December 13, 2012
Massive International Study Outlines Global Health Crisis: People Living Longer But With More Illness
Lawrence LeBlond for redOrbit.com - Your Universe Online
A health crisis has been developing around the world for decades. Despite life expectancies climbing for both men (11 years) and women (12 years) worldwide, we are paying for this added buffer with more mental and physical illnesses, according to the biggest-ever study of the global burden of disease.
The study, collaborated on by nearly 500 international researchers, and published in the journal The Lancet, has produced the most comprehensive database of the world´s health ever attempted. The database shows stark changes that have taken place over the last 40+ years, with rapid decline in premature deaths from infectious diseases and malnutrition among the most ambitious revelations.
But in place of malnutrition, the world is now faced with an even bigger problem: a world that eats too much. The Global Burden of Disease Study 2010 (GBD 2010) has found that the health of populations could be even more adversely affected by over-eating as they had as a malnourished society. Still, the success of tackling malnutrition has driven down nutrition-related deaths by two-thirds since 1990, with less than a million by 2010.
And with nations like the US and Europe–countries that have long been prosperous–continuing to see gluttonous behaviors, other countries that are increasing in prosperity are following suit, adding to the health crisis of ballooning waistlines.
The irony behind the revelation is simple: avoid premature death but live longer and less healthy. In essence, the study outlines not what is killing us, but rather what is making us sicker.
The GBD 2010 study is a collaborative project led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Findings of the massive study are being announced on 14 December at the Royal Society in London. The Lancet is dedicating, for the first time in its history, an entire triple issue to this one study, which covers seven scientific papers and accompanying commentaries assessing the world´s biggest health threats and challenges. The study not only assesses the threats, but also looks into ways to address them.
Other health issues covered in the multi-level study include consequences of high blood pressure, which is now considered the top health risk factor with the greatest toll worldwide, according to experts.
Smoking and alcohol use are also top health concerns and have even surpassed child hunger as the second and third leading global health risks globally. These are the top risks among 43 that have been outlined in the GBD 2010 study.
At one time childhood diseases and malnutrition were the leading causes of death around the world. Prior to 1990, the biggest contributor to the world´s health burden was premature mortality–driven by more than 10 million deaths in children under the age of 5–but now the disease burden is caused mainly by chronic diseases such as musculoskeletal disorders, mental health conditions, and also injuries. And the longer we live, the worse the problems become and the more we suffer.
Now, most deaths in the world are due to heart disease and stroke, which killed an estimated 12.9 million people in 2010, nearly 25 percent of all deaths for that year. High blood pressure is responsible for 9.4 million deaths and about 7 percent of all disability. Smoking ranks second with 6.3 million deaths, and alcohol is third with 5 million deaths worldwide. Alcohol is also a major issue in Europe, where it causes almost a quarter of all disease.
Physical inactivity and poor diet–particularly those with high levels of sodium and low levels of fruit consumption–were responsible for 12.5 million deaths in 2010.
Despite the transition in deaths from childhood disease and malnutrition to heart attack and stroke, people are still living longer, but with less years being healthy. In the two decades prior to 2010, men´s life expectancy rose by 4.7 years while a woman´s increased by 5.1 years. But of those extra years, nearly a year was in poor health, suggesting that illness and disability are taking a greater toll on our lives than 20 years ago.
While the trend is similarly felt throughout the world, women in four countries–Japan, Singapore, South Korea and Spain–have a healthy life expectancy greater than 70 years. In no country do men enjoy the same healthy lifespan. However, men in Afghanistan, Jordan and Mali are the only men globally that have longer life expectancies than women.
Women in Japan have the longest life expectancy, living on average to the age of 86. The average longest life expectancy for men comes from Iceland, where they enjoy an 80-year life expectancy.
This finding that people are living longer but unhealthier could lead experts to reconsider the way health systems work around the world.
“We're finding that very few people are walking around with perfect health and that, as people age, they accumulate health conditions,” Dr Christopher Murray, director of IHME at the University of Washington, said in a statement. “At an individual level, this means we should re-calibrate what life will be like for us in our 70s and 80s. It also has profound implications for health systems as they set priorities.”
“Overall we're seeing a growing burden of risk factors that lead to chronic diseases in adults, such as cancer, heart disease and diabetes, and a decreasing burden for risks associated with infectious diseases in children,” said Professor Majid Ezzati of the School of Public Health at Imperial College London, one of the study's senior authors. “But this global picture disguises the starkly different trends across regions. The risks associated with poverty have come down in most places, like Asia and Latin America, but they remain the leading issues in sub-Saharan Africa.”
In the study, researchers estimated both numbers of deaths attributed to each risk factor and disability-adjusted life years (DALYs), which takes into account both years of life lost and years lived with disability.
“We looked at risk factors for which good data are available on how many people are exposed to the risks and how strong their effects are, so that our results can inform policy and programmatic choices,” said Associate Professor Stephen Lim at IHME.
The risk factor that showed the greatest increase in health burden was high body mass index (BMI). In 1990, high BMI ranked as the 10th greatest risk factor; it was up to sixth by 2010. During that year, more than 3 million deaths were attributable to excess body weight, nearly triple that attributable to malnutrition. In Australia and southern Latin America, high BMI is the leading risk factor.
Still, the major health problems we see from risk factors are not killing us early, they are just making us more ill. We now live in a world with more health problems than ever before–a world with severe pain, impaired mobility, visual and hearing impairment, and a host of mental health disorders that weren´t that big of an issue just 20 years ago.
The study, which was funded exclusively by the Bill & Melinda Gates Foundation, involved more than 480 researchers from 302 institutions and 50 countries. It is the largest collaboration to ever work on a study on such a large scale.
Professor Ezzati said while the health issues today are vastly different than what we were dealing with before the 1990s, there are a number of actions that can be taken to address the growing host of problems worldwide.
“The good news is there are lots of things we can do to reduce disease risk,” he said. “To bring down the burden of high blood pressure, we need to regulate the salt content of food, provide easier access to fresh fruits and vegetables.”
We also need to “strengthen primary healthcare services,” said Ezzati. “Under-nutrition has come down in the ranking because we've made a lot of progress in many parts of the world. This should encourage us to continue those efforts and to replicate that success in Africa, where it's still a major problem.”
There have been several major improvements in global health over the years, most notably in children´s health. Child mortality has dropped nearly 60 percent from 1970 to 2010.
While child mortality has decreased, there has also been a startling 44 percent increase in the number of deaths among adults aged 15 to 49 between 1970 and 2010. This is partly because of increases in violence such as homicide and traffic accidents and the AIDS epidemic, the researchers said.
Lastly, the study also made note that the burden of household air pollution from the burning of fossil fuels such as coal or wood has also dropped significantly. Although in south Asia unclean cooking and heating fuels remains a leading risk factor for illness and death.