Taiwan’s life expectancy and infant mortality rates appear to lag behind its neighbors. But a closer look at the data reveals a more complex story influenced by changing reporting practices and societal factors.
Taiwan’s life expectancy and infant mortality rate seem to be increasingly lagging behind its neighbors Japan and Korea. The average number of deaths among babies aged one or below in 2022 – 4.4 per 1,000 births – is more than double that of Japan. Meanwhile, the average life expectancy for Taiwan’s citizens of 79.8 is roughly four years less than in both Japan and Korea.
Taiwan’s life expectancy peaked in 2020 at 81.3 years before slipping to 79.8 in 2022, influenced by the pandemic, according to the Interior Ministry. For Taiwanese men, it was 76.6 years in 2022, and for Taiwanese women it was 83.3. In contrast, life expectancy in Japan and Korea in 2021 both stood at around 84, according to the World Bank.
Life expectancy in Taiwan varies significantly depending on one’s place of residence. Taipei boasts the highest average life expectancy at 83.8 years, a figure near those of South Korea and Japan. New Taipei follows closely at 81.3 years, while Tainan lags slightly behind at 80.1 years and Kaohsiung reports a life expectancy of 79.7 years. Taitung has the lowest life expectancy among Taiwan’s 22 cities and counties – 76.5 years.
Lee Wui-chiang, vice superintendent at Taipei Veteran’s General Hospital, gives several reasons for the difference in longevity. One stems from the correlation between longevity and exercise. Surprisingly, studies have found that Taipei dwellers tend to exercise more often and for longer than people in locations such as Yunlin and Taitung, even though many of the latter may be farmers. Another important factor is access to medical services, Lee says.
“Early detection and early treatment is the golden rule,” Lee says. “People with high socioeconomic status are willing and capable to invest in this kind of behavior.”
Derrick Chan, director of the Department of Geriatrics and Gerontology at NTUH, agrees, noting that almost half of Taiwan’s medical centers – the highest-tier hospitals in Taiwan – are more concentrated in Taipei. Chan also points out that Taipei benefits from a highly efficient and accessible public transportation network. Experts have noted that infrequent public transport services can pose challenges for rural residents in terms of accessing urgent medical care, ultimately contributing to lower average life expectancy.
In addition, in Chan’s analysis, Kaohsiung’s average life expectancy is lower than that of Tainan because Tainan is smaller and more compact, making it easier for people to travel to doctors.
Lee and Chan agree that the overarching reason behind Taiwan’s comparatively lower life expectancy is the lower government investment in health. Similarly, AmCham’s 2023 Taiwan White Paper notes that although Taiwan has positioned itself as a developed economy since 2018, its investment in healthcare falls far below that of other developed countries. In 2022, Taiwan’s healthcare expenditures accounted for only 6.6% of GDP, lower than Japan’s 10.9% and South Korea’s 9.7%.
Lee points to a ranking of universal health coverage published in the prestigious medical journal The Lancet in 2020, which had Japan ranked first and Korea 19th. By contrast, Taiwan ranked 37th.
A statistical report from the Ministry of Health and Welfare (MOHW) also found that in 2021, Taiwan’s drug consumption expenditure accounted for 1.2% of GDP, lower than Korea’s 1.6%, and Japan’s, which reached 2.3% in 2019.
“Taiwan has clearly been lagging behind its neighbors in terms of investment in healthcare, and a key area where that can be seen is the insufficient funding for new and innovative drugs,” C.W. Chen, chief operating officer of the International Research-based Pharmaceutical Association (IRPMA) noted in a June interview with TOPICS.
In 2002, Taiwan’s National Health Insurance Administration fully implemented the “global budget” system, which sets an annual cap on total national healthcare insurance spending and restricts drug reimbursement prices by the NHI.
Pongo Peng, general manager of Gilead Sciences Taiwan branch and co-chair of AmCham’s Public Health Committee, praises Taiwan’s National Health Insurance system but adds that when the government decides its budget, it mainly focuses on the high level of public satisfaction, which is heavily influenced by the low cost of premiums. The government doesn’t “really look at health outcome indicators,” Peng says.
Peng stresses the importance of increasing screenings for various diseases. The White Paper, for example, notes that due to a lack of sufficient funding, significant delays occur in the availability of pneumococcal vaccines for people 65 and above.
A report from PwC (PricewaterhouseCoopers) also notes that the waiting time for new drugs in Taiwan is significantly longer than in Japan – 729 days on average and 783 for oncology-related medicines – due to the lengthy process for licensing by the Taiwan and Drug Administration and then assignment of reimbursement prices under the National Health Insurance program.
Average “disability-adjusted life years” – time lost due to ill health, disability, or early death – has also been increasing in Taiwan, amounting to eight years in 2020. “That means if you live to be 80, 10% of your life is not healthy,” Peng says.
He also notes that when it comes to raising national health insurance premiums, the stiffest resistance tends to come not from the public but from business owners, who in most situations pay 60% of an employee’s health insurance premium, while the employee covers 30% and the government 10%.
“How we educate the employer to support this kind of premium increase is very important,” notes Peng. He says organizations like AmCham could advocate the potential benefits of raised premiums to member companies. “You can make a positive investment in health, increase incomes, enhance quality of life… and have a positive spiral impact” on quality of life and the economy, he says.
Numbers game
Although infant deaths in Taiwan still constitute a major social issue, a close look at how these deaths are reported reveals that the situation is not as dire as the headline figure suggests.
Taiwan’s infant mortality rate is defined as the annual number of deaths of children under one year old per 1,000 live births. Taiwanese media trumpeted that the rate of 4.4 in 2022 was a 14-year high. By contrast, the 2021 figure stood at 1.7 for Japan and 2.5 for Korea, according to the World Bank, while the figure for the United States was 5.4 per 1,000 live births, according to the American Centers for Disease Prevention.
A subset within this category consists of neonatal mortalities, or deaths among children who are 28 days old or less. Taiwan’s neonatal mortality rate at 2.8 per 1,000 live births represents a 15-year high. By contrast, the figure was 1.4 for Korea and 0.8 for Japan in 2021. Taiwan’s neonatal mortality rate figures also show a curious pattern over the years – a dip from 3.5 per 1,000 live births in 1996 to an all-time low of 2.2 in 2014, before rising to 2.8 in 2022.
There’s a reason for the uptick, and much of it involves how these deaths are reported. Robert Lu, a professor of public health at National Cheng Kung University’s School of Medicine, has noted in a paper that advancements in neonatal medical care technology have lowered the threshold for helping a baby survive. In the past, doctors would give up on a pregnancy if it lasted less than 22 weeks or the baby weighed less than 500 grams. Now many medical centers will instead try to help these babies survive to “please their families,” Lu writes.
Lu adds that since former President Ma Ying-jeou declared Taiwan’s declining birth rate a national security crisis in 2011, various government entities, from county and city governments to village and township offices, have started offering mothers various subsidies for giving birth, and workplaces can offer maternity leave. Taiwan has also begun to tighten regulations and now defines a live birth as one where the baby or fetus breathes or shows other evidence of life, irrespective of the duration of the pregnancy.
Overall, this means that many Taiwanese mothers who give birth to or even abort fetuses with congenital malformations, along with newborns with an extremely low weight who sometimes won’t survive for longer than a day, can still request a birth certificate to collect subsidies. Parents can also request a birth certificate even if they decide not to try to keep a sickly fetus alive, provided it is born with signs of life. As a result, cases that in the past wouldn’t have been reported as live births now are.
Chou Hung-chieh, director of the Department of Pediatrics at National Taiwan University Hospital’s (NTUH) Yunlin branch, says Taiwan’s obstetricians feel conflicted about these developments. Doctors are under strict instructions from the government to declare a birth as a live one if there is any indication of life, such as breathing or a heartbeat. They are also aware that some parents request a birth certificate to receive subsidies.
“We have a moral conflict in Taiwan,” says Chou. In notes provided to Taiwan Business TOPICS, MOHW adds that once excluding live births of children weighing less than 500 grams and pregnancies of fewer than 22 weeks, Taiwan’s infant mortality rate stands at 3.4 per 1,000 live births – not 4.4.
The demographic factor
The other primary explanation for a rising infant mortality rate, aside from the slightly misleading statistical reporting, is that Taiwan’s mothers are considerably older than they were decades ago. Many women put off childbearing to make advances in their careers and improve their financial situation in order to care for their children. Older mothers are more likely to have babies with congenital abnormalities or low birth weights.
“Biologically, when you get older, you’re less likely to have healthy kids,” says Lien Reyin, chief of the Neonatal Intensive Care Unit at Chang Gung Children’s Medical Center. Older mothers are also more likely to try in vitro fertilization (IVF), which increases the risks of premature births and underweight newborns.
Lien notes Taiwan’s relatively higher infant mortality rate may actually reflect the country’s advances in feminism compared with Japan and Korea. “If we compare ourselves with Japan and Korea, Taiwanese women have more opportunities to advance in their work and in professions,” she says. “They are so focused on advancing their careers, they tend to put off childbirth – there is very clear evidence for this.”
NTUH’s Chou notes that in 2021, a high 31.6% of Taiwanese mothers were aged between 36 and 41. In contrast, the percentage of mothers in the UK aged 35 to 39 was 15.7%, and in Sweden it was 17.7%, suggesting that the popularity of motherhood later in life in Taiwan outstrips these Western countries.
Critics say that Taiwan’s high infant mortality also indicates that the government is not investing enough in healthcare and that more could be done to improve treatment for older mothers. “We need more care for them,” Chou says. “The government should pay more attention.”
Experts also note that medical resources such as hospitals and pediatricians are distributed unevenly across Taiwan, with Taipei getting the lion’s share. Places like Taitung and Hualien on Taiwan’s east coast have fewer pediatricians than urban areas in the west, notes Lee Wui-chiang, vice superintendent at Taipei Veteran’s General Hospital. “We don’t have enough neonatal experts in rural areas,” Lee says. “Our government needs to invest more.”
Lue Hung-chi, president of the Cardiac Children’s Foundation Taiwan and part of the Child Health Alliance Taiwan, says his alliance has written a letter to the Executive Yuan imploring it to set up a national-level government agency dedicated to families and children.
The letter cites examples of such agencies established by other countries. In the United States, the Administration of Children and Families is a division of the U.S. Department of Health and Human Services. Japan’s Children and Families Agency began operations on April 1, dealing with various issues ranging from low birth rates to school bullying. State-level ombudsman offices advocating for children’s rights have also been established in the United States. In contrast, Taiwan lacks ombudsmen for children. The letter also notes that the Ministry of the Interior did set up a children’s bureau in 1999, but that it was scrapped in 2013.
Lue argues that a dedicated agency could use its resources to track mothers’ health during pregnancies to better understand infant mortalities and provide increased and improved support. “Children have no vote, so they are not taken seriously,” he says.
For its part, MOHW informed TOPICS that the government in recent years has implemented new measures to provide more support for mothers. One of these efforts is the “Optimizing Children’s Medical Care Program,” which began in 2021 and is due to be expanded in 2024. The program helps identify mothers likely to experience high-risk pregnancies and includes a home care plan for low birthweight infants, as well as more frequent doctor visits and increased monitoring of these infants’ health once they return home. So far, 76 hospitals have joined the home-care program.
