Life expectancy in India was 25.4 in the year 1800, and over the course of the next 220 years, it has increased to almost 70. Between 1800 and 1920, life expectancy in India remained in the mid to low twenties, with the largest declines coming in the 1870s and 1910s; this was because of the Great Famine of 1876-1878, and the Spanish Flu Pandemic of 1918-1919, both of which were responsible for the deaths of up to six and seventeen million Indians respectively; as well as the presence of other endemic diseases in the region, such as smallpox. From 1920 onwards, India's life expectancy has consistently increased, but it is still below the global average.