The state of the world’s health: Global Burden Of Disease

This week, The Lancet publishes a wide-ranging report assessing the state of the world’s health. Overall, 1,870 experts from 127 countries have combined their efforts to produce the Global Burden of Disease, Injuries, and Risk Factors 2015 study collaboration.
[African water source]
Global health comes under unprecedented scrutiny.
The report combines a number of research papers, all released in one issue of The Lancet.
Designed to inform global leaders and non-governmental organizations (NGOs) about the state of global health, the report covers a myriad of topics.
Analyzing data from 1990-2015, the report collates information about 249 causes of death, 315 injury types and diseases, and 79 risk factors across 195 countries.
Some health parameters have shown improvements, such as life expectancy, whereas others have fared less well, including diet and obesity.
In this article, we summarize some of the major findings from the six papers that comprise this groundbreaking research.
Life expectancy rising
Incredibly, since 1980, the world’s population has gained more than a decade of life expectancy. Men can expect to reach an average of 69 years and women, 74.8.
The biggest factor to influence this reduction is the drop in deaths due to communicable diseases – in particular, HIV/AIDS (down 33.5 percent since 2005), malaria (down 37 percent since 2005), and diarrhea. Cancer and cardiovascular-related diseases have also fallen to a lesser extent.
 
The following video explains the headline results:
Headaches, tooth cavities, hearing, and vision loss
Since 1990, the main causes of health loss – measured in years lived with a disability (YLD) – have remained relatively constant.
Low back and neck pain, hearing and vision loss, depressive disorders, and anemia were the main causes of health loss in 2015.
The researchers uncovered eight chronic diseases that affect more than 1 in 10 people on earth:
 
Cavities in teeth: 2.3 billion people
Tension-type headache: 1.5 billion people
Iron-deficiency anemia: 1.47 billion
Hearing loss: 1.2 billion
Migraine: 959 million
Genital herpes: 846 million
Refractive vision problems: 819 million
Ascariasis (a type of intestinal worm): 762 million.
On a positive note, 14 chronic conditions dropped in prevalence to such an extent that, even though the population has grown, the actual numbers of people with the conditions has declined. These include asthma, cervical cancer, chronic obstructive pulmonary disease (COPD), and ischemic heart disease.
 
People live with disease longer
As mentioned, from 1990-2015, average life expectancy has risen more than a decade (10.1 years). However, healthy life expectancy has only risen by 6.1 years.
There has been a shift in burden of ill health, which is measured in disability-adjusted life years (DALYs) – in other words, the number of years lost to premature death and disability.
 
Rather than communicable, neonatal, maternal, and malnutrition-based conditions (such as measles and HIV/AIDS), the emphasis has shifted to disabling non-communicable diseases, such as drug use disorders and osteoarthritis.
 
Unsafe water, sanitation, diet, and drug use[Woman standing on scales]
Deaths related to a high BMI are on the rise.
In 2015, the world’s leading risk factors for premature death were smoking, high blood pressure, high blood sugar, high body mass index (BMI), and childhood undernutrition.
 
Since 1990, there have been particularly swift increases in deaths related to high BMI, occupational carcinogens, drug use, ozone pollution, and high blood sugar.
 
Dietary risks account for more than 10 percent of ill health worldwide; these risks include diets high in salt and low in vegetables, whole grains, fruit, nuts and seeds, and seafood.
 
The effects of high cholesterol, ambient air pollution, and alcohol have hardly changed over the time frame.
 
As far as improvements are concerned, preventable risks such as exposure to smoking (which dropped by more than a quarter), unsafe sanitation and water, and household air pollution have all improved, although they are still a significant cause of ill health.
 
Despite the drop in mortality rates, smoking remains a leading factor of ill health in the United Kingdom and United States.
 
Pregnancy and childbirth
Since 1990, worldwide maternal death rates have dropped by almost one third, from 282 deaths per 100,000 to 196 per 100,000. Still, in 2015, more than 275,000 women died during childbirth, mostly from preventable causes.
 
In total, 24 countries’ maternal death rates have worsened since 2000. Some of these countries have been impacted by conflicts – Afghanistan and Palestine, for instance. Other countries whose maternal death rates have worsened are perhaps more surprising and include Greece, Luxembourg, and the U.S.
 
In poorer countries, these deaths are most commonly due to hemorrhage; in wealthier countries, they are most often caused by blood clots, heart problems, and complications caused by non-communicable diseases.
 
Deaths of under-5s
In 1990, 12.1 million children under 5 died. In 2015, this figure had more than halved to 5.8 million. Additionally, the gap between the countries with the lowest and highest risk level for under-5s is shrinking. These positive findings are predominantly due to successes in treating and dealing with malaria, diarrhea, and measles.
 
Neonatal deaths (deaths within the first month of life) deserve special attention. These deaths are declining, but not as swiftly as deaths of under 5s. Neonatal deaths account for almost half of all deaths under the age of 5 – 2.6 million in total.
 
The worst performers in the category of neonatal mortality are as follows:
 
Mali: 40.6 deaths per 1,000
Central African Republic: 40.2 deaths per 1,000
Pakistan: 37.9 per 1,000.
 
Key regional findings: North America
Among other regions rated as high on the Socio-Demographic Index, North America had the worst healthy life expectancy at birth for both men (67.11) and women (69.8)
In 2015, in the U.S. and Canada, mortality rates among under 5s were worse than expected
Greenland performed particularly badly regarding alcohol and self-harm
Drug use disorders – particularly cocaine and opioids – caused a disproportionate level of ill health and early death; similarly, diabetes was disproportionately prevalent.
As with any report on such a huge scale, there are likely to be highs and lows. The findings will now provide a firm foundation on which to build solid health interventions. Globally, we are moving forward, but it was always going to be a slow walk.
 
Read about the ‘Sustainable Development Goals’ and their recent analysis.

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