Dramatic global health improvements save lives but new threats emerge

This was originally published on the Global Health TV on September 26, 2017.

Over the last decade, we’ve made great progress against diseases and health conditions that can kill people, especially children under 5, but because of political and budget challenges, we risk backsliding on those gains. And we’re facing a tsunami from health issues that do not always kills us – namely, obesity, conflict and mental illness – but cause poor health.

Those are my take-aways from two major reports that came out this month, one tracking how we are doing against the Sustainability Development Goals, particularly in global health, and the other a scientific study focused solely on global health.

“Goalkeepers: The Stories Behind the Data 2017,” a report from the Bill & Melinda Gates Foundation, was aimed at last week’s United Nations General Assembly. To draw attention to the report, the Gateses held a high-profile event featuring former President Barack Obama. The report touts the many global health advances that have been made but also cautions about the risks of complacency.

The Goalkeepers report plans to track 18 data points in the Sustainability Development Goals every year until 2030. The Gateses say their goal is “to accelerate progress by diagnosing urgent problems, identifying solutions, measuring results and spreading best practices.”

“Candidly, we are unlikely to reach every target – some are more realistic and some are more aspirational – but that doesn’t absolve us of the responsibility to get as close as we can,” write the Gateses.

The other report, the annual Global Burden of Disease (GBD) Study 2016, found that substantial progress has been made in driving down death rates from diseases and health conditions like lower respiratory infections, diarrhea, neonatal preterm birth, HIV/AIDS and malaria, which all declined by 30% or more in just ten years, according to the Institute for Health Metrics and Evaluation (IHME) which coordinated this year’s study.

“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, IHME director. “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.”

The Gateses highlight excellent global health and development news in Gatekeepers:

• The number of people living in extreme poverty (less than US $1.90/day) has declined from 35% in 1990 to 9% in 2016, with many of these decreases in China and India.
• After peaking in 2005, global HIV deaths per 1,000 people dropped dramatically from 0.3 deaths per 1,000 people to 0.14.
• The number of children under 5 dying dropped from 11.2 million in 1990 to 5 million in 2016.
• 300 million women now have access to contraception

The fight against HIV is increasingly seen as a global health success story. “2005 was when the world made the commitment to get low-cost drugs out to as many people as possible and something wondrous took place,” Bill Gates said at the event with Barack Obama. “The number of AIDS deaths came down dramatically. We had funding, we had commitments, we had people thinking about how to get those drugs out there. But now there really is a risk that the death rate could go back up. So we are challenged to maintain the funding.”

Child health is another bright spot. In 2016, for the first time in modern history, fewer than 5 million children under age 5 died in one year. Researchers attribute this accomplishment to a variety of factors – improvements in education of mothers, rising per capita incomes, declining fertility, increased vaccination, mass distribution of insecticide-treated bed nets, improved water and sanitation and other factors. But if we regress, says the report, we will lose an additional 800,000 children under 5 per year by 2030.

The “triad of trouble” cited in the GBD Study 2016 points to the growing and pernicious effects of non-communicable diseases (NCDs) in developing countries.

• Obesity: The rate of illness related to people weighing too much is rising quickly. High body mass index is the fourth contributor to the loss of health life (after high blood pressure, smoking and high blood sugar).
• Conflict: Deaths over the past decade due to conflict and terrorism have more than doubled. Last week at the UN General Assembly, Secretary-General Antonio Guterres and World Bank President Jim Yong Kim launched a report calling for greater political and financial commitments to prevent conflict. The bank and the U.N. are focusing on mitigating famine conditions in South Sudan, Yemen, Somalia and Nigeria.
• Mental illness and substance abuse: These disorders continue to contribute to the loss of healthy life in 2016, affecting both rich and poor countries. Treatment rates remain low and even in rich countries, prevalence of the most common disorders has not changed.

The study found much other evidence on the growing impact of NCDs including the fact that NCDs were responsible for 72% of all deaths worldwide in 2016, as compared to only 58% in 1990.

The full Gatekeepers report can be found here. The Global Burden of Disease 2016 study was published in The Lancet.