In the News
Causes of death have shifted from infectious to noncommunicable diseases over the past 20 years, according to the Global Burden of Disease Study (GBD 2010), to which the Lancet devoted its entire December 15, 2012, issue. The study examined disease and disability estimates in 187 countries between 1990 and 2010, giving a comprehensive view of public health changes over this time period. The effort started in 2007 and involved 486 researchers in 50 countries.
One of the eight reports from the study, by Wang and colleagues, actually went back as far as 1970 and revealed that life expectancy increased substantially in 179 of the 187 countries—in women by 12.1 years and in men by 11.1 years. But the GBD 2010 also reveals that even though people are living longer, they're doing so at a cost of increased illness and disability. After the age of 50, people spend more time in pain or incapacitated as a result of musculoskeletal disease, diabetes, chronic respiratory disease, vision and hearing loss, and other conditions. Disabilities hit women especially hard. “Disability from disease and injury will become an increasingly important issue for all health systems,” writes Richard Horton, editor-in-chief of the Lancet and one of several commentators on the study.
Over the study period, deaths from noncommunicable diseases rose by 8 million and now account for two out of three deaths worldwide. Hypertension is the leading risk factor for disease, followed by smoking and alcohol. In 2010, heart disease or stroke killed 12.9 million people, accounting for one in four deaths. Diabetes killed 1.3 million people, twice as many as in 1990, and cancer killed 8 million, a third more than in 1990. Road-accident deaths rose, too, by 50%.
Deaths among children younger than nine years fell by 60% from 1970 to 2010, although not in sub-Saharan Africa, where childhood deaths increased by 45%.
HIV-related disease remains a leading cause of death in southern and eastern Africa and is the number-three killer in Eastern Europe. Most importantly, AIDS kills more young women (ages 15 to 49) than any other disease and is the second leading cause of death among men in the same age group.
Although the reports highlight remarkable health achievements, they also illustrate the ongoing and emerging challenges that require action. The new focus must be on the growing burden of noncommunicable diseases and longer lives that are accompanied by debilitating conditions.—Carol Potera