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An ongoing modeling study and multiple burden of disease analyzes in 204 countries and territories reveal a dangerous combination of rising rates of preventable chronic diseases that increased vulnerability to COVID-19 and ineffective public health responses that failed to stop the pandemic. .
The Global Burden of Disease Study 2019, the most comprehensive known study of its kind, published yesterday as a special issue of The lancet, details the burden of 369 illnesses and injuries and analyzes 286 causes of death and 87 risk factors between 1990 and 2019. Led by researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the study is designed to identify countries with the greatest need for public health interventions.
America’s health declines
The researchers found dismal numbers in the United States, where life expectancy in 2019 was 78.9 years, which is less than 81.3 years in other high-income countries and has not increased since 2010, in part due to the growing number of deaths from cardiovascular diseases. , which has increased by 16.7% since 2010.
While the number of years a person can expect to be in good health has risen steadily over the past 30 years in the United States, to 65.2 years in 2019, lags behind similar-income countries (67.4 years) and has increased less rapidly as well. Healthy life expectancy has grown more slowly than life expectancy in the United States and 197 other countries, a sign that people are living longer in poor health than in 1990.
At 6.5 deaths per 1,000 live births, the mortality rate for American children under the age of 5 is significantly higher than the average of 4.9 per 1,000 in other high-income countries and nearly twice that of 3.6 per 1,000 in Australia.
Over the past 20 years, deaths among American adults ages 25-29 increased 18.7% and deaths among individuals ages 30-34 increased 15.6%, primarily due to rising rates of use disorder of drugs and alcohol and self-harm. In 2019, 65,700 Americans died from drug overdoses, up from 31,800 people in 2010, accounting for more than half of all drug overdoses worldwide.
The United States has seen setbacks in health improvements in the form of increased health losses, in part due to rising rates of high blood pressure, high blood glucose and obesity, declining smoking rates, and more overdose deaths. of drugs. Smoking was the number one contributor to health loss in 2019 (10-20% of health loss in most states, 13% nationwide).
Ill-equipped to deal with the growing burden of chronic diseases
Worldwide, rising rates of the major contributors to increased health loss over the past three decades include conditions that primarily affect older people, such as ischemic heart disease (up 50% since 1990), diabetes ( 148%), stroke (32%), kidney disease (93%), lung cancer (69%), and age-related hearing loss (83%).
Across all age groups, rates of four common conditions have increased, including HIV / AIDS (up 128% since 1990), a group of musculoskeletal disorders (129%), low back pain (47%), and depression (61 %).
Over the past 30 years, international efforts to curb infectious diseases and improve prenatal care have reduced the burden of disease in children under 10 years of age by approximately 55%, but similar efforts in older age groups have not had as much success.
While low- and middle-income countries have successfully launched efforts against infectious, maternal, and neonatal diseases, the authors said their health systems are not equipped to handle the growing burden of chronic diseases, which have increased in those countries, from approximately one third of the total disease burden in 1990 to almost two thirds in 2019.
Worldwide, disability has accounted for an increasing proportion of the burden of disease, from 21% of the total burden in 1990 to 34% in 2019. More than half of all health losses in 11 countries ( including Australia, Iceland, Ireland, New Zealand, Norway, Singapore, and Qatar) is now due to disability caused by non-communicable diseases and injuries.
The study’s lead author, Christopher Murray, MD, DPhil, of IHME, said in a Lancet press release that rising rates of disability require new and more effective approaches.
“With a rapidly aging world population, the demands on health services to address disabling outcomes and chronic conditions, which increase with age, will require higher levels of funding, strong political commitment, accountability backed by better data. and a coordinated global effort that prioritizes the most vulnerable, ”said Murray.
‘An acute on chronic health emergency’
The authors said that rising rates of high blood pressure, obesity, high blood sugar, and abnormal cholesterol levels, as well as rising rates of death from cardiovascular disease in regions such as the United States and the Caribbean, suggest that global life expectancy It may be aimed at slower or reduced earnings.
They noted that promised government disease prevention programs or those that reward healthy behaviors and improve access to health care have not been implemented globally. Governments should enact these types of programs to help people mitigate their risk factors for disease, which would bring many economic and social benefits, they added.
“Simply providing information on the harms of these risks is not enough,” IHME co-author Emmanuela Gakidou, PhD, MSc, said in the statement. “Since individual decisions are influenced by financial considerations, education, and the availability of alternatives, governments must collaborate globally on initiatives to enable healthier behavior for all.”
The researchers called for urgent action to address the heavy burden of chronic diseases, social inequities and COVID-19 to make countries less vulnerable to future pandemics.
In the statement, Richard Horton, MD, editor-in-chief of The lancet, called COVID-19 an “acute over chronic health emergency” fueled by social inequalities such as poverty, poor access to housing and education, and racial inequalities.
“And the chronicity of the current crisis is being ignored at our future risk,” he said. “Noncommunicable diseases have played a critical role in driving more than 1 million deaths caused by COVID-19 to date, and will continue to shape health in all countries after the pandemic subsides.”
In an attached comment, the Lancet editorial board said “the message of [the Global Burden of Disease study] is that unless deep-seated structural inequalities in society are addressed and a more liberal approach to immigration policies is adopted, communities will not be protected from future infectious outbreaks and the health of the population will not achieve the benefits they seek global health advocates “.
