Dying too soon or living long with disability

At least 1870 independent experts in 127 countries and territories collaborated to prepare an up-to-date analysis on the state of the world's health. Titled ‘Global Burden of Disease, Injuries, and Risk Factors (GBD) 2015’, the study by Lancet reveals the key drivers of ill health, disability and death in countries to help  governments and donors identify national health challenges.

The study analysed 249 causes of death, 315 diseases and injuries and 79 risk factors in 195 countries and territories between 1990 and 2015. For the first time, GBD 2015 includes the Socio-Demographic Index (SDI) to measure development. It is based on per capita income, level of education and total fertility rate.

According to the study, life expectancy increased by more than a decade. However, seven out of 10 deaths are now caused due to non-communicable diseases.

1. As of 2015, life expectancy for men and women stand at 69 years and 74.8 years respectively.
2. There has been a drop in death rates for many communicable diseases, especially in the last 10 years.
3. About 70 per cent (40 million) of global deaths (48 million) in 2015 were due to non-communicable diseases, including heart disease, diabetes and chronic kidney disease.
4. In 2015, an estimated 1.2 million deaths were due to HIV/AIDS, which is down by 33.5 per cent since 2005. Deaths due to Malaria (730,500) also dropped by 37 per cent since 2005.

The study also points out that that people are spending more years living with illness and disability. Although healthy life expectancy has increased in 191 of 195 countries between 1990 and 2015, it has not increased as much as overall life expectancy, which means people are living more years with illness and disability.

Since 1990, according to the study, there has been an alarming increase in exposure to high BMI, drug use, ozone pollution, occupational carcinogens (diesel exhaust) and high blood sugar which affect the burden of conditions like diabetes, heart disease and cancers.

Moreover, exposure to dietary risks like diets high in salt and low in vegetables account for more than 10% of ill health across the world. Ambient air pollution and high cholesterol and alcohol intake have also contributed to increased risk of diseases.

Though exposure to highly preventable risks like unsafe sanitation and water and household air pollution has been reduced, yet they remain major causes of poor health.

In 2015, unsafe sanitation claimed 306,000 fewer lives (total deaths 808000) compared to 2005. While exposure to smoking also came down by more than 25 per cent worldwide, it is still among the top five risks causing health loss in 140 countries. It claimed 289,000 more lives in 2015 (total deaths 6.4 million) than 2005. Interestingly, it is also the leading risk factor for poor health in the UK and the USA.

Globally, the number of deaths in children under the age of five reduced by more than 50 per cent from 12.1 million in 1990 to 5.8 million in 2015. Fortunately, the gap between countries with the lowest and highest rates of child mortality is shrinking.

However, the world fell short of the Millennium Development Goal (MDG) target to reduce child mortality by two-thirds between 1990 and 2015, and some countries, especially in sub-Saharan Africa, still have infant mortality rates as high as 1074 per 1000 live births.

The study draws attention to the fact that neonatal (first month) deaths, dropping more slowly than under-five deaths, accounted for nearly half (2.6 million) of all deaths in children under five in 2015. Besides pre-term birth complications, birth asphyxia and trauma are the leading causes of deaths.

The target of reducing neonatal mortality to fewer than 12 deaths per 1000 live births by 2030 is a challenge for more than one-third of countries, especially in low- and low-middle income categories.

The study on maternal mortality confirms the death of over 275,000 women during pregnancy or childbirth, and most of them from preventable causes. These many women died despite a reduction in maternal death rates from 282 deaths per 100,000 live births in 1990 to 196 in 2015.

While two-thirds (122) of countries have met the SDG target to reduce the the rate of maternal mortality to less than 70 for every 100000 live births.

Twenty-four countries, including high-income countries such as the USA, Greece and Luxembourg, have seen increasing maternal death since 2000.

The Lancet study highlights differences across regions and countries in terms of overall progress. It also shows wide variations between the progress in countries as compared to what was expected based on a country's level of development.

North America

• In 2015, North America had the worst healthy life expectancy at birth for men (67.11 years) and women (69.8 years), despite being a high-SDI region.
• In 2015, infant mortality rate was worse than expected in the US and Canada.
• Drug use disorders led to a disproportionate amount of ill health and early death in the US.

Europe

• In 2015, premature death due to drug use disorders crossed expected levels in Norway and Scotland. Same is the case with premature death from alcohol use in Denmark and Finland.
• Deaths in children below five also exceeded expected levels in Scotland and Wales in 2015
• In Western Europe, countries such as France, Spain and the UK fared better in reducing premature deaths from stroke.
• In Russia, premature death and illness due to alcohol were 10 times higher than expected. However, it improved its maternal survival rate but fared poorly at reducing infant mortality.

Oceania

• Other than the US, Australia is also a high-income country where drug use disorders were one of the top reasons for cause of disability

Sub-Saharan Africa

• Countries such as Zimbabwe, South Africa, Ethiopia and Botswana experienced rapid improvement in life expectancy at birth due to improved prevention and treatment for HIV/AIDS.
• Despite this, HIV/AIDS is still the leading cause of premature death and higher than expected disability in 16 of 48 countries.
• HIV/AIDS epidemic in southern sub-Saharan Africa prevented the region from improving healthy life expectancy levels since 1990.
• Countries such as Namibia and Zimbabwe have done better than expected at reducing maternal death rates.
• Since 2000, 16 countries, including Botswana, Burundi, Ethiopia, Liberia, Rwanda, Senegal and Zambia have recorded over a five per cent yearly decline in infant mortality rate.

North Africa and Middle East

• In 2015, war contributed to disability in Afghanistan, Iraq, Lebanon and Syria. Life expectancy of Syrian men reduced by more than 11 years as compared to the pre-war year of 2005.
• Morocco and Algeria have reduced maternal and child deaths since 1990.

Latin America and Caribbean

• Between 1990 and 2015, healthy life expectancy at birth exceeded expectations for men and women throughout this region.
• According to the study, diabetes and violence contributed to health loss.
• Barring Peru and Guyana, all countries in the Caribbean and Latin America have fared badly at reducing maternal deaths over past 25 years.
• Latin America recorded under-five death rates well below expected levels in 2015.

Asia

• Most countries in south Asia fared well in reducing deaths due to stroke and respiratory infections.
• India failed to tackle deaths due to tuberculosis and Bangladesh couldn’t arrest death due to drowning.
• Countries did worse than expected at reducing infant mortality. India recorded the largest number of under-five deaths (1.3 million) of any country in 2015.
• Bangladesh has improved maternal mortality rate much faster than expected, but India and Nepal struggled.
• In 2015, the burden of diabetes, heart disease and depression was much lower than expected in China. But the levels of premature death due to liver cirrhosis were three times higher than expected.