In this first representative study of low- and lower-middle-income countries, an attempt is made to identify the correlates that are associated with HALE. We found the mean years of schooling, TFR, freedom of the press, and achieving a level of health-related MDGs as the significant correlates of HALE. The effects of other independent variables on HALE are statistically insignificant.
The level of education of the respondents is an important factor of HALE. The findings of this study are consistent with the results of other studies conducted in developed and developing countries [4, 24]. This may be due to the fact that the higher education levels are typically related with well-timed receiving healthcare, and also more awareness about the health. The higher rate of receiving prenatal care, optimize the use of maternal healthcare services also found to be the higher among the educated individuals which are found as the influential factors of developing HALE. We know that the educated individuals earn higher real wages. The higher real wages indicate the high average household income and enabling people to enlarge the quality and quantity of the purchased healthcare services. Additionally, educated people have knowledge about proper nutrition, hygiene, and healthcare services, as well as common illness-preventative measures  and thus they seem to enhance their HALE. So, we see that HALE increases due to increase in mean years of schooling. A study conducted in the United Nations of America (USA) also supported that the increasing mean years of schooling is an important factor of widening the HALE . Valkonen et al. also supported by saying that the LE, as well as disability-free life expectancy (HALE), showed systematic relationships with the level of education: the higher the level of education, the higher LE and disability-free life expectancy . This finding is also supported by Deka and Nath , and Shin et al. . Thus, it is theorized that as mean years of schooling increases, average HALE will increase.
The coefficients for TFR and HIV prevalence rate are statistically significant and shown negative effects on HALE in all the regression models. The TFR of Nigeria and Mali are 7.60 and 6.20 respectively whereas it is on an average 1.60 in the high-income countries . The increase in an average number of births to a woman means the decrease in HALE. Mondal and Shitan suggested that increases in TFR are likely to decrease average LE in a country . As the TFR decreases the average LE so the HALE is also decreasing due to the TFR. Hence it is needed to reduce the TFR to maximize the average HALE of the population. HIV has become a major public health problem in many countries and one of the world’s most serious health and development challenges. Eventually, the HIV attacks the immune system of the infected individual which is a non-curable virus. Without treatment, the net median survival time with HIV is 9–11 years , meaning that individuals who have tested positive for HIV face a drastically reduced lifespan. A greater percentage of infected adults could also mean higher HIV transmission rates to children. This virus reduces a country’s average HALE. The HIV prevalence rate was identified as a responsible factor of lowering HALE by the authors in the previous studies, like . HIV prevalence rate is likely to decrease average LE due to the increase in HIV prevalence . As the HIV prevalence rate decreases the average LE, so we can say that the HIV prevalence rate also decreases the HALE at birth. Thus, it is seen that as the percentage of HIV-infected adult increases, average HALE will decrease. So, it is needed to control the HIV prevalence rate to maximize the average HALE of the population. Greater health expenditure, physician density, improved drinking-water sources using rate, freedom of the press, and CPI mean the greater HALE. Thus, it is hypothesized that if the values of these variables increase, the average HALE will be increased. On the other hand, if both the CO
emission rate and prison population rate decrease, the average HALE at birth will increase. The above findings have significant effects on increasing HALE. HALE increases throughout the countries at a more rapid rate than LE, advising to reduce the disability for reducing mortality . Wolfson, and Tareque et al. also supported by saying that HALE increases more rapidly than LE [11, 13].
Another measure of a country’s standard of living is freedom of the press, and obviously, it is related to HALE. The freedom of communication and expression through various mediums like electronic media and published materials is known as the freedom of the press or freedom of the media. In the twentieth century, Liebling, an American journalist, was excellently abridged the idea of “freedom of the press”, who wrote, “Freedom of the press is guaranteed only to those who own one” . In which place, it exists mostly implies the absence of interference from the government and other powerful organizations; it is maintained through the constitution or other legal protections. Freedom House, the US-based non-governmental organization, is published a yearly report on freedom of the press by measuring the level of freedom and editorial independence enjoyed by the press in every nation and significant disputed territories around the world. Levels of freedom are scored on a scale from 0 (most free) to 100 (least free) . But we converted this scale to 100 (most free) to 0 (least free). Depending on the basics, the nations are then classified as “Free”, “Partly Free”, or “Not Free”. The impact of freedom of the press on HALE has never been measured. It is difficult, though not impossible, to calculate such impact. However, freedom of the press always has a positive influence on HALE. To achieve the high HALE, and MDGs a freer press has a great contribution . In 2015, the countries where the press was the freest were Micronesia, Vanuatu, Solomon Islands, Cabo Verde, and Sao Tome and Principe , and in these countries, the HALE is high than others . The country with the least degree of press freedom was Uzbekistan, Eritrea, Syrian Arab Republic, Gambia, and Sudan , and in these countries, the HALE is low than others . By promoting the level of freedom of the press, Government and international organizations provide a powerful development tool. A free press establishes an instrument of development, as such in the same way as education or investment, which promotes the HALE of the country’s population . Thus, it is concluded that as the level of freedom of the press increases, average HALE will increase.
One of the most important factors of a country’s standard of living is achieving a level of health-related MDGs which is highly significant with HALE and has the great influences on HALE . The MDGs are eight international development goals that all 194 UN member states and at least 23 international organizations have agreed to achieve by the year 2015 . In 2015, the MDGs have come to the end of their term. Progress towards the MDGs, on the whole, has been remarkable. Country progress towards the achievement of the health-related MDGs and targets has also been considerable. During the MDG era, many of the health-related MDGs were achieved, with the corresponding targets. The results of this study demanded that the HALE is low in those African countries where the achieving a level of health-related MDGs is observed very low, and the HALE is high in those Asian countries where the achieving a level of health-related MDGs is observed very high . In a study, Lomazzi and others also supported that the achieving a level of health-related MDGs has a positive impact on HALE . Thus, it is assumed that as the achieving a level of health-related MDGs increases, average HALE will increase.
A limitation of this work is that we only studied the data for the most common affecting factors, i.e., those factors which are found to be significantly related to HALE. We did not consider the mortality-related factors which will be our next study. Also, the study is limited to the low- and lower-middle-income countries. Again, the sources and quality of data are different in different countries. Some low- countries have complete civil registration and vital statistics and regular censuses of the entire population as the data sources. On the other hand, many lower-middle-income countries have an incomplete birth and death registration systems as well as the lack of continuous realistic data on mortality and HALE. But, all data which are analyzed in this study collected from the very reliable sources.