Conflict, terrorism and gun violence are claiming more lives around the world now than a decade ago, according to a new study published Thursday in the health journal The Lancet.
Deaths caused by war and terrorism spiked after 2006, with 150,500 reported in 2016 — a 143% increase from 10 years earlier. These fatalities occurred largely as a result of conflicts in North Africa and the Middle East, the researchers noted.
Worldwide, gun deaths also climbed during the same period: In 2016, firearm suicide fatalities reached 67,500 and firearm assault casualties rose to 161,000, increases of 4.3% and 5.7%, respectively, from 2006.
Guns may be the direct cause of more deaths, but the there was an overall 3% decrease in fatalities caused by self-harm during the decade ending in 2016, the study indicated.
The Global Burden of Disease study, an annual assessment of health trends, provides worldwide and national estimates on more than 330 diseases, causes of death and injuries in 195 countries and territories. The study, coordinated by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, requires assistance from more than 2,500 researchers around the globe.
One of several sunny spots in the report: Worldwide, people are living longer.
Life expectancy on the rise
Generally, male life expectancy was lower than female from 1970 through 2016. Currently, the average global life expectancy for women is 75.3 years, while men can expect to see 69.8 years on the planet. Life expectancy for both sexes combined is 72.5 years.
By contrast, global life expectancy combined was 58.4 years in 1970 and 65.1 in 1990. In 2000, the combined expectancy was 66.8 years, and in 2005, it was 68.4 years.
Of all the nations, Japan boasts the highest life expectancy at 83.9 years (a combined figure for both sexes), while people living in the Central African Republic can expect only 50.2 years, a global low.
Several countries have seen recent large increases in life expectancy, far beyond expectations for their levels of development.
These countries include Ethiopia, where life expectancy in 2016 was 64.7 years for men and 66.5 for women; the Maldives (77.6 years for men and 81.3 years for women); Nepal (69.7 years for men and 71.9 years for women); Niger (60.6 years for men and 62.8 years for women); Portugal (77.8 years for men and 84.0 years for women); and Peru (77.8 years for men and 81.6 years for women).
These “exemplar” nations may offer insight into which policies are most successful for accelerating health progress, the study authors noted.
Children reach a milestone
“In 2016, for the first time in modern history, fewer than 5 million children under age 5 died in one year, as compared to 1990 when 11 million died,” Christopher Murray, a co-author of the report and director of the Institute for Health Metrics and Evaluation, wrote in an email. In 1970, 16.4 million deaths were recorded for this age group.
Last year, lower respiratory infections, neonatal preterm birth complications and neonatal encephalopathy due to birth asphyxia and trauma were the most common causes of fatality for children under 5. Combined, these three causes resulted in 1.80 million deaths in 2016.
Overall, there was what researchers described as a “profound” shift toward deaths at older ages: a 178% increase in deaths among people 90 to 94 and a 210% increase among those older than 95.
In 2016, there were 1.7 million stillbirths worldwide. The rates decreased substantially between 1970 and 2016, from 41.5 stillbirths per 1,000 live births to just 13.1 per 1,000.
This decrease occurred against a backdrop of increasing live births around the globe; in 2016, 128.8 million live babies were born, compared with 114.1 million in 1970.
Finland had the lowest rate of stillbirths at 1.1 per 1,000 live births, while South Sudan had the highest rate, at 43.4 per 1,000. Central sub-Saharan Africa’s stillbirths, which exceeded 23 per 1,000 live births in 2016, rank as the highest regional rates on the globe.
Taking aim at early death
A key measure of health is mortality — particularly at younger ages — and so avoiding early death from any cause is a key goal of health systems worldwide, noted the researchers.
Early death is most often caused by diseases of various stripes.
In 2016, noncommunicable diseases contributed 72.3% to the total number of deaths around the globe — 54.7 million — with 19.3% of deaths caused by communicable, maternal, neonatal and nutritional diseases. Injuries, including those incurred by violence, accounted for 8.4% of all deaths.
“Population growth does not inherently mean there will be more deaths — it depends on a number of factors,” Mohsen Naghavi, a study co-author and a professor of global health at the Institute for Health Metrics and Evaluation, wrote in an email.
“We provide total counts of death, death rates by age, and age-standardized rates of death to tease out what component of change in deaths comes from a population increasing in size over time, the ageing of populations, and true change at each age,” Naghavi wrote.
Ischemic heart disease — a condition that restricts blood flow throughout the body — caused 9.48 million deaths in 2016, an increase of 19% since 2006. It ranked as the leading cause of early mortality in all regions of the globe, apart from low-income countries.
In the poorest nations, the leading cause of early death was lower respiratory infections, including pneumonia and other bronchial conditions. Combined, these resulted in 2.38 million deaths, a decrease of 8.2% since 2006. Diabetes caused 1.43 million deaths globally last year, an increase of 31.1% since 2006.
Deaths from infectious diseases have decreased since 2006, but HIV/AIDS claimed 1.03 million lives in 2016 (a 45.8% decrease since 2006), while 719,500 people died from malaria (a 25.9% decrease) and 1.21 million died from tuberculosis (a 20.9% decrease) last year.
Dengue, a mosquito-borne infection that can lead to a fatal hemorrhagic fever, increased sharply over the decade — by 81.8% — and caused 37,800 deaths in 2016. Extensively drug-resistant tuberculosis, which caused 10,900 deaths in 2016, also showed increasing rates throughout the past decade, rising by 67.6% since 2006.
‘Triad of troubles’
Nearly one in every five deaths is linked to a poor diet, the report revealed. Diets lacking in whole grains, fruit, nuts and seeds and fish oils while providing too much salt were the most common dietary risk factors, the authors noted.
As a result, high blood glucose, high blood pressure, high body mass index and high total cholesterol were among the top 10 leading risk factors for death for men and women globally.
Nations and people are likely to tackle — or at least attempt to tackle — those diseases that kill at high rates, Murray noted, since death is a powerful motivator. “But, we’ve been much less motivated to address issues leading to illnesses,” he said
Tobacco, which caused 7.1 million deaths across the globe in 2016, is another issue leading to illness.
Another factor that sometimes lacks attention from policy-makers is mental illness, which in many cases contributes to disability.
“Mental illnesses tend not to discriminate based on income,” Theo Vos, a study co-author and professor of global health at the Institute for Health Metrics and Evaluation, wrote in an email.
“In 2016, 1.1 billion people were living with mental health and substance use disorders,” he noted. “Major depressive disorders ranked in the top 10 causes of years lived with disability in all but four countries worldwide.”
Those four nations are American Samoa, Philippines, Myanmar and Indonesia.
“There is considerable overlap between mental health disorders and substance use disorders,” Vos wrote. “People suffering from both types of disorders present considerable extra challenges to health services as one problem can interfere with the successful treatment of the other.”
Overall, the National Institutes of Health-funded study reveals a portrait of a globe precariously balanced between health successes and health failures — with some of the latter being intractable yet avoidable.
“A ‘triad of troubles’ — obesity, conflict, and mental illness, including substance use disorders — poses a stubborn and persistent barrier to active and vigorous lifestyles,” Murray wrote.
