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Global progress in health is not inevitable

Burden of disease figures: ‘disturbing’

Jo Carlowe

Friday, 09 November 2018

Global progress in health is not inevitable according to new analysis published this week.

The latest Global Burden of Disease study (GBD), published in a special issue of The Lancet, estimates that improvements in mortality rates for adults were less pronounced overall and stagnated or got worse in some countries in 2017. In addition, no countries are on-target to meet the United Nation’s Sustainable Development Goals to improve health by 2030.

Emerging adverse trends could lead to negative shifts over time if action is not taken, the authors warn. For example, conflict and terrorism is an increasing threat to global health (with numbers of related deaths increasing by 118% between 2007-2017), and an era-defining epidemic of opioid dependence continues – with more than 4 million new cases and around 110,000 deaths in 2017. In addition, half of all global deaths (51.5%, 28.8 million of 55.9 million deaths) were caused by just four preventable risk factors in 2017 (high blood pressure [10.4 million deaths], smoking [7.1 million deaths], high blood glucose [6.5 million deaths], and high body mass index [4.7 million deaths]), presenting a public health challenge and an opportunity for action. 

For the first time, the estimates include a global analysis of health worker density using surveys and census data on people’s occupations, and indicate a health worker shortfall. 

Historically, in 2006, the World Health Organization (WHO) estimated there should be a minimum of 23 physicians, nurses, or midwives per 10,000 population. However, this estimate has not since been updated and the study authors expect that larger, more varied health workforces are needed to provide a broader range of services and achieve universal health care.

In 2017, the estimates suggest only 41 out of 195 countries had more than 30 physicians per 10,000 population, while only 28 countries had more than 100 nurses or midwives. Almost half (47.2% - 92 of 195 countries) of the countries included had fewer than 10 physicians per 10,000 people, while 46.2% (90/195 countries) had fewer than 30 nurses or midwives for every 10,000 people.

“The balance of physicians, nurses, midwives and pharmacists in a country’s workforce underpins the types of care that are available to the population. While increasing the overall number of health workers will be important for many countries, it’s vital that this growth ensures a varied workforce composition,” says lead author Professor Rafael Lozano, of the Institute for Health Metrics and Evaluation at the University of Washington, USA.

Non-communicable diseases (NCDs) comprised the greatest fraction of deaths globally in 2017 (contributing 73.4% of total deaths, equivalent to approximately 41.1 million deaths). The total numbers of deaths from NCDs increased from 2007 to 2017 by 22.7% (from 33.5 million in 2007 to 41.1 million in 2017), representing an additional 7.6 million deaths in 2017. 

And, the prevalence of obesity continues to rise in almost every country in the world, with more than one million deaths estimated as being due to type 2 diabetes, almost half a million (426,300 deaths) deaths due to diabetes-related chronic kidney disease, and more than 180,000 deaths due to non-alcoholic steatohepatitis (NASH)-related liver cancer and cirrhosis in 2017. 

An accompanying editorial* from The Lancet describes GDB 2017 as “disturbing”.

“Not only do the amalgamated global figures show a worrying slowdown in progress but the more granular data unearths exactly how patchy progress has been. GBD 2017 is a reminder that, without vigilance and constant effort, progress can easily be reversed. But the GBD is also an encouragement to think differently in this time of crisis,” the editorial states. 

The GBD is the only annual, comprehensive, peer-reviewed assessment of global trends in health, providing global and national estimates for around 280 causes of death, 359 diseases and injuries, and 84 risk factors in 195 countries and territories worldwide. 

The study is coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle (USA), and involves more than 3,500 collaborators from across more than 140 countries and territories. 

* GBD 2017: a fragile world. The Lancet, Volume 392, issue 10159, P1683, November 10, 2018.

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