Tommy Trenchard for NPR
What is the biggest driver of human suffering?
Every year an international team of researchers aims to answer that question by compiling a set of data called the “Global Burden of Disease.” It has become a source for monitoring and ranking the impact of almost every disease or condition that kills, offends or otherwise disables people in almost every country on the planet.
But this year’s report also points to some intriguing solutions – researchers highlighted in a piece published this week in the medical journal The Lancet at the same time their latest data release.
To learn more, NPR spoke with project scientist Christopher Murray of the University for Washington’s Institute for Health Metrics and Evaluation. Here are three takeaways:
1. The key to health is … wealth. (And education … and women’s rights).
The Global Burden of Disease is not just made up of health data. Researchers have also compiled and analyzed measures for economic and social well-being over time – including per capita income, average educational attainment and women’s status (shown). of the average number of children born to a woman there)
And in these socioeconomic fields, researchers have found that since 2000 the worst countries have taken enormous steps. “The bottom 20% of countries are catching up. They are now developing at a faster rate than the top countries,” Murray said.
During this same period the poorest nations have also seen major benefits in so-called “healthy life expectancy” – or as Murray puts it “how many years you expect to live in full health.”
And here’s the kicker: Through statistical analysis, Murray and his colleagues have shown that almost all of this increase in healthy life expectancy is a direct result of gains in income, education and status of women.
For example, between 2000 and 2019, for countries at the absolute lowest socio-economic level, healthy life expectancy rose by 9 years. And almost 80 percent of that increase can be explained by their socioeconomic development at the same time.
One precaution is the less pronounced link for countries at the higher end of the socioeconomic level. But for the poor the lesson seems clear, Murray says: One of the most effective ways to boost people’s health is to focus on advancing their social and economic development.
2. We need to pay attention to “infectious” diseases.
As wonderful and commendable as the health achievements in poor countries are, one downside is that they focus on only four types of ailments: communicative, maternal, neonatal and nutritional
This is not surprising, Murray said. Conditional problems that allow these diseases to develop tend to disappear as a country becomes richer and more educated and gives higher status to women.
For example, Murray says, “once people and society have more resources they are more likely to face water supply and sanitation. Also major malnutrition begins to disappear.” Both factors play an important role in how many children in a country contract infectious diseases that kill them before the age of 5.
In fact, one of the best outcomes of the last 20 years is that the annual death toll in children under the age of 5 has dropped from 9.6 million in 2000 to nearly 5 million in 2019.
Unfortunately, says Murray, many of the drivers of various disease categories – known as “non-communicable diseases” – actually tend to get more severe as countries begin to raise socio-economic levels.
Get air pollution – linked to lung cancer and other respiratory diseases. “You know, if you’re in a preindustrial society, there’s not a lot of air pollution,” Murray said. “As industrialized societies tend to deteriorate.”
Other risk factors that worsen as countries progress include the incidence of overweight, high blood sugar and high blood pressure – which are variously associated with diabetes and heart disease.
The result is that the achievements of poor countries against the first category of diseases – infectious, maternal, neonatal and nutritional – in the last 20 years have not been matched by development in response to non-communicable diseases. So today, the non-communicable disease carries a much larger share of the health burden faced by low-income countries. Specifically, between 1990 and 2019 non-communicable diseases ranged from providing about 40% of the health burden to 66%. (The Global Burden of Disease project measures the health burden as the number of healthy years of disease in a country per year.)
Unfortunately, many countries and health systems are still being set up as if the biggest source of poor health are infectious diseases. “Because of the way people train, governments are often focused on the problems of the last generation and not the current one,” Murray said.
“Ride to a place like Indonesia,” he added. “It’s really just dramatic. Now more than 80% of the health burden is on infectious diseases. But [those] is not the main focus of policy development. They are still worried about past problems. “
India is another example, Murray said. “They have a big problem with high blood pressure, and there should be a national strategy to get more people to primary care and treat their blood pressure,” he said. And yet, “they really don’t have a national approach to blood pressure.”
3. Preparing for the next pandemic … could mean taxing on soda pop.
Any national strategy aimed at non-sharing disease is needed to address the behaviors of both individuals and corporations, Murray said. That is because many of the risk factors involved are related to corporate decisions – what they put into our diet – and our own choices about what (and how much) we consume and whether how much do we use.
Murray suggests taking lessons from a government success story can point when it comes to suppressing a risk factor for non-communicable diseases: smoking. “We learned that regulatory and taxation strategies continue to evolve [on smoking] in recent decades, “Murray said. After all, the more inaccessible and expensive tobacco is, the less people are likely to use it.
It can be difficult to build support for regulatory measures – just look at the pushback against the tax on sugar beverages in many countries. But Murray said it could help to consider these techniques not only as efforts to address non-communicable diseases but as an important element of the world’s strategy for preparing for the next pandemic.
Prior to COVID-19, he said, health experts specializing in infectious diseases and pandemic readiness “lived in separate universes.” Then, he said, “COVID-19 suddenly came along and we found out that excess weight and blood pressure were the main determinants of your risk of dying from COVID. And it emphasizes how we have an older population and more of these factors are at risk and we are creating more vulnerabilities. “
The sound risk factors that Murray said in this year’s report are also alarming: “I think this is an encouraging set of findings. There are many things we recognize where governments can take action. and individuals. “