Every year an international team of researchers tries to answer this question by compiling a mammoth data set called “Global Burden of Disease”. It has become the focal point for tracking and grading the effects of virtually any disease or illness that kills, makes sick, or otherwise impedes people in virtually every country on earth.
However, this year’s report also points to some fascinating solutions that were highlighted by the researchers in an article published in the medical journal this week The lancet that accompanies their latest data release.
To learn more, NPR spoke to the researcher leading the project, Christopher Murray of the Institute of Health Metrics and Assessment at the University of Washington. Here are three food stalls:
1. The key to health is… wealth. (And education … and women’s rights).
The global burden of disease is not just about health data. The researchers also pull together and analyze measures related to economic and social well-being over time – including each country’s per capita income, average level of education, and the status of women (which is reflected in the typical number of children who have a Woman gives birth there).
And on these socio-economic fronts, researchers find that the worst-off countries have made tremendous strides since 2000. “The bottom 20% of countries are catching up. They are now developing faster than the upper countries, ”says Murray.
In the same period, the poorest countries also saw significant increases in so-called “healthy life expectancy” – or as Murray puts it: “How many years can you expect to be in full health?”.
And here’s the kicker: through statistical analyzes, Murray and his staff were able to show that almost the entire increase in healthy life expectancy was the direct result of increases in income, education and women’s status.
For example, between 2000 and 2019, healthy life expectancy increased by 9 years for countries at the absolute lowest end of the socio-economic scale. And almost 80 percent of that increase could be explained by their socio-economic progress over the same period.
One caveat is that the association was much less pronounced for countries at the top end of the socio-economic scale. But for the poor, the lesson seems clear, says Murray: One of the most effective ways to improve people’s health is to focus on promoting their social and economic development.
2. We need to pay more attention to “non-communicable” diseases.
As impressive and laudable as the health benefits in poor countries, one drawback is that they focus on only four types of disease: communicable, maternal, neonatal, and dietary.
That’s not surprising, says Murray. The problematic conditions in which these diseases can thrive tend to go away as a country gets richer, more educated, and gives its women higher status.
For example, says Murray, “once people and societies have more resources, they tend to concern themselves with water supplies and sanitation. Basic malnutrition is also beginning to go away. ”Both factors play a key role in the number of children in a country who develop infectious diseases, which kill them before the age of five.
In fact, one of the best results in the last 20 years has been that the annual number of deaths among children under 5 years of age fell from 9.6 million in 2000 to around 5 million in 2019.
Unfortunately, Murray says, many of the drivers of various disease categories – known as “non-communicable diseases” – tend to actually get worse when countries begin to improve the socio-economic scale.
Take air pollution – which is linked to lung cancer and other respiratory diseases. “You know, when you’re in a pre-industrial society, there isn’t a lot of air pollution,” says Murray. “With the industrialization of societies, things tend to get worse.”
Other risk factors that worsen as countries develop include the occurrence of obesity, high blood sugar and high blood pressure, which are variously related to diabetes and heart disease.
The result is that the gains poor countries have made over the past 20 years against this first category of diseases – communicable, maternal, neonatal, and dietary – have not been accompanied by advances in non-communicable disease control. Non-communicable diseases cause a far greater proportion of the health stress faced by low- to middle-income countries. In particular, between 1990 and 2019, non-communicable diseases contributed from around 40% to the health burden to 66%. (The Global Burden of Disease project measures health stress as the number of healthy years a country loses each year due to illness.)
Unfortunately, many countries and health systems are still set up as if the biggest cause of poor health are communicable diseases. “Very often, because of the way people are trained, governments focus on the problems of the last generation rather than the current one,” says Murray.
“Take a place like Indonesia,” he adds. “It’s really just dramatic. Now more than 80% of the health burden is non-communicable diseases. But [those] are not at the center of policy formulation. You are still worried about the previous issues. ”
India is another example, says Murray. “They have a big problem with high blood pressure and there should be a national strategy to get more people into primary care and get their blood pressure treated,” he says. And yet “they don’t really have a national blood pressure strategy.”
3. Preparing for the next pandemic … could mean taxing soda pop.
Any national strategy targeting non-communicable diseases would have to take into account the behavior of individuals and companies, says Murray. This is because many of the risk factors involved are related to decisions made by companies – what they put in our food – and our own decisions about what (and how much) we consume and how much we exercise.
Murray suggests drawing lessons from the governments of one success story can point out when it comes to reducing a risk factor for non-communicable diseases: smoking. “We found that regulatory and tax strategies have made sustained progress [on smoking] in the last few decades, “says Murray. The more inaccessible and expensive tobacco, the fewer people are likely to use it.
It can be difficult to build support for regulatory approaches – just look at the backlash against taxes on sugary drinks in many countries. However, Murray says it might be helpful to view these strategies not just as efforts to fight non-communicable diseases, but as an integral part of the global strategy in preparing for the next pandemic.
Before COVID-19, health professionals specializing in infectious diseases and pandemic preparedness lived “in separate universes”. Then he says, “All of a sudden, COVID-19 comes along and we are discovering that obesity and blood pressure are key factors in your risk of death from COVID. And it shows how we have older populations and more of those risk factors and we’re creating a far greater vulnerability. ”
As worrisome as these risk factors sound, Murray says of this year’s report, “I think these are important findings. We identify many things that governments and individuals can take action on. ”
Copyright 2020 NPR. Further information is available at https://www.npr.org.
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