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:

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:

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.


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

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.


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 ( 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

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Did the world achieve the Millenium Development Goals for health?

15239_Cover_11.5mm spine_MDGs to SDGs for Printing.pdfIn 2015 the Millennium Development Goals (MDGs) come to the end of their term, and a post-2015 agenda, comprising 17 Sustainable Development Goals (SDGs), takes their place.

My Department published a report in December 2015 assessing the achievement of the MDG health targets over the period 1990-2015, key factors influencing successes and failures and also assessing the main challenges that will affect health in the coming 15 years




Progress towards the MDGs, on the whole, has been remarkable, including, for instance, poverty reduction, education improvements and increased access to safe drinking water. Progress on the three health goals and targets has also been considerable. Globally, the HIV, tuberculosis (TB) and malaria epidemics were “turned around”, child mortality and maternal mortality decreased greatly (53% and 44%, respectively, since 1990) despite falling short of the MDG targets (see Figure below, which shows % declines for the main MDG health indicators at regional and global levels). Regional progress has been uneven, as can be seen in Table 1.1, and substantial inequalities remain within and across countries.

FINAL_15239_Master Layout for Web

During the MDG era, many global progress records were set. The MDGs have gone a long way to changing the way we think and talk about the world, shaping the international discourse and debate on development, and also contributed to major increases in development assistance. However, several limitations of the MDGs have also become apparent, including a limited focus resulting in verticalization of health and disease programmes in countries, a lack of attention to strengthening health systems, the emphasis on a “one-size-fits-all” development planning approach, and a focus on aggregate targets rather than equity.

The new Sustainable Development Goals (SDGs) for the year 2030  are broader and more ambitious than the MDGs. SDG3 specifically sets out to “Ensure healthy lives and promote well-being for all at all ages.” Its 13 targets build on progress made on the MDGs and reflect a new focus on noncommunicable diseases and the achievement of universal health coverage.

The report includes “Snapshots” on 34 different health topics outline trends, achievements made, reasons for success, challenges and strategic priorities for improving health in the different areas. These “snapshots” range from air pollution to hepatitis to road traffic injuries, and can be viewed/downloaded individually below.

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Maternal mortality has been almost halved in the last 25 years.

Last week, we released the latest global estimates of maternal mortality from the UN Interagency Group led by WHO (also includes UNICEF, UNFPA, World Bank and UN Population Division)

These also represent our final assessment of country, regional and global achievement (or not) of the Millenium Development Goal to reduce maternal mortality by 75% between 1990 and 2015. The map below shows estimated maternal mortality rates per 100,000 live births (MMR) in 2015.



Maternal deaths around the world dropped from about 532,000 in 1990 to an estimated 303,000 this year, a 44% drop. This equates to an estimated global maternal mortality ratio (MMR) of 216 maternal deaths per 100 000 live births, down from 385 in 1990. This almost halving of the risk of dying from pregnancy-related causes represents a real achievement for the world, although the goal was not reached.

The UN has established ambitious new Sustainable Development Goals for the year 2030, which includes an ambitious target to “end preventable maternal deaths” by reducing maternal deaths to fewer than 70 per 100,000 live births globally, with no country having a rate higher than 140. This is ambitious given that maternal mortality rates remain over 700 per 100,000 in middle and west Africa, and over 1000 in a number of countries. But most of these deaths are entirely preventable!

The UN assessments of country achievement of the MDG goal to reduce maternal mortality rates (MMR) by 75% between 1990 and 2015 was published simultaneously in a Lancet paper available at

Based on point estimates, only 17 of the 194 WHO Member States achieved that goal: Belarus, Bhutan, Cambodia, Cabo Verde, Estonia, Iran, Kazakhstan, Laos, Lebanon, Libya, Maldives, Mongolia, Poland, Romania, Rwanda, Timor-Leste and Turkey. Despite this important progress, the MMR in some of these countries remains higher than the global average.

For the 95 countries with high maternal mortality in 1990 (>100 per 100,000 live births), the paper assessed country progress in four categories shown in the graph below. Only 9 of these countries achieved the MDG goal, and for 26 countries the chance that the MMR decreased is less than 90% or the point estimate of the country-specific decline is less than 25%.




Despite global improvements, only 9 countries achieved the MDG 5 target of reducing thematernal mortality ratio by at least 75% between 1990 and 2015. Those countries are Bhutan, Cabo Verde, Cambodia, Iran, Lao People’s Democratic Republic, Maldives, Mongolia, Rwanda and Timor-Leste. Despite this important progress, the MMR in some of these countries remains higher than the global average.

By the end of this year, about 99% of the world’s maternal deaths will have occurred in developing regions, with Sub-Saharan Africa alone accounting for 2 in 3 (66%) deaths. But that represents a major improvement: Sub-Saharan Africa saw nearly 45% decrease in MMR, from 987 to 546 per 100 000 live births between 1990 and 2015.

WHO carries out a consultation with member States before releasing any statistics relating to population health outcomes at country level. We anticipated much greater interest and concern from our Member States for the consultations on the MDG targets for maternal and child health this year, as it is the target year for the MDGs and we and the UN are reporting on final achievement of the targets. However, the level of controversy about the maternal mortality estimates was substantially greater than we anticipated and much greater than for child mortality or other MDG health indicators.

We had carried out some revisions to methods to address concerns expressed by countries in previous consultations. These revisions allowed us to take better account of the trends in country data in assessing time trends. We had seen more and better data coming from countries, enhancing the accuracy of the absolute numbers of maternal deaths reported, and we were able to reduce our reliance on covariate predictors of maternal mortality for many countries. Additionally, we eliminated a classification of countries into four groups based on types of data available, which resulted in a somewhat artificial change of methods across groups.

We were aware that revisions to methods in the final year of the MDG period could be controversial, but the improvements were so substantial that it was necessary. In the event, there were a number of countries where non-technical people objected strenuously to the revisions and demanded that the older methods be applied, even though these resulted in worse trends for many of these countries. In collaboration with WHO Regional Offices, we held consultation meetings with countries and were able to convince them that the revisions resulted in “better” and generally more favourable assessments, but in any case assessments that reflected better the trends in the country data.

Even in countries with high maternal mortality, a maternal death is a relatively rare event compared to child deaths, and there are much more substantial limitations in the completeness of data. For example, for countries relying on survey reporting of deaths of sisters, the respondent may not be aware that the sister was pregnant at the time of death, and deaths associated with unsafe abortion may not be known or reported. There are particular problems in countries with high HIV prevalence to decide whether the maternal death of an HIV-positive woman is a maternal death “aggravated by the HIV status” or is an HIV-death, to which the pregnancy was incidental. Additionally, there is typically significant under-reporting in surveys of sibling deaths or deaths in household, generally for all causes of death.

Even for countries with medically certified causes of death and complete death registration, confidential enquiries and studies show that there is substantial under-identification of deaths on death certificates. On average, across all such studies there is a 33% under-reporting rate. The UN Interagency Group applies an adjustment factor based on country studies even for countries with high quality death registration systems such as Australia or France.

MMR = 100000* (number of maternal deaths)/(number of live births)

The UN method starts with data on the proportion of all deaths which are maternal (PM) derived from death registration data or survey data on deaths in the reproductive age range 15-49 years. PM is used rather than number of maternal deaths to deal with incomplete recording of deaths in death registration systems and under-reporting of deaths in surveys and censuses, on the assumption that the reporting biases are the same for maternal and non-maternal deaths.

The MMR is then calculated as

   MMR = 100000* PM *(total deaths)/(total live births)

where total deaths and total live births are derived from WHO/UN assessments of total death rates, population numbers and live birth rates. All of these may differ from country assessment of the same quantities.

As a result, the UN estimates of MMR may differ from official country estimates and from the MMR estimates reported in survey and census reports derived directly from reported data without adjustments. For all these reasons, many countries express concern about the UN estimates, and considerable communication and discussion is sometimes needed to ensure that the reasons for these differences are understood and hopefully accepted. The discussion process also often results in provision of additional data and information on data quality which improves the accuracy of estimates. For some countries, who have introduced high quality real-time surveillance systems for maternal deaths, there is now complete agreement between country and UN estimates for MMR. Since 2012, WHO, UNFPA and partners have developed Maternal Death Surveillance and Response for identification and timely notification of all maternal deaths, followed by review of their causes and the best methods of prevention. An increasing number of low- and middle-income countries are now implementing this approach.

WHO, other UN agencies and the World Bank are also ramping up efforts to assist countries to implement death registration systems and to improve the quality of death registration. It is still the case, that very few African countries have useable death registration data at country level, although some have functioning systems for urban deaths or hospital deaths, and there is increasing commitment to improve these systems.

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Meat DOES NOT rank alongside smoking as a cause of cancer

“Bacon, ham and sausages rank alongside cigarettes as a major cause of cancer, the World Health Organisation has said, placing cured and processed meats in the same category as asbestos, alcohol, arsenic and tobacco.”  Guardian 26 Oct 2015.

The Guardian and most other media have got this story completely wrong. It was based on a press release from IARC (International Agency for Research on Cancer) which is part of WHO, but quite independent. What IARC did was assess the strength of the evidence, NOT the strength of the association. So processed meat had strong evidence of a VERY SMALL increased ca risk which put it in the same “quality of evidence” category as smoking which has a VERY strong risk, such that even now smoking is responsible for 25% of deaths under age 70 in UK and will kill one third of Chinese men. Red meat has a PROBABLE slight cancer risk, and in fact there is no conclusive evidence of any risk yet.

Meat DOES NOT rank alongside smoking as a cause of cancer.

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Child deaths in 2015: much accomplished, but more to do

IGME Report 2015_CoverIn 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. Today the UN Interagency Group on Child Mortality Estimation (UN-IGME), which my team is heavily involved with, released its “final” assessment of the achievement of MDG 4 and global, regional and country levels. The report is available at child_mortality_trends.

Child mortality rates have plummeted to less than half of what they were in 1990. Under-five deaths have dropped from 12.7 million per year in 1990 to 5.9 million in 2015. This is the first year the figure has gone below the 6 million mark.

The global under-5 mortality rate reduced by 53% in the past 25 years and therefore missed the Millenium Development Goals (MDG) target of a 2/3 reduction. Roughly one-third of the world’s countries – 62 in all – have actually met the MDG target to reduce under-five mortality by two-thirds, while another 74 have reduced rates by at least half.

A child’s chance of survival is still vastly different based on where he or she is born. Sub-Saharan Africa has the highest under-five mortality rate in the world with 1 child in 12 dying before his or her fifth birthday – more than 12 times higher than the 1 in 147 average in high-income countries. In 2000-2015, the region has overall accelerated its annual rate of reduction of under-five mortality to about two and a half times what it was in 1990-2000. Despite low incomes, Eritrea, Ethiopia, Liberia, Madagascar, Malawi, Mozambique, Niger, Rwanda, Uganda, and Tanzania have all met the MDG target.

The world as a whole has been accelerating progress in reducing under-five mortality – its annual rate of reduction increased from 1.8 per cent in 1990-2000 to 3.9 per cent in 2000-2015. In an accompanying Lancet paper (…/PIIS0140-6736%2815%2900…/abstract), we assess the progress over the last 25 years and project likely child deaths under a range of scenarios between 2015 and 2030. If countries continue to improve child survival at current rates, 69 million children will still die over the next 15 years. This rate of reduction will need to increase if the world is to meet the new Sustainable Development Goal to end preventable child deaths by 2030.


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