To improve how people live, we must understand the reasons people die.
Further, knowing how and why people get sick, contract disease and manage chronic conditions helps determine where communities and health organizations allocate resources for everything from research to health services provided. This means we have to understand mortality (death) and morbidity (the condition of suffering from a medical condition or disease) through characteristics such as geographic location, age and sex.
Changes over time also give us insight into the evolutions that take place for humans and the world around us. Thus, the importance of a new WHO report that investigates the top 10 causes of death and disability between 2000 and 2019. Not only are there significant findings about what humans have and haven’t changed in the last 20 years, but great implications for what we have seen – and will continue to see – play out during the Covid-19 pandemic. It also allows for a timely comparison for how morbidity and mortality will be impacted by, and as a result of, the pandemic.
According to WHO’s Global Health Estimates, here’s what we know about how humans were living and dying around the world before Covid-19:
- People are living longer. Globally, life expectancy increased by more than 6 years between 2000 and 2019. The average person lived about 67 years in 2000, but just over 73 years in 2019.
- However, we’re living with more disability. Many of the diseases and health conditions that cause the most deaths are those that also take away healthy years of life. Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease are affecting more people globally. All of which are pre-existing conditions that put people at higher risk of complications and death due to COVID-19.
- Heart disease has remained the leading cause of death at the global level for the last 20 years. However, it is now killing more people than ever before, making up 16% of total deaths.
- For the first time, diabetes and dementia entered the top 10 causes of death worldwide.
- Alzheimer’s disease and other forms of dementia are ranked 3rd in both the Americas and Europe in 2019. Unsurprisingly, due to longer life expectancy, women are disproportionally affected, making up about 65% of deaths from Alzheimer’s and other forms of dementia.
- Neonatal conditions (defined as 0-28 days from birth) are still ranked 5th for overall cause of death in the world, but there were vast improvements. More than a million less newborns and young children died from neonatal conditions in 2019 than in 2000. But sadly, disproportionate numbers of young children die in low-income countries, where neonatal conditions remain the leading cause of death.
- The Americas stood out from all other regions of the world with drug use as a significant contributor to both disability and death. Between 2000 and 2019 there was almost a threefold increase in deaths from drug use disorders in the Americas. And, it’s the only region for which drug use disorder is a top 10 contributor to healthy life-years lost because of premature deaths and disability. No other region had drug use in the top 25.
- In 2019, the 4th leading cause of death was pneumonia and other lower respiratory infections, proving to be the deadliest group of communicable diseases. This could have big implications going forward as it pertains to the respiratory impact of Covid-19 infections. However, compared to 2000, lower respiratory infection of deaths decreased by nearly half a million globally showing improvements pre-pandemic.
- In positive news, tuberculosis and HIV/AIDS both dropped out of the top 10 causes of death between 2000 (7th and 8th, respectively) and 2019 (13th and 19th, respectively). According to the WHO, these changes reflect successful prevention efforts over the last two decades.
- Unfortunately, although tuberculosis is no longer in the global top 10, it does remain among the top 10 causes of deaths in the African and South-East Asian regions. In fact, WHO reports Africa saw an increase in tuberculosis mortality after 2000. But it has started to decline in recent years.
- Communicable diseases are still taking a toll in low-income countries. Diseases such as malaria, tuberculosis and HIV/AIDS remain significant problems. Of further concern is that WHO reports “slow-downs or plateauing of progress” against infectious diseases in these regions before 2020, which will likely continue to suffer greatly as the Coronavirus pandemic continues.
- A shocking finding was that deaths from diabetes increased by 70% globally between 2000 and 2019. Further, there was an estimated 80% rise in deaths among males due to diabetes. Specifically, in the Eastern Mediterranean deaths from diabetes more than doubled, representing the greatest percentage increase of all WHO regions.
- Since 2000, the African region has seen a significant rise in road traffic injuries, resulting in an almost 50% increase in both death and healthy life-years lost. This plays a role in the life expectancy differences between the sexes as road traffic injuries are 75% male drivers.
While it is important to know why people die, what it really tells us is how people live. Monitoring how many people die each year – and how many years of healthy life were lost due to disability – helps to assess the effectiveness of health systems and support timely and effective decision-making ranging from lifestyle choices to medical prevention and intervention and community endeavors.
However, while this new WHO report lends insight into where we are improving and where we are faltering (as well as the unequal distribution of prevention and medical measures) a lot of important data is still critically absent. Meaning that what we know still under-reports much of what’s happening, particularly in lower-income countries. 2020 will certainly be a year of changes, and despite not having perfect data, we have an informative baseline from which to understand those changes.