Global Burden of Disease: New Estimates of What’s Killing Us
March 15, 2013
Senior Adviser, Global Health Policy Center
The Seattle-based Institute for Health Metrics and Evaluation (IHME) recently published the most recent global estimates of disease burden that update the leading causes of death and disability across the world, based on data from 2010. It seems a devilishly complicated and ambitious endeavor. While a number of smart people have raised concerns about the reliability of the underlying data, the study report tells a powerful, compelling story about trends in mortality and disability.
- Within Africa, the greatest disease burden continues to come from maternal health, child health, and HIV, TB, malaria (U.S. funding investments align well with these top-line priorities).
- Outside of Africa, the burden of disease is changing rapidly and that is raising life expectancy.
- Non-communicable diseases are now the biggest killers across a broad spectrum of low, middle income and wealthy countries.
- People are living longer, and an increasing proportion of disease burden relates to chronic disability.
- Poor people in poor communities are increasingly impacted by “behavioral risks” such as tobacco and alcohol use.
Personally, I was particularly struck by what the report tells us about causes of death among children, including its breakdowns by age (see Figure 1). Newborns in their first month of life are most susceptible to a range of things that are grouped under labels like Preterm Birth Complications (29%), Neonatal Encephalopathy (17%), and Sepsis and Other Infectious Disorders (17%). In lay terms, this is premature birth, asphyxia during birth, or infections during or right after birth; in total, these causes claimed nearly 3 million children in 2010. According to the World Health Organization, two-thirds of these deaths are preventable.
For children who make it past the first month, their biggest risk comes from Lower Respiratory Infections (20%), Diarrheal Diseases (17%), and Malaria (12%). About 2 million children died in 2010 during this period from 28 to 364 days. Beyond the first year, malaria is the biggest killer of children, accounting for 21% of the 2 million deaths for those aged 1 to 4 years.
Together, from birth to 4 years of age, we lost 7 million children in 2010. Though down from the 12 million kids that died in 1990, it’s still a staggering number and ought to energize a lot more action (and funding) then it does. There have been some notable efforts, and we hope these translate into steep declines in the coming years. One that I’m especially encouraged about is the GAVI Alliance, which has been successful in attracting the financing needed to help the poorest countries immunize children. GAVI’s been an amazing investment, having already reached 370 million children since 2000. This greatly expanded access should dramatically lower child deaths from many vaccine-preventable illnesses, including rotavirus and pneumonia, and future disease burden analyses should reflect these gains.
As noted by Dr. Murray, the new data also remind us of the continued high burden in Africa from HIV, TB, and malaria. HIV/AIDS is the top killer of women ages 15-49 and the second leading killer of men in that same age bracket. The current and former UNAIDS directors (Michel Sidibe and Peter Piot, respectively) and the Global Fund’s new director (Mark Dybul), in a recent Lancet opinion piece, note that overall trends in HIV are positive, with declining death rates for all three diseases over the last five years studied (see Figure 2). But they also caution against letting our guard down: “…the persistent and substantial global burden associated with HIV and AIDS compels us to do more—and do better…”
Clearly, major shifts are underway across the globe that should inform how the U.S. and other major donors allocate their funding. Jennifer Kates from the Kaiser Family Foundation, who presented with Dr. Murray, noted that funding levels for health from the U.S. and other major donors have flattened, so “any discussions about future policy decisions or directions are really about trade-offs and prioritizing, and the risk [is] there because there's tremendous unfinished business.” She also points out that U.S. support for non-communicable diseases outside of Africa could take the form of diplomatic engagement, technical expertise, and research collaborations rather than traditional donor financing or services and projects.
It’s great to hear that these data are now going to be updated annually, and that there’s work underway to make them more accessible, including to non-technical people (like me!). Hopefully, donors will also support efforts in poorer countries to improve the quality of data they gather and to use them to guide their own health strategies.