47% Over (1992)
Saharan Africa
lower than without AIDS Annual
per capita growth will be
between +0.17% and –0.6%
compared to without AIDS
1990–2025
Tanzania (a)
Annual GDP growth falls from Cuddington
Solow-type growth 3.9% without AIDS to 2.8–3.3% (1993a)
model
Annual GDP per capita growth
falls from 0.7% without AIDS to
0.2%–0.7%
1985–2010
Tanzania (b)
AIDS reduces real GDP by 11% Cuddington
As
above
but to 28% over period
(1993b)
introduces
Per capita income change ranges
dual labour market from rise of 3.6% to a decline of
16.1% over period
1985–2010
Malawi (a)
Annual GDP growth rates Cuddington and 1985–2010
As for Tanzania (a) reduced by 0.2–1.5%
Hancock (1994a)
Annual GDP per capita growth
reduced by 0.1–0.3%
Malawi (b)
Annual GDP growth reduced by Cuddington and 1985–2010
As for Tanzania (b) 3% to 9%
Hancock (1994b)
Annual GDP per capita growth
reduced by 0% to –3%
Botswana
Rate of GDP growth falls from Botswana Institute 1996–2021
Production
3.9% per annum without AIDS for Development
functions
to 2.0–3.1%
Policy Analysis
(takes
Cobb- After 25 years, economy 24– (BIDPA) (2000b)
Douglas form)
38% smaller. In the best case per
capita GDP rises from 1.5% to
1.9% a year, average incomes
9% higher after 25 years. In the
worst case, GDP per capita
growth will fall to 1% a year,
and be 13% lower after 25 years
Sub-Saharan Africa African economic growth has Bonnel (2000b)
Growth equations been reduced by 0.8% in the
Ordinary
Least 1990s
Squares and Tuso Per capita growth was reduced
Stage Least Squares by 1.2% per year 1990–95
1990–97
South Africa
Real GDP is 0.3% lower in Quatteck (2000)
Full supply-demand AIDS as opposed to no AIDS
econometric model scenario in 2001, 0.4% in 2006–
10
2001–15
By year to 2005
then
2006–10
and 2011–15
14
South Africa
CGE model
The difference in GDP growth is Arndt and Lewis
2.6% in 2008, by 2010 the (2000)
economy is 17% smaller than it
would have been without AIDS.
The per capita income is 8%
smaller
Trinidad & Tobago GDP in 2005 is 4.2% lower in Nicholls
(T&T) and Jamaica T&T and 6.4% lower in Jamaica (2000b)
than it would have been in the
absence of AIDS
et
1997–2010
al. 1997–2005 but
results seem to
be for 2005
2000 - 2080
South Africa
Overlapping
generations model
Bell et al. (2003)
Potential for economic collapse
in three generations
3. Costs as reflected in losses associated with non-quantifiable or hard to quantify longterm effects
HIV/AIDS and international development targets
The potential effects of the AIDS epidemic on international development goals as set by the
Millennium Development Goals can be seen in the following table:
Table 3: Impact of HIV/AIDS on Development Goal at Global and National Level
Development goal
Effect of HIV/AIDS
Global and national impact
Reduction by one-half of AIDS
increases
poverty Will slow global progress,
proportion of people living in especially at the household some national impact but
extreme poverty by 2015
level, has serious impact on population decline reduces
human capital
this,
main
impact
at
community/ household level.
Goal hard to achieve
Universal primary education Impact
on
supply
of
in all countries by 2015
education through teacher
deaths and resources, on
demand side through uptake
especially female students
Demonstrated
progress
towards gender equality,
women’s empowerment by
eliminating
disparity
in
primary
and
secondary
education by 2005
Worst affected countries will
see
declining
enrolment
especially
among
most
vulnerable
groups.
Goal
harder to achieve in some
countries
Girl children most likely to be Disparity will not be reduced
kept out of school to provide with out targeted intervention.
care or when resources are Goal harder to achieve
limited
Reduction by two-thirds in the Infant and child mortality will The target will not be met and
mortality rates for infants and continue to increase for the in some countries there will
children under age 5 by 2015 next decade and possibly be deterioration over the
15
longer
period
Reduction by three-fourths in Little impact recorded to date No impact recorded
maternal mortality by 2015
Access through the primary
health-care
system
to
reproductive health services
for
all
individuals
of
appropriate ages and no later
than 2015
Demand from HIV/AIDS
patients will put pressure on
the public health-care system,
additional
human
and
financial resources required
Will require more resources
than previously envisaged.
Goal may be more difficult to
achieve
Implement national strategies
for sustainable development in
all countries by 2005, to
reverse
the
loss
of
environmental resources by
2015
Little impact recorded to date, Not yet known
but may be some – and
surprising, e.g. loss of skills,
increased demand for wood
for cremation or land for
burial
One of the most measurable impacts of AIDS is on mortality rates. Adults and many infants
and children are dying prematurely. This impact is measured in the Human Development
Index4 through the life expectancy component. The following table shows how AIDS
mortality has affected both life expectancy and HDI scores and rankings for selected
countries. Botswana is worst affected and fell from 71st to 122nd by 2000, and then to 128th
place by 2004. Even Thailand, where the epidemic is under control has been affected. Life
expectancy has fallen slightly and this has contributed to the decline in its position from 52nd
to 76th place in the HDI rankings by 2000, and to 92nd place by 2004.
4
"The HDI is a composite of three basic components of human development: longevity, knowledge and
standard of living. Longevity is measured by life expectancy. Knowledge is measured by a combination of adult
literacy (two thirds weight) and mean years of schooling (one third weight). Standard of living is measured by
purchasing power, based on real GDP per capita adjusted for the local cost of living (purchasing power parity)."
(UNDP, Human Development Report 1994, p.91).
16
Table 4: Life expectancy and position in the HDI (selected countries)
2000 Report
2001 Report
2002 Report
2003 Report
(1998 data)
(1999 data)
(2000 data)
(2001 data)
2004 Report
(2002 data)
RANK LEX HDI RANK LEX HDI RANK LEX HDI RANK LEX HDI RANK LEX HDI
Cambodia 136
53.5 0.512 121
56.4 0.541 130
56.4 0.543 130
57.4 0.556 130
57.4 0.568
Thailand
68.9 0.745 66
69.9 0.757 70
70.2 0.762 74
68.9 0.768 92
69.1 0.768
Botswana 122
46.2 0.593 114
41.9 0.577 126
40.3 0.572 125
44.7 0.614 128
41.4 0.589
Côte
d’Ivoire
154
46.9 0.420 144
47.8 0.426 156
47.8 0.428 161
41.7 0.396 163
41.2 0.399
Kenya
138
51.3 0.508 123
51.3 0.514 134
50.8 0.513 146
46.4 0.489 148
45.2 0.488
Malawi
163
39.5 0.385 151
40.3 0.397 163
40.0 0.400 162
38.5 0.387 165
37.8 0.388
South
Africa
103
53.2 0.697 94
53.9 0.702 107
52.1 0.695 111
50.9 0.684 119
48.8 0.666
Zimbabwe 130
43.5 0.555 117
42.9 0.583 128
42.9 0.551 145
35.4 0.496 147
33.9 0.491
Zambia
153
40.5 0.420 143
41.0 0.427 153
41.4 0.433 163
33.4 0.386 164
32.7 0.389
Haiti
150
54.0 0.440 134
52.4 0.467 146
52.6 0.471 150
49.1 0.467 153
49.4 0.463
76
Source: UNDP (2004, 2003, 2002, 2001, 2000). LEX = life expectancy
17
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2
Paper prepared for this meeting by Kates, Morrison and Lief, p. 1.
20