People worldwide are living longer and sicker; injuries, mental health disorders, pain and disabilities are undermining people’s overall health, according to the “Global Burden of Disease Study 2010 (GBD 2010)”, published in The Lancet today.
This is the first time The Lancet has dedicated an entire triple issue to one study, consisting of 7 scientific papers and accompanying commentaries. The aim being to assess the world’s main health challenges, and seek out how best to address them.
43% of deaths worldwide occurred at age 70+ in 2010, compared to 33% in 1990. Although a smaller proportion of people are dying early, many more today are living with chronic diseases, pain, and disability.
The authors describe the world’s health advances as a devastating irony: “avoid premature death, but live longer and sicker”.
The “Global Burden of Disease Study 1010 (GBD 2010)” is the result of a massive collaboration involving nearly 500 researchers from 50 countries, led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. There were six other core collaborators: Imperial College London, Harvard School of Public Health, the University of Tokyo, the University of Queensland, the Johns Hopkins Bloomberg School of Public Health, and the World Health Organization.
It was funded by the Bill and Melinda Gates Foundation.
The first Global Burden of Disease study was completed in 1990. Since then, people’s life expectancies have become considerably longer. The primary cause of death used to be infectious diseases and childhood illnesses associated with malnutrition.
Today, most of the world’s children – with the exception of sub-Saharan Africa – are expected to live into adulthood, and have too much to eat rather than too little.
Although living into adulthood is better than dying by the age of five, in many cases it will be a relatively unhealthy adulthood.
- In 1990, life expectancy was 62.8 for men and 68.1 for women
- In 2010, life expectancy was 67.5 for men and 73.3 for women
- The gap between the years lived and the total number of years in which people had good health widened during those 20 years to 9.2 for males and 11.5 for females
Peter Piot, director of the London School of Hygiene and Tropical Medicine, said in a press conference today:
“We should live as long as we can and as healthy as we can until the last day of life, and that doesn’t seem to be the case.”
He added that the way things are going, medical systems are being pushed into a “train-wreck scenario”.
People’s risks in developing cardiovascular diseases, diabetes, and cancer are driven partly by their behavior. Experts say this makes it much harder for global, national and regional health authorities to have any significant impact. It is much more difficult to get people to change their behaviors than setting up vaccination programs to protect populations from infectious diseases.
- In 1990 the world’s main health burden was premature mortality. Over 10 million children under the age of 5 years died each year.
- Today the main health burdens involve chronic diseases, mental health conditions, injuries, and musculoskeletal disorders. As lifespans are getting longer, these burdens intensify.
Today, more and more people are living with health problems that affect the way they think, see, hear; conditions that cause a great deal of pain, disabilities, and undermine mobility.
In other words, a much greater proportion of today’s global population is living well into old age and dying from diseases which are prevalent in rich nations, such as cancer, diabetes type 2, and heart disease.
Cancer today accounts for approximately two out of every three deaths globally, compared to slightly more than one in every two in 1990.
One of the founders of the Global Disease Burden, Director of IHME, Dr. Christopher Murray, said:
“We’re finding that very few people are walking around with perfect health and that, as people age, they accumulate health conditions. At an individual level, this means we should recalibrate what life will be like for us in our 70s and 80s. It also has profound implications for health systems as they set priorities.”
In Latin America, Asia, and North Africa the average age of death increased by over 25 years between 1990 and 2010, compared to just 10 years in sub-Saharan Africa.
Childhood illnesses, infectious diseases, and maternity-related causes of death today account for 70% of the disease burden in sub-Saharan Africa, compared to just one third in South Asia, and less than one-fifth in Latin America.
Co-author, Dr. George Mensah, visiting Full Professor at the University of Cape Town, said “Sub-Saharan Africa continues to present a special challenge for a variety of methodological, geographic, and economic reasons. The evidence base for estimating causes of death in Africa remains limited. The data do show modest progress in lowering child mortality, but communicable and nutritional causes still account for half of premature deaths in Africa. Nearly as troubling is the rising burden of chronic illness, such as stroke and heart disease.”
Typically “Western ailments”, such as pain, anxiety and depression are also eroding quality of life and productivity for millions of people in sub-Saharan Africa. They are now ranked among the top causes of years lived with disability throughout the region.
Dr. Felix Masiye, head of the Department of Economics at the University of Zambia, said “African nations have not even begun to confront the consequences of exploding cases of mental illness, depression, pain, and the enormous burden of substance abuse that stem from those conditions. The direct link between mental illness and physical well-being is at the core of this unexplored terrain, and can only grow as the years go by.”
The authors explain that there have been some amazing achievements since 1990, such as a dramatic reduction in child mortality, which beat every single prediction published. The change reflects considerable improvements in medical services, sanitation, and access to food throughout most developing countries, as well as public health efforts.
However, they add that a great deal more work needs to be done.
Rotavirus and measles kill over one million children under five annually, despite aggressive vaccination campaigns.
Certain age groups are suffering disproportionate mortality rates. The number of deaths in the 15 to 49 year age group rose 44% between 1970 and 2010. The authors explain that the ongoing challenges of HIV/AIDS and increases in violence – which kill 1.5 million people every year – are partly to blame.
Nutrition and other lifestyle factors
- Malnutrition has been cut by over 60%. Malnutrition used to be the top risk factor for years of life lost and death in 1990; it has dropped to No. 8.
- Poor eating habits and a sedentary lifestyle are contributing to rapidly growing obesity rates. 10% of the disease burden are collectively attributed today to dietary risk factors and physical inactivity
- Smoking and excessive alcohol consumption have increased the number of people with hypertension (high blood pressure) and other chronic diseases
- Several factors, including some mentioned above, have contributed to a dramatic rise in people with high blood sugar. Diabetes was the cause of 1.3 million deaths in 2010, twice as many as in 1990
Over the last 20 years, improvements in health figures in the USA have been disappointing, compared to other developed nations. American women’s average lifespans grew by just under two years, compared to 2.4 years in Canada and 2.3 years in Cyprus. American women have dropped to 36th place in the global ranking of life expectancy, according to the report. In 1990, female life expectancy in the USA was 78.6 years, and rose to 80.5 in 2010.
The authors found Japan to be the healthiest nation on earth. Nobody is completely sure why; it could be their diet, physical activity, good public health services, genes, or a combination of all four.
Healthy life expectancy refers to how many years a person is expected to live while enjoying good health. In 1990 Japan came top for both males and females, and did so again twenty years later.
Top ten countries, male healthy life expectancy, 2010:
- South Korea
The USA was in 29th place
Top ten countries, female healthy life expectancy, 2010:
- South Korea
The USA was in 33rd place
A large proportion of the health burden is caused by a relatively small number of ailments, the report pointed out.
The researchers gathered data on over 300 diseases, injuries and risk factors. They found that only 50 distinct causes account for 78% of the global health burden – 18 account for over 50%.
One of the lead authors, Dr. Kenji Shibuya, from the University of Tokyo, said:
“If we only could crack the code on just this small group of illnesses, we could make enormous progress in improving health.
Top ten causes of death, which have moved up, down, or remained the same, from 1990 to 2010?
- The following remained the top two during the whole period – ischemic heart disease and stroke
- The following have moved up – COPD (chronic obstructive pulmonary disease), lung cancer, and diabetes.
- The following have moved down – tuberculosis, lower respiratory infections, and diarrhea
Written by Christian Nordqvist