Worldwide, people are living longer than they were a decade ago, in large part because deaths from infectious diseases and childbirth complications have decreased. But people across the globe are living more years in poor health, particularly in countries where access to health care is problematic.
And deaths from conflict and terrorism have more than doubled in the past decade.
Those are some of the key findings from the latest Global Burden of Disease report published last Friday in a series of articles in The Lancet. This marks the 20th year of the report, which is funded by the Bill and Melinda Gates Foundation.
“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates,” said Dr. Christopher Murray, co-author of the report and director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, in a released statement. “But, we’ve been much less motivated to address issues leading to illnesses. A ‘triad of troubles’ — obesity, conflict, and mental illness, including substance use disorders — poses a stubborn and persistent barrier to active and vigorous lifestyles.”
Longer lives
The average global life expectancy in 2016 was 72.5 years — 75.3 years for women and 69.8 years for men — according to the report. That’s up from 65.1 years in 1990 and from 58.4 years in 1970.
Japan had the highest life expectancy in 2016 (83.9 years), while the Central African Republic had the lowest (50.2 years).
Average life expectancy in the United States was 78.9 years in 2016 — only the 58th highest life expectancy in the world. That’s our lowest ranking since 1970. Our life expectancy seems to have stalled, rising only 0.1 percent per year between 2010 and 2016 after increasing 1 percent per year during the previous five years.
The report calls out five countries — Ethiopia, the Maldives, Nepal, Niger, Portugal and Peru — for having shown improvements in their life expectancies that exceeded expectations. Peru and Niger, for example, had life expectancies about six years longer than would be expected based on their levels of economic development.
The report also notes that the life-expectancy gaps between wealthy and poor nations are shrinking.
Shifting causes of early death
A driving factor behind rising global life expectancies is the dramatic drop in early deaths from communicable diseases and from complications related to childbirth. Deaths from lower respiratory infections, diarrhea, HIV/AIDS, malaria and preterm birth all declined by 25 percent or more between 2006 and 2016.
A major exception to that trend, however, was dengue fever. Deaths from that mosquito-borne disease have increased by 81.8 percent since 2006, to 37,800 in 2016.
One of the most encouraging findings in the study involved young children, who often die of complications from an early birth. In 2016, fewer than 5 million children under the age of 5 died, compared to 11 million in 1990 and 16.4 million in 1970.
The report cites several factors for these positive milestones in global health, including higher levels of education among women, lower levels of poverty, wider use of vaccinations, safer water and sanitation systems, and greater distribution of anti-malaria bed nets.
On the other hand, noncommunicable diseases — such as heart disease, stroke, cancer and diabetes — are now responsible for almost three out of four (72.3 percent) of early deaths.
And deaths from those diseases are increasing. Early deaths associated with diabetes, for example, totaled 1.4 million in 2016, up 31 percent since 2006.
Another troubling trend involves deaths from conflict and terrorism, which numbered 150,500 in 2016. That’s an increase of 143 percent since 2006, and is largely due to conflicts in North Africa and the Middle East, the report says.
Living longer with illness
People may be living longer across the globe, but they are also spending more years in ill health, particularly in poorer countries without access to quality health care, as the report also makes clear.
The biggest fatal contributors to this ill health are high blood pressure, smoking, high blood sugar and obesity. The biggest nonfatal contributors are low-back pain, migraines, hearing loss, anemia, depression and substance abuse disorders.
Mental illness and substance abuse disorders affected more than 1 billion people in 2016, yet access to treatment for these health problems remains abysmally low, even in high-income countries, the report notes.
The report also cites poor diet — one low in whole grains, fruits, vegetables, nuts, seeds and fish oil — as a factor in both ill health and in one in five early deaths.
“Unless and until the world addresses behavioral risks effectively, advances in life expectancy and well-being will continue to be compromised,” said Murray.
FMI: You can read the “Global Burden of Disease” report in full on The Lancet’s website. The IHME has posted some interactive tools on its website, if you want to dig deeper into the data.
Changing approaches
There are multiple facets to life expectancies, and they each deserve their own story. I’ll address just one.
Mr. Sessions’ obsession obsession with illegal substance use notwithstanding, I’m inclined to think that we (the state, the country, the world) would be much better off if substance abuse was approached and treated as a matter of public health rather than criminal conduct. I speak/write as a life-long teetotaler who’s never used an illegal substance, and would much prefer that they not be used at all. Until we start to treat it as a medical condition (or, if you want something more dramatic, a “disease”), our approach to drug use will continue to be schizophrenic, and will continue to fail. It’s illogical and counterproductive to treat drug use and alcohol use as is they have nothing to do with each other. Yet we legislate and regulate one while we criminalize the other.
Want to put drug dealers away? Go after your local (or national) liquor store operator and see how far you get. That’s how illogical our current policies are. I can sell you enough alcohol to kill yourself with, and do so without legal repercussions in many/most instances. If I sell you enough cocaine or heroin to accomplish that same thing, I’m a murderer as far as the law is concerned. It makes no sense, and we have ample historical and empirical evidence that prohibition simply does not work. Addictive behavior ought to be approached as the mental health issue that it is.