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  Center for Family and Community Health
 The UC Berkeley Prevention Research Center
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     University of California, Berkeley
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 A CDC Center for Chronic Disease Prevention
       and Health Promotion Research 
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New �Burden of Disease� study shows world�s people living longer but with more disability

David Brown, Washington Post, December 13, 2012

How long will we live � and how well? A new analysis looks not only at the number of years we can expect to live, but also at the number of years we can expect to live in good health. In most of the world, life expectancy is longer than it was 20 years ago, but often a smaller percentage of those years will be healthy ones.

Interactive graphic: http://www.washingtonpost.com/wp-srv/special/health/healthy-life-expectancy/

The health of most of the planet�s population is rapidly coming to resemble that of the United States, where death in childhood is rare, too much food is a bigger problem than too little, and life is long and often darkened by disability.

High blood pressure is now the leading �risk factor� for disease around the world. Alcohol use is the third. Low back pain now causes more disability than childbirth complications or anemia.

�We are in transition to a world where disability is the dominant concern as opposed to premature death,� said Christopher J. L. Murray of the University of Washington, who headed the Global Burden of Disease Study published Thursday. �The pace of change is such that we are ill prepared to deal with what the burden of disease is now in most places.�

Produced over five years by 486 researchers at 302 institutions in 50 countries, the study is the most detailed look at health on the population level ever attempted.

It charts the effect of 235 causes of death, everything from AIDS and alcoholism to bladder cancer and animal bites. It examines the effects of 67 �risk factors� � as diverse as not enough fruit in the diet to childhood sexual abuse � that can lead to illness.

The calculations are made for two points in time � 1990 and 2010. As a consequence, the study reveals how the world�s health has changed over two decades and provides a trajectory of where it may be headed. The purpose is to give governments, international agencies, donors and researchers an idea of what to plan for.

The study provides both a broad-brush portrait of 7 billion people and a detailed etching of what�s happening in 187 individual nations.

Heart disease and stroke were the first- and second-leading causes of death in 1990 and remained so in 2010. Over that two-decade period, however, malnutrition dropped from the 11th to the 21st cause of death. Diabetes, car accidents and lung cancer all rose in the rankings.

Africa remains the one place where afflictions of the poor � AIDS, malaria, childhood infections, malnutrition, childbirth calamities � remain hugely important. They account for three-quarters of all premature deaths.

The study also reveals many highly localized variations in health.

As a consequence of Haiti�s 2010 earthquake, Haitian men had the globe�s lowest life expectancy that year: 33 years. Egypt has the highest rate of cirrhosis of any country, caused by hepatitis C unwittingly transmitted to millions of people through unclean needles used in public health campaigns against the tropical infection schistosomiasis. Ethio�pian men gained 13 years of �healthy life expectancy� between 1990 and 2010, the most of any group in the world. There�s a �homicide belt� in Latin America and a �suicide belt� in Asia.

The package of seven papers totaling 196 pages is being published in the Lancet. It is the first time an entire issue of the journal has been given over to one research study.

Although population aging, declining poverty and smaller family size have been the major forces changing the world�s health profile over the last two decades, improvements in medicine and public health have also made a huge difference. Measles tells the story.

In 1990, 631,000 people died from that childhood infection, which was the world�s 19th leading cause of death. In 2010, only 125,000 people died from measles, which had fallen to the 62nd leading cause.

�There have been very, very big payoffs in all the investments made to improve child survival,� said Alan D. Lopez, the dean of the school of population health at the University of Queensland in Australia, who with Murray led the project.

Those investments include vaccines, vitamin A and zinc supplements, antibiotics for children with pneumonia, insecticide-treated mosquito nets for children to sleep under in malaria zones, and better obstetrical care, among other things.

The risk of dying prematurely from many �adult� diseases (such as heart attacks and cancer) has also fallen because of better treatment and prevention. As a result, the average age of the world�s population is getting older. Soon after 2015, for the first time in history there will be more people over 65 years old than under the age of five.

That has had two consequences.

More people are surviving to die of diseases that only occur in old age. These include Alzheimer�s disease, deaths from which tripled from 1990 to 2010, and Parkinson�s disease, whose deaths doubled. At the same time, people are living with conditions that don�t kill them but that affect their health.

�These are things like mental disorders, substance abuse, musculoskeletal pain, vision loss, hearing loss,� Murray said. �They cause a huge amount of disability but not a whole lot of death.�

People are living longer lives, but the time they are gaining isn�t entirely time with good health. For every year of life expectancy added since 1990, about 9¹ / ₂ months is time in good health. The rest is time in a diminished state � in pain, immobility, mental incapacity or medical support such as dialysis. For people who survive to age 50, the added time is �discounted� even further. For every added year they get, only seven months are healthy.

�People are living longer, and usually with several conditions. Is that a bad thing? Not necessarily. It is the old �victims of our success� argument,� Murray said.

The trend of adding increasing amounts of bad health to life is known as the �expansion of morbidity.� It�s likely to be the biggest challenge to patients, doctors and people who pay for medical care for the next few centuries.

http://www.washingtonpost.com/national/health-science/burden-of-disease-study-shows-a-world-living-longer-and-with-more-disability/2012/12/13/9d1e5278-4320-11e2-8061-253bccfc7532_story.html

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Global Burden of Disease Study 2010

Lancet, Dec 13, 2012

Executive summary

The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

GBD 2010 consists of seven Articles, each containing a wealth of data on different aspects of the study (including data for different countries and world regions, men and women, and different age groups), while accompanying Comments include reactions to the study's publication from WHO Director-General Margaret Chan and World Bank President Jim Yong Kim. The study is described by Lancet Editor-in-Chief Dr Richard Horton as "a critical contribution to our understanding of present and future health priorities for countries and the global community."

http://www.thelancet.com/themed/global-burden-of-disease