The third edition of Disease Control Priorities was launched by the WHO Director General, Dr Tedros Adhanom, in London earlier this month. These nine volumes provide up-to-date evidence on priorities that countries should consider in order to reach Universal Health Coverage. The 9th and last volume includes a chapter from my team that summarizes global and regional patterns of causes of death for 2015 and trends for 2000–15 (chapter-deaths-cause-2000-and-2015). Further information available on the DCP3 website at http://dcp-3.org/
The chapter colleagues and I contributed to Volume 9 summarizes global and regional patterns of causes of death for 2015 and trends for 2000–15 using the 2015 Global Health Estimates (GHE 2015) released by WHO in early 2017. This period marks the end point for the Millennium Development Goals (MDG) and the starting point for the Sustainable Development Goals (SDGs) for the year 2030. This chapter documents major changes during the MDG era. Progress toward the MDGs, on the whole, has been remarkable, including, for instance, poverty reduction, improved education, and increased access to safe drinking water. Progress on the three health goals and targets has also been considerable. Globally, the HIV/AIDS, tuberculosis, and malaria epidemics have been “turned around,” and child mortality and maternal mortality have decreased greatly (53 percent and 44 percent, respectively, since 1990), despite falling short of the MDG targets. Large reductions in mortality have occurred in Sub-Saharan Africa since the early 2000s, coinciding with increased coverage of HIV/AIDS treatment, methods of malaria control, and scale-up of vaccination coverage. Despite this progress, major challenges remain in achieving further progress on child and maternal mortality and on infectious diseases such as HIV/AIDS, tuberculosis, malaria, neglected tropical diseases, and hepatitis.
The rate of increase in life expectancy in LICs over the past 15 years has exceeded the rate of growth observed for life expectancy in the countries with the highest life expectancies. Longer life expectancies and population aging have resulted in an increased focus on NCDs and their risk factors in LMICs and in HICs. Three-quarters of NCD-related deaths occurred in LMICs in 2015.
The SDGs expand the focus of health targets from the unfinished Millennium Development Goals (MDG) agenda for child and maternal mortality and priority infectious diseases to a broader agenda including noncommunicable diseases (NCDs), injuries, health emergencies, and health risk factors as well as a strong focus on universal health care. The GHE 2015 estimates of trends and levels of mortality by cause will contribute to WHO and UN monitoring and reporting of progress toward the SDG health goals and targets.
Overall, the nine volumes identify 21 essential packages of health interventions across five delivery platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines essential universal health coverage in terms of 218 cost-effective interventions that provides a starting point for country-specific analysis of priorities. In the Foreword to Volume 9, Bill and Melinda Gates describe DCP3 as innovately addressing the different needs of countries at different stages in the development of their health systems. DCP3 maps out pathways—essential packages of related, cost-effective interventions—that countries can follow to accelerate progress toward universal health coverage.
The Disease Control Priorities projects provide fitting book-ends to my career in international health statistics. The first Disease Control Priorities project stimulated the original Global Burden of Disease Study for the year 1990 at a time when I was just getting involved in the international work on healthy life expectancy and summary measures of population health. I was experimenting with a form of disability-adjusted life years when the World Development Report 1993, edited by Dean Jamison, published the first global and regional DALY results. I applied the DALY and burden of disease methodology to Australian data to produce the first Australian Burden of Disease study in 1996 and a few years later moved to the World Health Organization to work on updating the Global Burden of Disease Study with Chris Murray and Alan Lopez. I joined Dean Jamison, Alan Lopez, Chris Murray and Majid Ezzati in producing the second volume of the Disease Control Priorities (Edition 2): Global Burden of Disease and Risk Factors in 2006. And now with the third edition, I have contributed another chapter on the latest WHO assessment of global and regional causes of death in 2015, the end of the MDG period and the start of the SDG period.