Dec 18, 2012

World - The World: Living Longer but Living Sicker

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Massive new study says bad diet, lack of exercise, smoking take their toll

Although people are living longer, they are more likely to be sicker as bad diet, lack of exercise, smoking and other health risks take their toll, according to a massive new study conducted by the Institute for Health Metrics and Evaluation at the University of Washington to quantify rends in the world’s health problems.

The report, the Global Burden of Disease Study, was to be formally released today at the Royal Society in London and published in The Lancet, which has dedicated an entire triple issue to the study, conducted by 486 authors from 50 countries, including 26 low- and middle-income countries.

The global health landscape has witnessed massive shifts during the 20 years from 1990 to 2010, with fewer people dying but more with disabilities. Infectious disease and childhood illnesses related to malnutrition were once the primary causes of death. But obesity and high blood sugar are replacing lack of food as leading risks. Children in most parts of the world are more likely to suffer ill health from eating too much rather than too little, according to the study.

While scientists have done a tremendous job battling fatal illnesses, more health problems are now caused by chronic diseases and injuries such as musculoskeletal disorders and mental health conditions that impair physical and mental wellbeing.

“We’re finding that very few people are walking around with perfect health and that, as people age, they accumulate health conditions,” said Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation and one of the founders of the Global Burden of Disease study. “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.”

Some findings:

(i) While child mortality decreased dramatically by 41 percent (although, despite effective vaccines, diarrhea and measles continue to kill more than 1 million children below 5 every year), there was a startling 44 percent increase in the number of deaths among adults aged 15 to 49 between 1970 and 2010. India has recorded a 61.5 percent reduction in child mortality since 1970. Yet it ranks only above Pakistan (20.3 percent) and Afghanistan (44 percent) amongst all the 8 SAARC nations (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka). However, what is really disconcerting is that India registered a substantial increase of 35.6 percent in adult mortality, with 2.11 million young Indian adults in the age group 15-49 years dying before their 50th birthday in 2010, as compared to 1.56 million in 1970.

This is troubling indeed, and as much a cause of concern as the significant number of children who die every year. India also ranked a poor 136th of 187 countries in terms of female life expectancy (67.5 years) while Japan ranked first at 85.9 years. Among the 30 high-income countries, Republic of Korea recorded the maximum increase of 6.5 years in female life expectancy bringing it to 82.7 years.

(ii) The burden of malnutrition has been reduced by two-thirds, but dietary risk factors and physical inactivity together caused 10 percent of the disease burden. Poor diets and physical inactivity are contributing to rising rates of obesity and other lifestyle-related risk factors, including high blood pressure, smoking, and harmful alcohol use.

(iii) The types of illnesses causing death and disability are changing. While ischemic heart disease and stroke remained the top two in the list of 10 leading causes of death during 1990-2010, diarrhea, lower respiratory infections, and tuberculosis moved down, while diabetes, lung cancer and chronic obstructive pulmonary disease moved up their earlier rankings. Neonatal encephalopathy, an often fatal brain condition in newborns, and protein-energy malnutrition, the leading cause of starvation, fell out of the list and were replaced by lower back pain and road injuries.

“We have gone from a world 20 years ago where people weren’t getting enough to eat to a world now where too much food and unhealthy food – even in developing countries – is making us sick,” said Dr Majid Ezzati, Chair in Global Environmental Health at Imperial College London and one of the study’s lead authors.

(iv) Much of the disease burden is caused by a relatively small group of ailments. After examining more than 300 diseases, injuries and risk factors, researchers found that just 50 distinct causes account for 78 percent of the global burden of disease and a mere 18 account for more than half the burden.

“If we only could crack the code on just this small group of illnesses, we could make enormous progress in improving health,” said Dr Kenji Shibuya, Chair of the Department of Global Health Policy at the University of Tokyo and one of GBD 2010’s lead authors.

(v) The trends identified in GBD 2010 occur across the world, with the notable exception of sub-Saharan Africa, where infectious diseases, childhood illnesses, and maternal causes of death account for as much as 70 percent of the burden of disease—as against only 33 percent of the burden in South Asia and Oceania, and less than 20 percent in all other regions.

Also, while the average age of death throughout Latin America, Asia, and North Africa increased by more than 25 years between 1970 and 2010, it rose by less than 10 years in most of sub-Saharan Africa.

According to Dr George Mensah, Visiting Professor at the University of Cape Town and a co-author of GBD 2010, “Sub-Saharan Africa continues to present a special challenge for a variety of methodological, geographic, and economic reasons. 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.”

The seven scientific papers and accompanying commentaries of GBD 2010 provide the evidence for a range of new research projects and targeted policymaking with a view to find the best ways to address the world’s biggest health challenges.

“At a time when world economies are struggling, it is crucial for health systems and global health funders to know where best to allocate resources,” said Dr Paul Ramsey, Chief Executive Officer of UW Medicine and Dean of the University Of Washington School Of Medicine. “I see GBD 2010 as much more than the health data it provides, which itself is of enormous value. I see it as a management tool for ministers of health and leaders of health systems to prepare for the specific health challenges coming their way.”

Shobha Shukla

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