A Population Reference Bureau report shows a global dearth of primary care and its effects on life expectancy.
The following article was published in the January - February 2025 issue of NewsNotes.
Roughly 50 percent of the world’s population lacks access to good primary health care, according to the Population Reference Bureau, a non-profit organization that tracks population indicators for more than 200 countries and territories. In their 2024 World Population Data Sheet, issued in September, the Population Reference Bureau estimated that 60 million deaths could be prevented by 2030 with reasonable investments in primary healthcare (PHC) in low- and middle-income countries. As a result, average life expectancy could increase by 3.7 years. Increased investment in primary health care can improve health outcomes and help nations achieve “Good Health and Wellness,” the third Sustainable Development Goal (SDG) the UN has prioritized for 2030.
The report defines primary health care as “an approach to health that is integrated, tailored to individuals’ and families’ needs, and delivered as close as possible to people’s daily environment.” The definition is expansive, since adequate health service must meet a populations’ changing needs. This includes care at every age: during pregnancy, through childhood, and in elder care. It also includes noncommunicable diseases and maladies like high blood pressure. In essence, PHC helps people live longer and healthier lives.
The report suggests that investments to improve access to people-centered, continuous, comprehensive, and coordinated care across low- and middle-income countries can be achieved by increasing the availability and retention of staff. At the same time, the report acknowledges that many countries lack sufficient resources, and shortages in trained health professionals contribute to overworked personnel and degraded quality of care.
Other metrics from the report illustrate the disparities of care access around the world. Nursing and midwifery availability varies widely from country to country. While globally, there are 38 nursing and midwifery personnel per 10,000 population, this number is 137 in Australia and 119 in the United States. For other countries, that number is markedly lower: 35 in China, 23 in Guatemala, and 6 in Kenya. The report also provides data on the number of medical doctors and community health workers per capita, which reveals similar extremes of coverage.
The report also tracks the number of people aged 30 to 79 for whom hypertension is controlled. In eastern Africa, only eight percent of adults have hypertension under control, the lowest percentages in the world. In comparison, the number of adults in the United States for whom hypertension is controlled is 48 percent.
Health spending per capita (in USD), includes total health spending and primary health care-specific spending. South Asia spends only $29 per person on primary health care, among the lowest in the world.
The Population Reference Bureau captures the totality of each country’s metrics to create a Universal health care (UHC) service coverage index, measuring average coverage of essential PHC services among general and most disadvantaged populations. The UHC service coverage index sits on a range from 0 to 100, with 100 indicating maximal coverage. Some scores include 27 for Somalia; 35 for Ethiopia, Madagascar, and Niger; 44 for Cameroon and Togo; 54 for Nepal and Haiti; 63 for India; 81 for China; and 91 for Canada.
While the report tells of the status of healthcare for the year 2024, it also looks to the future of population change. Population Reference Bureau projects the global population will grow from over 8 billion to nearly 9.6 billion by 2050. Eastern Europe’s population is anticipated to fall by nine percent by 2050, while Africa is expected to account for 62 percent of global population growth in that same period. The report highlights that 10 percent of the world’s population is aged 65 and older, while 25 percent is under the age 15. The world’s youngest region is sub-Saharan Africa, where 41 percent of the population is aged 15 or younger. Southern Europe is the oldest region in the world, with 22 percent of its population aged 65 and older.
Population aging poses challenges such as shifts in the burden of disease to include more chronic diseases such as hypertension and diabetes and a higher demand for caregiving. Addressing these challenges may be more urgent at present in countries in East Asia, Europe, and Northern America, where the share of older adults is about 20 percent, than among countries in sub-Saharan Africa, where the share is 3 percent, but all countries need to prepare for aging societies. An aging population need not be a problem, provided it is planned for.
Primary health care (PHC) includes preventive measures that are crucial in delaying the onset of age-related diseases and maintaining older adults’ health. It also helps reduce the long-term burden on health systems. PHC can decrease mortality rates for mothers and young children and improve outcomes across the life course.
Photo of nurse sanitizing finger of patient by Riaz Jahanpour for USAID Tanzania / Digital Development Communications via Flickr.