Ilia State University

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Issue III 2014
POLICY REPORT OF THE PUBLIC POLICY RESEARCH
AND TRAINING CENTER
ANALYSIS OF CHANGES TO AVERAGE
LIFE EXPECTANCY IN GEORGIA
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Mission of the Public Policy Research and Training Center
Public Policy Research and Training Center (PPRTC) of Ilia State University was
founded in November 2013 and is focused on supporting development of public policy
research in Georgia through capacity building of research personnel and public
servants, conducting evidence-based analytical studies and ensuring highly qualified
targeted short-term training courses.
This publication was made possible with the generous support of the Policy, Advocacy,
and Civil Society Development in Georgia (G-PAC) project, which is implemented by the
East West Management Institute (EWMI) and funded by the American people through
the United States Agency for International Development (USAID). The views expressed
in this publication are those of the authors and do not necessarily reflect the views of
G-PAC, EWMI, USAID, or the US Government.
Analysis of changes to average life expectancy in Georgia
Table of Contents
Executive Summary ............................................................................................................................................ 4
Description of the Problem and Rationale ............................................................................................... 5
Research Methodology ..................................................................................................................................... 7
Key Findings ........................................................................................................................................................... 8
Conclusions and Recommendations ....................................................................................................... 14
Bibliography ......................................................................................................................................................... 16
About Authors ..................................................................................................................................................... 17
Ilia State University
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Analysis of changes to average life expectancy in Georgia
Table of Contents
Executive Summary ............................................................................................................................................ 4
Description of the Problem and Rationale ............................................................................................... 5
Research Methodology ..................................................................................................................................... 7
Key Findings ........................................................................................................................................................... 8
Conclusions and Recommendations ....................................................................................................... 14
Bibliography ......................................................................................................................................................... 16
About Authors ..................................................................................................................................................... 17
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Executive Summary
Average life expectancy is an indication of demographic statistics for the generation that has
already been born and is a generalization characteristic of mortality.
For the past 24 years, in spite of certain changes, average life expectancy did not increase, but
underwent certain stagnation and at the moment, in certain cases it is even lower in case of
men than nit was in 1989. Reasons for death and its change are direct determinants of changes
to average life expectancy. This study uses methods of decomposition and substantial attention
is paid to the analysis of correlation between the average life expectancy and reasons for death.
This studys findings show that biggest potential for increasing average life expectancy, both for
men and women, is to reduce mortality from neoplasms, or cancer and other tumors.
The author believes that in order to reduce the role of neoplasms in mortali ty in reductionof
average life expectancy in Georgia the state should undertake the following policy:
1. Strengthen healthcare system with the purpose of effective cancer control
2. Reduce exposition of cancer risk-factors
3. Eliminate stigma and disease-related myths about cancer
4. Improve universal access to national cancer screening and early detection
5. Improve provision of continuous medical service towards oncological patients
6. Ensure universal access to pain and stress management
7. Improve education and training of medical personnel.
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Description of the Problem and Rationale
Average life expectancy is an indication of demographic statistics for the generation that
has already been born and is a generalization characteristic of mortality.
For the past 24 years, in spite of certain changes, average life expectancy did not
increase, but underwent certain stagnation and at the moment, in certain cases it is
even lower in case of men than nit was in 1989. Unlike Georgia, average life
expectancy in countries with higher income has increased since 1950 (see Diagram 1).
Diagram 1. Dynamics of average life expectancy in Georgia, France, Japan and USA
(Source: http://www.mortality.org/, Demographic Yearbook of Georgia 2012)
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Average life expectancy depends on many factors, including healthcare condition of the
population, as one of the important. Reasons for mortality and its change directly define
changes to the average life expectancy.
Analysis of mortality according to reasons of death enables to assess meaning of each
of the reasons of mortality, making conclusions on which diseases to target main efforts,
determine effectiveness of measures while combating certain diseases.
Significant change in the structure of mortality resulted from the changes in the
correlation between infectious and non-infections diseases. If infectious diseases were
primary cause of mortality at the dawn of the 20
th
century, during 60-ies of the same
century mortality for the same reason decreased tenfold and more and mortality caused
by circulation system diseases, neoplasms and accidents, poisons and injuries has
become primary.
At the moment, in order to analyze reasons for mortality, 10
th
revision of disease
classification is used.
According to epidemiological transition theory distribution of mortality and morbidity as
well as determinants of these phenomena can be explained.
Epidemiological transition theory is based on several preconditions.
The main precondition of epidemiological theory is that mortality is one of the key
factors of population dynamics. The second precondition is that changes to mortality
and morbidity indicators, within the period of epidemiological transition undergo certain
changes, as a result of which key reasons for morbidity and mortality like infectious
disease pandemics are gradually replaced by degenerative (circulation system,
neoplasms, digestive system disorders) and occupational diseases. The third
precondition is that relative possibility of mortality according to age and gender, during
epidemiological transition, the most significant changes in morbidity and mortality are
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visible in children and women of young age. According to the fourth precondition, during
the period of epidemiological transition, changes associated with heath and illness of
the population are closely linked with demographic and social-economic transitions.
During the epidemiological transition stage of Georgia, it is expected for mortality to
increase due to cardio-vascular system diseases and neoplasms, mainly in older age
(Tsuladze, Maglapheridze, Vadachoria, 2001).
Statistics of mortality causes according to age and gender give certain opinion on which
reasons of mortality are leading in total mortality. However, it is not sufficient to identify
the impact of certain reasons of death on changes to average life expectancy.
Based on this, the paper will pay substantial attention to the analysis of correlation
between reasons of average life expectancy and reasons of death.
This document will provide healthcare system professionals with a good overview of
increase or decrease of life expectancy according to ages, volume, and reasons for
death.
Findings of this paper could be used while formulation of state healthcare policy.
Research Methodology
In demographic research it is common to observe changes of certain demographic
characteristics over the certain period of time. Demographic characteristics sometimes
increase, decrease or remain the same. Increased observation over the changes to
demographic characteristics could be an interesting objective in order to understand,
why certain changes take place. Decomposition of demographic characteristics enables
such analysis. During this survey we will try and analyze, why average life expectancy
in Georgia has decreased between 2007 and 2012 both for men and women.
This scientific research uses methods of decomposition. Discrete method of
decomposition of changes to average life expectancy was independently developed by
three scientists from Russia, USA and France in 1980-ies (Andreev, 1982, Arriaga,
1984, Pressat, 1985). Data on Georgia will mainly be used provided by demographic
census (Tsuladze, Maglapheridze, Vadachkoria, 2012).
The use of decomposition of changes to average life expectancy at birth shows the size
of diseases influencing average life expectancy in terms of age, both for men and
women. The study is important for demographic as well as healthcare policy purposes.
Results provided herein show a picture of which age group has improvement or backset
in terms of diseases and the magnitude of impact of each of the age groups and
disease in general on changes of average life expectancy at birth.
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Diagram 3. Role of key reasons of death in change of average life expectancy for
women in 2012 compared to 2007. Change is -0.85
As the diagram shows, in case of both men and women increase of average life
expectancy was supported by reduction of deaths due to diseases of circular system,
while certain share in reduction of average life expectancy falls on certain infectious and
parasitic diseases and injury, poisoning and other consequences of external causes.
Due to these two mutually exclusive processes (positive in one case, and negative in
the other), average life expectancy in men has insignificantly reduced, and
insignificantly increased for women, in 2012.
Decomposition of average life expectancy at birth by age and reasons for death has
enabled us to evaluate the role of age and reasons of death for changes of average life
expectancy in 2012 compared to 2007, both for men and women (see Diagram 4 and
Diagram 5).
Key Findings
In 2012, compared to 2007, average life expectancy at birth has insignificantly
increased for both genders (0.22 years). There was an insignificant reduction for men
(0.46), while insignificant increase was detected for women (0.85 years).
Decomposition of changes of average life expectancy at birth according to reasons of
death enabled us to assess roles of key reasons for death for the change of average life
expectancy in 2012 compared to 2007, both for men and women (see Diagram 2 and
3).
Diagram 2. Role of key reasons of death in change of average life expectancy for men
in 2012 compared to 2007. Change is -0.46.
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Diagram 3. Role of key reasons of death in change of average life expectancy for
women in 2012 compared to 2007. Change is -0.85
As the diagram shows, in case of both men and women increase of average life
expectancy was supported by reduction of deaths due to diseases of circular system,
while certain share in reduction of average life expectancy falls on certain infectious and
parasitic diseases and injury, poisoning and other consequences of external causes.
Due to these two mutually exclusive processes (positive in one case, and negative in
the other), average life expectancy in men has insignificantly reduced, and
insignificantly increased for women, in 2012.
Decomposition of average life expectancy at birth by age and reasons for death has
enabled us to evaluate the role of age and reasons of death for changes of average life
expectancy in 2012 compared to 2007, both for men and women (see Diagram 4 and
Diagram 5).
Key Findings
In 2012, compared to 2007, average life expectancy at birth has insignificantly
increased for both genders (0.22 years). There was an insignificant reduction for men
(0.46), while insignificant increase was detected for women (0.85 years).
Decomposition of changes of average life expectancy at birth according to reasons of
death enabled us to assess roles of key reasons for death for the change of average life
expectancy in 2012 compared to 2007, both for men and women (see Diagram 2 and
3).
Diagram 2. Role of key reasons of death in change of average life expectancy for men
in 2012 compared to 2007. Change is -0.46.
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Diagram 4. The role of age groups and key reasons of for death in changes to average
life expectancy for men during 2012 compared to 2007. Average life expectancy at birth
for men was 67.34 in 2012, and 66.88 in 2007. Change made up -0.46.
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Diagram 5. Role of age groups and main reasons of death in changes to the average
life expectancy in 2012 compared to 2007. Average life expectancy at birth for women
was 75.59 in 2012, and 76.44 in 2007. Change made up +0.85.
Diagrams 4 and 5 show that in case of both men and women increase of average life
expectancy was supported by reduction of deaths due to diseases of circular system.
This tendency for men is shown from the age of 15, and age of 5 for women, while the
biggest share on the reduction of average life expectancy falls on neoplasms form the
age of 50, both for men and women.
It is a known fact that average life expectancy for women exceeds average life
expectancy for men.
Such difference has always been visible for Georgia, and it still exists.
In 2007 difference between average life expectancy of women and men was 8.2 years,
while this indicator was 9.6 in 2012.
Decomposition of different of average life expectancy for men and women according to
key reasons of death and age enables us to calculate the role of age and reasons for
death on the influencing the difference between life expectancy and death in 2007 and
2012.
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Diagrams 6 and 7 show that both in 2007 and 2012 the biggest difference between average life
expectancy of men and women was due to diseases of circulation system in older ages, while in
case of young people more important factors are injuries, poisoning and certain other
consequences of external causes.
Diagram 6. Role of age groups and main reasons for death on the changes to average life
expectancy between men and women in 2007. Average life expectancy for women in 2007 was
75.59, and 67.34 for men. The difference made up 8.25 years.
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Diagram 7. Role of age groups and main reasons for death on the changes to average
life expectancy between men and women in 2012. Average life expectancy for women
in 2012 was 76.44, and 66.88 for men. The difference made up 9.56 years.
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Conclusions and Recommendations
Changes to the average life expectancy in 2012 compared to 2007 was positively
impacted by reduction of deaths for reasons of diseases of circulation system both for
men and women. This tendency can be noticed from the age of 15 for men, and 5 years
for women. However, main share for the reduction of average life expectancy both for
men and women falls on neoplasms from the age of 50.
Both in 2007 and in 2012 the biggest difference between average life expectancy for
men and women was between circular system diseases and neoplasms in older ages,
while for younger groups injuries, poisons, and certain other consequences of external
causes are more important.
The biggest reserve of increasing average life expectancy for men as well as women is
in reduction of neoplasms.
There are state healthcare programs in Georgia that include treatment of cardio-
vascular system diseases both on ambulatory as well as stationary
level(http://ncdc.ge/pdf/GEO502.pdf). There is also a program for treatment of
oncological diseases. However, there is no systemic approach towards prevention of
diseases; primary healthcare system is not refined that would be responsible for the
management of preventive diseases.
Even though there is a state cancer screening project in the country, implemented by
the National Center for Disease Control in collaboration with the National Screening
center, percentage indicators for identifying 3
rd
and 4
th
stages of cancer is still very high,
therefore, percentage of deaths during the first year of diagnostics is very high, while
indicators for recovered is low. During 2011 the structure of newly detected trachea,
bronchite and lung cancer is as follows according to structures: Stage 1 - 0.6%, Stage 2
7.2%, Stage 3 13.8%, Stage 4 - 69.8%, diagnostics of unknown stage 8.6%.
Among those primarily registered 50.8% died during the first year after diagnostics
(NCDC, http://www.ncdc.ge/index.php?do=fullmod&mid=502).
It should be noted that USAID provides technical assistance to the Government of
Georgia and its Ministry of Labor, Health and Social Protection to improve on prevention
and early diagnostic services for breast and cervical cancer that are primary causes for
the death of women and raise awareness of the population on these diseases.
With the purpose of reducing neoplasms public awareness on cancer should be
increased, wile stigma associated with disease has to be broken along with different
myths on cancer. Public should receive information on accessible screening and other
oncological services, and healthy lifestyle should be promoted. Level of knowledge on
education should increase for sure, which involves active communication with the
public. Health education can positively influence attitudes of people and enables
positive impact over the behavior. Informed citizens take better care of their own health
and welfare. During 2006-2007 the Ministry of Labor, Health and Social Protection
conducted a study in Tbilisi supported by WHO, according to which information on
healthcare does not reach most of the target group. While only less than 10% attend
health-related activities a year. Moreover, healthcare professionals do not always
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provide advice relevant for healthy lifestyle (quitting smoking, losing weight, reduction of
salt and fat consumption, increasing physical activities and reduction of alcohol
consumption). As a result, only small portion of the population tries to change lifestyle,
while the number of people who successfully achieve this goal is even less.
Ministry of Labor, Health and Social Protection should develop a comprehensive
strategy targeted towards disease prevention and improvement of health conditions.
Prevention of diseases means early detection and reduction of health-related risks.
Successful implementation of preventive measures requires integration and effective
coordination of activities targeted towards protection of public and individual health.
In order to ensure of reduction of deaths caused by neoplasms one of the key reasons
for death the state should implement the following policy:
The author believes that in order to reduce the role of neoplasms in mortality in reduction
of average life expectancy in Georgia the state should undertake the following policy:
1. Strengthen healthcare system with the purpose of effective cancer control
2. Reduce exposition of cancer risk-factors
3. Eliminate stigma and disease-related myths about cancer
4. Improve universal access to national cancer screening and early detection
5. Improve provision of continuous medical service towards oncological patients
6. Ensure universal access to pain and stress management
7. Improve education and training of medical personnel.
Bibliography
Andreev, E.M. (1982). Metodkomponentv analizeprodoljitelnostyzjizni. [The method of
components in the analysis of length of life].VestnikStatistiki, 9, 42-47.
Arriaga, E. (1984).Measuring and explaining the change in life
expectancies.Demography 21(1), 83-96.
Pressat, R. (1985). Contribution des carts de mortalit par ge la diffrance des vies
moyennes. Population, 4-5, 766-770.
Tsuladze G., Maglaperidze N. ,Vadachkoria A. 2002. Demographic Overview of Georgia
2001. UNFPA. Tbilisi,
Tsuladze G., Maglaperidze N., Vadachkoria A. (2013) Demographic Yearbook of
Georgia 2012 UNFPA



Comments and Questions
Public Policy Research and Training Center
Nino Imedashvili, Coordinator
Phone: (+995 32) 223 10 57
E-mail nino.imedashvili.1@iliauni.edu.ge
Ilia State University
3/5 Kakutsa Cholokashvili street, Tbilisi 0162, Georgia
Phone: (+995 32) 223 10 57
About Authors
NikolozMaglapheridze is a professor of Science and Arts School of Ilia State
University, Head of the Demography and Sociology Department, is a co-author of
scientific publications (including publications funded by UNFPA), and participant of
international conferences.
Marina Chodrishvili is a staff member of Demography and Sociology Department of Ilia
State University