Life Expectancy Disparities in Three Countries

How long will this child live?

No one can say what the future holds for Crispin Brake, who was born last month at the Bwaila District Hospital in Malawi. But he and the other babies born in Malawi that year have an expected lifespan of more than 65 years – an unimaginable prospect just two decades ago, when the country's life expectancy was just 44 years.

Today, people around the world live an average of 73 years, more than twice as long as a century ago. And today the gap between rich and poor countries around the world is widening.

Crispin Brake, a few minutes after delivery.

But gains are slow, and within some wealthy nations the differences have continued or even widened. Global health experts say further advances will mean not only uplifting poor nations, but also ensuring that populations are not left behind.

The New York Times Magazine sent photographers to Malawi, Australia and the UK to capture a thread here and there of the tapestry of health and life expectancy around the globe, including health workers trying to make it more equal.

Any further advances in global life expectancy must come to sub-Saharan Africa, which continues to lag far behind the rest of the world. But Ethiopia, Malawi and Rwanda are just a few of the countries that prove that progress can be made very easily even without wealth and resources.

Thanks to the commitment of the government, international action and the commitment of the community, Malawi now has the third lowest gross domestic product in the world per capita and a life expectancy higher than that of around 30 richer countries.

Glory, 26, work in progress at the Kawale Health Center in Lilongwe, capital of Malawi.

Much of what gives Crispin Brake the prospect of a long and healthy life has already been determined. His mother received prenatal care and gave birth in a medical facility where health professionals promoted skin contact and breastfeeding.

Crispin Brake and his mother Eunice Soda, 24, the day after he was born.

New mothers care for their babies skin to skin at Bwaila District Hospital in Lilongwe.

The kindergarten at Bwaila District Hospital.

After Crispin goes home, vaccinations, antibiotics, insecticide-treated bed nets, and other free health services help him survive past the age of five. This is the critical point where infections are less of a threat in children.

Many of the health improvements in Malawi are due to government and international investment in basic services, maternal and child health, and H.I.V. Reduction and treatment.

Brenda receives a antenatal exam at the Kawale Health Center.

In Malawi, many of the most effective programs tend to be simple and community-based. The villagers are trained to provide basic services: monitoring households for malnutrition, teaching family planning.

Tuma, 22, and her son, who was examined for malnutrition by a community volunteer in Mutawale Village.

Looking for signs of edema and malnutrition at the Nsaru Health Center in Lilongwe.

The country has also seized opportunities for collaboration and innovation. It is one of three countries that are participating in a pilot program for a new malaria vaccine, for example. Coronavirus vaccinations began there in March, ahead of several other countries in the region with deeper pockets and stronger health systems.

A coronavirus vaccination will be carried out at the Kawale Health Center.

Of course, health is closely interwoven with the wider socio-economic fabric of a country. No medicine can make or sustain someone who does not have access to clean water, nutritious food, safe housing or quality education, among other things.

In the village of Kunkhongo, Felesiya receives instructions on how to prepare meals as part of the Scaling Up Nutrition Movement.

Linda, who serves her daughter pumpkin tea, can feed her six children from her garden.

Education, for example: In Malawi, school enrollment reached 91 percent in 2019, while the average in sub-Saharan Africa was closer to 80 percent. Education is vital to household health. A child born to an educated mother has a 50 percent higher chance of survival than 5 years.

The maternity ward at the Chitedze Health Center in Lilongwe.

Justina, 22 years old and pregnant with her second child, at the Chitedze Health Center.

As a rule, longer lifetimes go hand in hand with economic development. However, this does not mean that everyone will live longer in high-income countries. "Overall, national life expectancy can hide the unevenness of these gains," said Ashish Jha, dean of Brown University School of Public Health.

In reality, a country's health is only as good as the health of its least healthy people. The global health professionals I've spoken to, whether they're from the US or not, all wanted to talk about the gross inequalities and recent decline in life expectancy in America. What is worrying is that some of these patterns seen in the US are present or cropping up in some other high-income countries, albeit not as strongly.

In Australia, where the total population can be 83 years old, indigenous peoples – especially those living in remote areas like the Yarrabah Aboriginal Community in rural Queensland – have long faced comparatively poorer health outcomes.

Jamahl Creed, 30, cools off after work in Yarrabah.

A home in Yarrabah. There is a housing crisis in indigenous communities across Australia.

Royston Dabah and Iris Davidson in front of their house in Yarrabah – a fisherman's hut.

The life expectancy of the two indigenous groups – the majority of the Aborigines and the islanders of Torres Strait – is more than eight years behind that of non-Indigenous Australians, and their infants and young children are twice as likely to die.

Rheumatic heart disease, a disease often based on poverty and reflecting lack of access to basic health services, occurs almost exclusively among young indigenous peoples in Australia, indicating the country's extreme health disparities.

Finette Mundraby, 33, at home in Yarrabah with her youngest daughter Reannan Kynuna, 3rd Mundraby, suffers from rheumatic heart disease.

John Gordon, 13, has rheumatic heart disease and has had an operation to replace his heart valves.

The differences in mortality are mainly due to cardiovascular disease, diabetes and cancer. But mental health is also a harrowing problem: Indigenous Australians die of suicide twice as often as their non-indigenous counterparts – and this inequality almost doubles among young people.

James Noble, 50, at home in Yarrabah. He lost his leg to complications from a blood clot and has rheumatic heart disease.

Maxwell Sexton, a 17-year-old with rheumatic heart disease and type 1 diabetes, with his cousin in Yarrabah.

Many indigenous communities in Australia have provided their own health care through more than 300 primary care clinics that are aligned with their culture and values.

Jimmy Perry, 68, is seen by a health worker at the Gurriny Yealamucka Health Center in Yarrabah.

Mina Andrews, 67, is undergoing kidney dialysis at the primary care clinic in Yarrabah. Kidney disease is a leading cause of illness and death among indigenous Australians.

The national initiative Closing the Gap was launched in 2007 with the aim of eliminating the difference in life expectancy between Indigenous and non-Indigenous Australians within a single generation. However, over the past decade, the gap has only narrowed by about three years, so the target is unlikely to be met.

In the UK, overall increases in life expectancy have almost stalled. And just like in the United States – where, in Ashish Jha's words, "your zip code is your destiny" – the differences can vary widely by neighborhood.

The Legion of Mary Wayside Club in central Glasgow offers meals for the homeless and the needy.

National Health Service staff visit 71 year old diabetic and insulin addict Michael Wood in Blackpool, England.

Shannon D., 20, injects heroin into a private, volunteer-run, safe room for drug users in Glasgow.

Residents of Westminster, England, can expect to live about a decade longer than those in Glasgow, the place with the shortest lifespan in the four British countries – known as the "Glasgow Effect". A similar inequality can be seen when comparing Westminster to Blackpool, one of the most deprived areas in England.

Connie Morrison, 97, and a nurse at Loveday Chelsea Court Place, a luxury nursing home in London.

Roy Dantzic, 76, trains with Louise Appel at his Westminster home.

Lalla Hurst, 92, after a psychotherapy session with dance moves on Loveday Chelsea Court Place.

Michael Marmot, the director of the Institute of Health Equity at University College London, published a report on the country's health inequalities a decade ago. "England is stalling," he wrote last year.

Across the UK, death rates are rising in some of the most socioeconomically disadvantaged areas, showing that inequalities in health reflect inequalities in society.

Mick Fleming, 55, a pastor recovering from drug and alcohol use, visits Kayleigh Hacking, 34, and her partner in Burnley, England.

Jamie Smith, 44, lives in a tent on Blackpool Promenade.

Economists Anne Case and Angus Deaton found that white people of working age without a college degree have seen death rates rise in recent years in the United States. A major factor are "deaths of desperation" – from drugs, alcohol, suicide – which can now also be observed in other groups.

Robert Griffiths, 44, injects cocaine in Glasgow. He has been taking drugs since he was 13.

Sylvia McGrath, 66, outside her Glasgow home. She has emphysema and has lost both parents and a brother to the disease.

Eileen Hopkins suffered from many illnesses. She died at the age of 67 days after this picture was taken.

"Put simply," warns Michael Marmot, "if health is no longer improving, it is a sign that society is no longer improving."

Fleming offers a blessing to Patrick Marren, 56, a Burnley drug user.

The Amazing Graze Soup Kitchen in Blackpool offers hot meals and grocery packages to those in need.

A National Health Service nurse takes care of Doris Winston, 75, a diabetic and home-bound in Blackpool.

As these photos show, extending its lifespan does not require cutting edge technology or advanced, specialized maintenance. In certain locations, the greatest returns on health investments are achieved by improving births, preventing infections in children, and providing other basic health care services.

But even in the richest countries, which have high average life expectancies, the numbers can obscure how certain populations are left behind.

Above all, these photographs should give rise to inspiration and vigilance. They show how it is possible to drastically extend the promise of long life – but also how extraordinarily fragile those extra years can be.

An extended family in Glasgow.

Helen Ouyang is a doctor, writer, and assistant professor at Columbia University. She was a finalist for the National Magazine Award. Lynsey Addario is an American photojournalist and writes regularly for the magazine. She is a MacArthur Fellow, Pulitzer Prize winner, and author of the New York Times best-selling memoir, "It's What I Do: A Photographer's Life in Love and War." Yagazie Emezi is a Nigerian artist and self-taught photojournalist writing stories about African women and their health, sexuality, education and human rights. Morganna Magee is a documentary photographer from Australia. She is currently working on projects exploring the interface between memory, grief and photography.

Additional design and development by Jacky Myint.