Global health is improving, so is global health information

Yesterday we released World Health Statistics 2017: Monitoring health for the SDGs. This WHO flagship publication compiles data from the organization’s 194 Member States on 21 health-related SDG targets, providing a snapshot of both gains and threats to the health of the world’s people. While the quality of health data has improved significantly in recent years, many countries still do not routinely collect high-quality data to monitor health-related SDG indicators.

However, there have been improvements in data collection. We highlight that now almost half of all deaths globally are now recorded with a cause. Of the estimated 56 million deaths globally in 2015, 27 million were registered with a cause of death, according to WHO’s annual World Health Statistics. In 2005, only about a third of deaths had a recorded cause. Several countries have made significant strides towards strengthening the data they collect, including China, Turkey and the Islamic Republic of Iran, where 90% of deaths are now recorded with detailed cause-of-death information, compared with 5% in 1999.

 

 

 

 

 

 

 

 

 

 

 

 

 

As reported last year, overall global health is improving. Average life expectancy at birth has increased by five years globally, and more than 9 years in Africa. This year we report that premature mortality from the four main non-communicable diseases (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases) has declined by 17% since the year 2000.  This is driven mainly by improvements in cardiovascular disease mortality in high income countries, and chronic respiratory disease mortality in low and middle income countries. Cancer mortality is also declining, but more slowly.

The report also includes new data on progress towards universal health coverage. Those data show that globally, ten measures of essential health service coverage have improved since 2000. Coverage of treatment for HIV and bed nets to prevent malaria have increased the most, from very low levels in 2000. Steady increases have also been seen in access to antenatal care and improved sanitation, while gains in routine child immunization coverage from 2000 to 2010 slowed somewhat between 2010 and 2015.

Access to services is just one dimension of universal health coverage; how much people pay out of their own pockets for those services is the other. The most recent data from 117 countries show that an average of 9.3% of people in each country spend more than 10% of their household budget on health care, a level of spending that is likely to expose a household to financial hardship.

A selection of additional results are also available in the press release. This is the 12th edition of World Health Statistics, which has been published annually since 2005.

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University of Sydney Award for contributions to global health

On 27 April, I was awarded the University of Sydney’s President’s Award for my contributions to global health monitoring. I did an Honours Degree in Science majoring in Physics and followed that with a PhD (1979) in theoretical physics. However i then applied my analytic and modelling skills in the field of population health, and my career has seen me working to improve international health outcomes. For 15 years I have led the WHO on global health statistics helping international agencies work together by having access to the same information.

You can read more at the following link: http://sydney.edu.au/news-opinion/news/2017/04/24/global-health-pioneer-receives-prestigious-university-award.html

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Future life expectancy in 35 industrialized countries: projections to year 2030

Today, the Lancet published our study projecting life expectancy trends to 2030 for 35 countries:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/abstract

Life expectancy at birth is projected to exceed 90 years for Korean women in 2030, a level of average life expectancy many thought impossible to achieve.  South Korean men are also likely to lead at 84.1 years, closely followed by Switzerland and Australia. The USA is likely to have the lowest life expectancy at birth in 2030 among high-income countries, with levels similar to that of middle-income countries like Croatia and Mexico. My colleague, Professor Majid Ezzati at Imperial College London, says this may be due to a number of factors including a lack of universal affordable access to health services, as well as the highest child and maternal mortality rate, homicide rate and obesity among high-income countries.

The study was led by Majid Ezzati at Imperial College, London, with much of the statistical work carried out by Vasilis Kontis and James Bennett. I collated the country mortality data from the WHO Mortality Database and contributed to the development of the methodology and the interpretation of results. Countries in the study included both high-income countries, such as the USA, Canada, UK, Germany, Australia, and emerging economies such as Poland, Mexico and the Czech Republic. The methods involved development and averaging of an ensemble of 21 Bayesian forecasting models, all of which contributed probabilistically to the final projections. The Bayesian model averaging (BMA) resulted in smaller projection errors than the best single model. The projection errors were assessed by projecting withheld data.

Projected life expectancy at birth in the year 2030

Projected life expectancy at birth in the year 2030

The BMA projections resulted in probability distributions of life expectancy in 2030. The paper included graphical presentations of these posterior probability distributions, as shown in the Figure above  for projected life expectancy at birth. The red dots indicate the median projected life expectancy, and countries are ordered vertically by this median.  A baby girl born in South Korea in 2030 will expect to live 90.8 years (median projection). Life expectancy at birth for South Korean men will be 84.1 years. The British Telegraph newspaper also reproduced one of these graphs, and I suspect it is the first time a tabloid newspaper has given its readers information on Bayesian posterior probability distributions for anything.

http://www.telegraph.co.uk/science/2017/02/22/life-expectancy-study-shows-many-likely-live-beyond-90-2030/

The study also calculated how long a 65-year-old person may expect to live in 2030.  The results revealed that the average 65-year-old woman in South Korea in 2030 may live an additional 27.5 years, resulting in an average age at death of 92.5 years.

James Fries in the late 1980s argued that the 85 years represented the upper limit of human life expectancy at population level (the upper limit of individual longevity is somewhere above 120 and probably at present below 130). Others such as Olshansky have also forcefully argued that we will not see much more substantial progress in life expectancy.  However this study suggests we will break the 90-year barrier, and we may still be a long way from the upper limit of life expectancy – if there is one.

I spoke about the results of this study today on the BBC World Service and on the BBC television news. They also published an article on their website:

http://www.bbc.com/news/health-39040146

Other findings from the study include:

  • The five countries with the highest life expectancy at birth for men in 2030 were: South Korea (84.1), Australia (84.0), Switzerland (84.0), Canada (83.9), Netherlands (83.7)
  • The five countries with the highest life expectancy at birth for women in 2030 were: South Korea (90.8), France (88.6), Japan (88.4), Spain (88.1), Switzerland (87.7)
  • The five countries with the highest life expectancy for 65-year-old men in 2030 were: Canada (22.6 additional life years), New Zealand (22.5), Australia (22.2), South Korea (22.0), Ireland (21.7)
  • The five countries with the highest life expectancy for 65-year-old women in 2030 were: South Korea (27.5 additional life years), France (26.1), Japan (25.9), Spain (24.8), Switzerland (24.6)
  • The five countries in Europe with the highest life expectancy at birth for men in 2030 were: Switzerland (84.0), Netherlands (83.7), Spain (83.5), Ireland (83.2) and Norway (83.2)
  • The five countries in Europe with the highest life expectancy at birth for women in 2030 were: France (88.6), Spain (88.1), and Switzerland (87.7), Portugal (87.5) and Slovenia (87.4).
  • The UK’s average life expectancy at birth for women will increase from 82.3 years in 2010 to 85.3 years in 2030. This places them 21st in the table of 35 countries (compared to 22nd in 2010).
  • The average life expectancy of a UK man at birth will increase from 78.3 years in 2010 to 82.5 years in 2030. This places them 14th in the table of 35 countries (compared to 11th in 2010).
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One of the world’s most influential scientific minds…..

I have been included for the second time in the Thomson Reuters list of “Highly Cited erResearchers”. Around 3,000 researchers, in 21 fields of the sciences and social sciences, were selected for the recently released 2016 list based on the number of highly cited papers (in the top 1% for papers in their field for number of citations from January 2004 to December 2014). My papers were classified in the field of medicine, making me one of the 377 “of the world’s most influential scientific minds” in this field, or perhaps more broadly in the health field.  I am the only person from WHO on the list, but several academic colleagues are there:  Harry Campbell (University of Edinburgh), Majid Ezzati (Imperial College), Simon Cousens (London School of Hygiene and Tropical Medicine), Juergen Rehm (University of Toronto) and Chris Murray, Alan Lopez and Mohsen Naghavi (University of Washington).

http://hcr.stateofinnovation.thomsonreuters.com/?_ga=1.240755651.1589634766.1477833109

http://ipscience.thomsonreuters.com/news/clarivate-analytics-names-2016-highly-cited-researchers/

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More than 1 billion people globally are living with high blood pressure

This finding come from a new study published last Tuesday in The Lancet, which found that the number of people affected by high blood pressure has almost doubled over the past 40 years: lancet.com/high_blood_pressre

The study highlighted a stark contrast between where people are most affected, with high-income countries showing declines in blood pressure among their populations in recent decades, while low- and middle-income countries have seen substantial increases — particularly in South Asia and Africa. Half the world’s adults with high blood pressure now live in Asia, and high blood pressure is a condition of poverty, not affluence.

gr4_lrgmgr4_lrgfThe study was led by Professor Majid Ezzati at Imperial College, London in collaboration with WHO staff, including my colleague Gretchen Stevens. Hundreds of scientists around the world also collaborated in compiling data from  1,479 population-based studies that had measured the blood pressures of 19·1 million adults. These data were used to estimate trends from 1975 to 2015 in blood pressure distributions for 200 countries. Other analyses by WHO and the Imperial College group have estimated that raised blood pressure causes  7.5 million deaths globally, almost 13% of all deaths.

This study has provided the most complete picture to date of long-term trends in adult blood pressure for all countries and provides important guidance for addressing the global target set by the WHO World Health Assembly to reduce the prevalence of high blood pressure by 25% by 2025.

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Progress in reducing child deaths: updated estimates of causes and trends

Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. A paper published last week examined updated estimates of causes of child death, the cause-specific contributions to progress toward the MDG 4 and considered implications for the Sustainable Development Goals (SDG) target for child survival:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31593-8/fulltext

This work is part of a collaboration between WHO and  an academic research group on Maternal and Child Epidemiology Estimation (MCEE) funded under by a grant from the Bill and Melinda Gates Foundation.

The causes of the 5.9 million deaths of children under 5 is summarized in the following Figure 1 from the paper.

Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR between 2000 and 2015 (see Figure 2 below, from the Lancet paper). Most of these causes relate mainly to the period 1-59 months after the neonatal period. The faster decline in these “post-neonatal” causes over the last 15 years has resulted in preterm birth complications now being the leading cause of under 5 deaths in 2015.

childcod_lancet_2016-5

However, pneumonia remains the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia are both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR.

This year, 2016, marks the beginning of the UN implementation of the Sustainable Development Goals (SDGs). The SDGs target an U5MR of no more than 25 per 1000 livebirths in every country of the world in 2030.

Achievement of the SDG target, would require a 58% reduction in U5MR between 2015 and 2030, higher than the 55% reduction achieved between 2000 and 2015.  This will require substantial progress for countries in sub-Saharan Africa and Southern Asia, with a particular focus on preventing preterm births and preterm birth complications, as well as continued focus on infectious causes such as pneumonia, diarrhoea, malaria, meningitis and sepsis.

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Major improvements in global life expectancy, Africa is starting to catch up

WHS2016cover copy1Today we released World Health Statistics 2016, our annual publication summarizing information on the health of the world’s people . Global average life expectancy increased by 5 years between 2000 and 2015, the fastest increase since the 1960s. Those gains reverse declines during the 1990s, when life expectancy fell in Africa because of the AIDS epidemic, and in Eastern Europe following the collapse of the Soviet Union. The gap between African life expectancy and European life expectancy has narrowed by 4.9 years since the year 2000. Big contributors to the African increase were improvements in child survival, progress in malaria control and expanded access to antiretrovirals for treatment of HIV.
The report is available at

http://www.who.int/gho/publications/world_health_statistics/2016/en/

World Health Statistics 2016 contains data from 194 countries on a range of mortality, disease and health system indicators, including life expectancy; illness and death from key diseases; health services and treatments; financial investment in health; and risk factors and behaviours that affect health. This is the 11th edition of World Health Statistics, which has been published annually since 2005.

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This year we changed the format quite a bit, to focus on the health-related targets within the Sustainable Development Goals (SDGs) adopted by the United Nations General Assembly in September 2015. The report highlights significant data gaps that will need to be filled in order to reliably track progress towards the health-related SDGs. For example, an estimated 53% of deaths globally aren’t registered, although several countries — including Brazil, China, the Islamic Republic of Iran, South Africa and Turkey — have made considerable progress in that area.

lifw-expectancy-310x200The report provides baseline statistics for close to 200 countries for the 13 health targets, as well as for 9 health targets in other SDG goals. These and many other health indicators are also available online in the WHO’s Global Health Observatory (www.who.int/gho) which provides access to an online database of more than 1000 health indicators.
While the Millennium Development Goals focused on a narrow set of disease-specific health targets for 2015, the SDGs look to 2030 and are far broader in scope. For example, the SDGs include a broad health goal, “Ensure healthy lives and promote well-being for all at all ages”, and call for achieving universal health coverage. This year’s World Health Statistics shows that many countries are still far from universal health coverage as measured by an index of access to 16 essential services, especially in the African and eastern Mediterranean regions. Furthermore, a significant number of people who use services face catastrophic health expenses, defined as out-of-pocket health costs that exceed 25% of total household spending.

The World Health Statistics 2016 provides a comprehensive overview of the latest annual data in relation to the health-related targets in the SDGs, illustrating the scale of the challenge. Each year:
• 303 000 women die due to complications of pregnancy and childbirth
• 5.9 million children die before their fifth birthday
• 2 million people are newly infected with HIV, and there are 9.6 million new TB cases and 214 million malaria cases
• 1.7 billion people need treatment for neglected tropical diseases
• More than 10 million people die before the age of 70 due to cardiovascular diseases and cancer
• 800 000 people commit suicide
• 1.25 million people die from road traffic injuries
• 4.3 million people die due to air pollution caused by cooking fuels
• 3 million people die due to outdoor pollution
• 475 000 people are murdered, 80% of them men

Addressing those challenges will not be achieved without tackling the risk factors that contribute to disease. Around the world today:
• 1.1 billion people smoke tobacco
• 156 million children under 5 are stunted, and 42 million children under 5 are overweight
• 1.8 billion people drink contaminated water, and 946 million people defecate in the open
• 3.1 billion people rely primarily on polluting fuels for cooking

More detailed statistics for a wide range of health indicators are available in the WHO Global Health Observatory at  www.who.int/gho.

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