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The interaction of covid-19 with the increase in chronic diseases and associated risk factors, such as obesity and pollution, in the last 30 years, created the perfect storm to “feed” the deaths from the new coronavirus, defend the scientists .
In a study published Thursday in The Lancet, experts reveal that increased exposure to major risk factors (such as hypertension, high blood sugar, and high cholesterol), combined with increased deaths from cardiovascular disease in some countries , “suggests that the world may be approaching a tipping point in average life expectancy gains.”
The findings come from the Global Burden of Disease (GBD) Study, which involves experts working at more than 1,100 universities, research centers, and government agencies in 152 countries and provides new insight into how countries have prepared in terms for the covid-19 pandemic and establish the true magnitude of the challenge posed by new pandemic threats
GBD’s work has served to support health policies in several countries, as well as to provide scientific information to international organizations such as the World Bank or the World Health Organization (WHO).
The authors emphasize that the promise of disease prevention through government actions or incentives that lead to healthier behaviors and access to health resources is not having the same results around the world.
“Most of the risk factors are preventable and treatable and addressing them will bring enormous social and economic benefits. We are failing to change behaviors that are detrimental to health, particularly those related to diet quality, caloric intake and activity. physical, in part due to inadequate policy of care and funding for public health and behavioral research ”, says Christopher Murray, from the University of Washington (USA), who led the work.
The study highlights that several risk factors and non-communicable diseases, such as obesity, diabetes and cardiovascular diseases, are associated with an increased risk of serious diseases and death from covid-19, and highlights the importance of social factors for the final score.
“Diseases not only interact biologically, they also interact with social factors. Urgent action is needed to address the coexistence of chronic diseases, social inequalities and covid-19, ”argues Murray, referring to the interplay of several epidemics that exacerbate disease burden in already overburdened populations and increase their vulnerability.
The authors stress that there is a belated recognition of the importance of social and economic development for health in general and point out the need for a much broader approach, paying more attention “to all the factors that drive the health of the population.”
“Given the overwhelming impact of social and economic development on health progress, intensifying policies and strategies that stimulate economic growth, expand access to education, and improve the status of women should be our collective priority,” she says Murray.
According to the study, although overall healthy life expectancy (the number of years a person can expect to live in good health) has risen steadily (over 6.5 years) between 1990 and 2019, it has not grown as much as overall life expectancy in 198 of the 204 countries evaluated in this study and people are living “longer years with health problems.”
Disability, rather than premature death, has become a growing part of the global burden of disease, rising from 21% in 1990 to more than a third (34%) in 2019, it notes.
In 11 countries, including Singapore, Iceland, Norway, Ireland, Australia, New Zealand and Qatar, more than half of all health losses (measured by disability-adjusted life years – DALYs) are due to disease problems. non-communicable diseases and injuries.
Global health efforts to combat infectious diseases and address prenatal care have been successful in improving the health of children under 10 years of age in recent decades (with the overall burden of disease decreasing by 55%), ” but this did not correspond to a similar response in the older age groups ”, the experts emphasize.
According to the study, the top 10 contributors to increased health losses worldwide in the past 30 years include six causes that heavily affect older adults: ischemic heart disease, diabetes, stroke, chronic kidney disease, cancer of lung and age-related hearing loss.
In addition, four causes are common from adolescence to old age: HIV / AIDS, musculoskeletal problems, low back pain, and depressive disorders.
Those responsible recall that the increase in health problems “threatens to overload health systems ill-equipped to deal with chronic conditions associated with population growth and aging.”
They also indicate that, in the last decade, developing countries have made “impressive advances in health”, largely “as a result of successful efforts against infectious, maternal and neonatal diseases”, but they highlight that their health systems countries “are not well equipped to cope with the growing burden of noncommunicable diseases, which rose from about a third of the total disease burden in 1990 to almost two-thirds in 2019.”
Furthermore, they note, “while deaths from infectious diseases have fallen substantially in developing countries, deaths from noncommunicable diseases are on the rise.”
In contrast, “improvements in health have begun to stagnate in most developed countries and have even reversed in several countries, particularly in the United States, where the age-standardized rate of health loss has risen by almost a quarter. 3% in the last decade. “
The authors believe that reasons for this lack of progress may include increasing rates of obesity, as well as decreasing the potential to reduce smoking and making further improvements in the coverage of treatments for hypertension and high cholesterol, which it will be necessary to maintain the reduction in deaths from cardiovascular diseases.
The coordinator of the study recalls that, with a rapidly aging world population, “seeking health services to address disabling problems and chronic conditions, which increase with age, will require higher levels of funding, strong political commitment, the accountability backed by better data and a coordinated global effort that prioritizes the most vulnerable. “
The study notes that over the past decade “there have been particularly large and worrying increases (more than 0.5% per year worldwide) in exposure to several highly preventable risks”: obesity, high blood sugar, consumption of alcohol and drugs, which are contributing to the growing burden of noncommunicable diseases.
“The greatest cumulative impact on health comes from the marked increase in metabolic risks (Body Mass Index [IMC] high levels, high blood sugar, hypertension and high cholesterol), which have risen 1.5% per year since 2010, “the authors explain, highlighting that among the main risks of non-communicable diseases, only smoking has decreased substantially.
The study also notes that the impact of risk factors also varies widely across regions: in much of Latin America, Asia, and Europe, hypertension, high blood sugar, high BMI, and tobacco use are the main factors contributing to health problems. health, while in Oceania the main risks are malnutrition and air pollution.
The most notable differences are in sub-Saharan Africa, which is dominated by malnutrition.
“Simply providing information on the harms of these risks is not enough,” says co-author Emmanuela Gakidou, adding: “Since individual decisions are influenced by financial considerations, education, and availability of alternatives, governments must collaborate globally on initiatives to doing the healthiest possible behavior for everyone. “
“And, taking lessons from decades of tobacco control, when there is a great risk to the health of the population, such as obesity, concerted government action through regulation, taxes and subsidies may be necessary,” he stresses.
In an editorial accompanying the study in The Lancet, the caveat is still left: “Unless entrenched structural inequalities in society are addressed and a more liberal approach to immigration policies is taken, communities will not be protected. of future infectious outbreaks and the health of the population will not achieve the benefits sought by advocates of global health. “
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