“We are in transition to a world where disability is the dominant concern as opposed to premature death,” said Christopher J.L. Murray, who headed the Global Burden of Disease Study, published Thursday. “The pace of change is such that we are ill prepared to deal with what the burden of disease is now in most places.”
Produced over five years by 486 researchers at 302 institutions in 50 countries, the study is the most detailed look at health on the population level ever attempted.
It charts 235 causes of death, including AIDS, alcoholism, bladder cancer and animal bites. It examines the effects of 67 “risk factors” — as diverse as not enough fruit in the diet and childhood sexual abuse — that can lead to illness.
The calculations are made for two points in time — 1990 and 2010. As a consequence, the study reveals how the world’s health has changed over two decades and provides a trajectory of where it may be headed. The purpose is to give governments, international agencies, donors and researchers an idea of what to plan for.
The study provides both a broad-brush portrait of 7 billion people and a detailed etching of what’s happening in 187 individual nations.
Heart disease and stroke were the leading and second-leading causes of death in 1990 and remained so in 2010. But over that two-decade period, malnutrition dropped from the 11th to the 21st cause of death. Diabetes, car accidents and lung cancer all rose in the rankings.
Africa remains the one place where afflictions of the poor — AIDS, malaria, childhood infections, malnutrition, childbirth calamities — remain hugely important. They account for three-quarters of all premature deaths.
The study also reveals many highly localized variations in health.
As a consequence of the earthquake in Haiti in 2010, Haitian men that year had the globe’s lowest life expectancy: 33 years. Egypt has the highest rate of cirrhosis of any country, caused by hepatitis C unwittingly transmitted to millions of people through unclean needles used in public health campaigns against the tropical infection schistosomiasis. Ethiopian men gained 13 years of “healthy life expectancy” between 1990 and 2010, the most of any group in the world. There’s a “homicide belt” in Latin America and a “suicide belt” in Asia.
The package of seven papers totaling 196 pages is being published in the Lancet. It is the first time an entire issue of the journal has been given over to one research study.
‘Very, very big payoffs’
Although population aging, declining poverty and smaller family size have been the major forces changing the world’s health profile over the two decades, improvements in medicine and public health have also made a huge difference. Measles tells the story.