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Report: Medical Advances Reshape Health Landscape Worldwide — But Not Always for the Better

Fewer people dying, but more live with disability (Dec. 13)

Globally, health advances present most people with a distressing irony: avoid premature death, but live longer and sicker.

That’s one of the main findings from the Global Burden of Disease Study 2010 (GBD 2010), a collaborative project led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The study will be published in the December 14 issue of The Lancet.

The new research reveals major shifts in health trends around the world since 1990, the starting point of the first Global Burden of Disease study. Since that time, the world’s populations have grown considerably older. Where infectious diseases and childhood illnesses related to malnutrition were once the primary causes of death, now children in many parts of the world — outside of sub-Saharan Africa — are more likely to live into an unhealthy adulthood and suffer from eating too much food rather than too little, the report says.

In addition, health burden is increasingly defined by what’s making people sick rather than what’s killing them. The biggest contributor to the world’s health burden used to be premature mortality — driven by more than 10 million deaths in children under the age of 5 years — but now the disease burden is caused mostly by chronic diseases, such as musculoskeletal disorders and mental health conditions, along with injuries. This burden intensifies as people live longer.

“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 IHME. “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.”

While child mortality has decreased, GBD 2010 found a dramatic 44% increase in the number of deaths among adults aged 15 to 49 years between 1970 and 2010. This is partly because of increases in violence and the ongoing challenge of HIV/AIDS, which kills 1.5 million people annually.

Another mixed success is that while the burden of malnutrition has successfully been cut by two-thirds, poor diets and physical inactivity are contributing to rising rates of obesity and other lifestyle-related risk factors, including high blood pressure, tobacco smoking, and harmful alcohol use. Dietary risk factors and physical inactivity collectively caused 10% of the disease burden, and the burden due to excess weight and high blood sugar are rising substantially.

These findings are consistent with one of GBD 2010’s repeated themes: Disability is causing a greater and greater proportion of the burden of disease as demographics and epidemiology evolve. Much of this burden is caused by a relatively small group of ailments. Researchers examined more than 300 diseases, injuries, and risk factors and found that only 50 distinct causes account for 78% of the global burden.

The types of illnesses and injuries causing death and disability are also changing. While ischemic heart disease and stroke remained the two greatest causes of death between 1990 and 2010, all the other rankings in the top ten causes changed. Diseases such as diabetes, lung cancer, and chronic obstructive pulmonary disease moved up, and diarrhea, lower respiratory infections, and tuberculosis moved down.

The trends identified in GBD 2010 occur across regions with one notable exception: sub-Saharan Africa, where infectious diseases, childhood illnesses, and maternal causes of death account for as much as 70% of the burden of disease. By comparison, these conditions account for only one-third of the burden in Southern Asia and Oceania, and less than 20% in all other global regions.

Source: IHME; December 13, 2012.

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