Health Progress Slowed Down Globally Amid Growth in Noncommunicable Diseases

Progress in health around the globe has stagnated in some countries and gotten worse in others as the world faced increases in conflict and terrorism, epidemics, and noncommunicable diseases, according to global disease estimates published in The Lancet.

The assessment of approximately 280 causes of death, 359 diseases and injuries, and 84 risk factors in 195 countries and territories worldwide found that half of all global deaths were caused by just 4 preventable risk factors.¹ Of the 55.9 million deaths in 2017, 28.8 million (51.5%) were a result of high blood pressure (10.4 million deaths), smoking (7.1 million), high blood glucose (6.5 million), and high body mass index (4.7 million).

Almost every country saw an increase in the prevalence of obesity. It was estimated that type 2 diabetes accounted for more than 1 million deaths, diabetes-related chronic kidney disease accounted for almost half a million deaths, and nonalcoholic steatohepatitis—related liver cancer and cirrhosis accounted for more than 180,000 deaths.

The total number of deaths from noncommunicable diseases (NCDs) increased by 22.7% between 2007 and 2017. The age-standardized death rate from NCDs decreased by 7.9% during that time, but the rate had slowed in recent years. From 2003 to 2007 there was a decrease of 7.8%, and in 2013 to 2017 there was a decrease of 2.1% in the age-standardized death rate from NCDs.

“…[T]he combination of increasing metabolic risks and aging will continue driving problematic trends in noncommunicable diseases,” Christopher J.L. Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation at the University of Washington, said in a statement. “This represents both a challenge and opportunity, and highlights the value of the GBD [Global Burden of Diseases] study to inform good policy decisions and strategic health planning.”

The study also analyzed years lived with disability (YLD)² and found that although YLD rates decreased slightly from 1990 to 2017, “the number of total YLDs has increased by more than 50% during this time.” Low back pain, headache disorders, and depressive disorders were the top 3 causes of YLDs, accounting for nearly 20% YLDs globally.

They also found that while women are living longer, they are living more years in poor health. Life expectancy for women was 75.6 years in 2017 compared with 70.5 years for men. The proportion of years women spent in poor health varied greatly, from less than 20% in Bosnia and Herzegovina, Burundi, and Slovakia to 100% of extra years in Bahrain.

An accompanying editorial³ from The Lancet called the findings of GBD 2017 “disturbing.”

“Not only do the amalgamated global figures show a worrying slowdown in progress but the more granular data unearths exactly how patchy progress has been,” according to the editorial. “GBD 2017 is a reminder that, without vigilance and constant effort, progress can easily be reversed. But the GBD is also an encouragement to think differently in this time of crisis. By cataloguing inequalities in health-care delivery and patterns of disease geography, this iteration of the GBD presents an opportunity to move away from the generic application of UHC [universal health coverage] and towards a more tailored precision approach to UHC.”

References

1. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980—2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-1788. doi: 10.1016/S0140-6736(18)32203-7.

2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990—2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7.

3. The Lancet. GBD 2017: a fragile world. Lancet. 2018;392(10159):1683. doi: 10.1016/S0140-6736(18)32858-7.