Global progress in health is not inevitable

Findings from this year’s recent Global Burden of Disease study (GBD) published in a special issue of The Lancet suggest that global progress in health is not inevitable.

The study estimates that improvements in mortality rates for adults were less pronounced overall and stagnated or got worse in some countries in 2017. Furthermore, it found that no countries are on-target to meet the United Nation’s Sustainable Development Goals to improve health by 2030.

Regarding fertility rates, the study found that total fertility rates, representing the number of children a woman delivers over her lifetime, have declined since 1950. The lowest rate was found to be in Cyprus, where, on average, a woman would give birth to one child throughout her life. The highest rate was found to be in Niger, with a total fertility rate of seven children.

“These statistics represent both a ‘baby boom’ for some nations and a ‘baby bust’ for others,” said Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, US. “The lower rates of women’s fertility clearly reflect not only access to and availability of reproductive health services, but also many women choosing to delay or forgo giving birth, as well as having more opportunities for education and employment.”

Another finding was that half of countries are estimated to face shortfall in healthcare workforce, with 47 per cent having fewer than 10 doctors to serve 10,000 people and 46 per cent having fewer than 30 nurses or midwives to serve 10,000 people. “The balance of physicians, nurses, midwives and pharmacists in a country’s workforce underpins the types of care that are available to the population. While increasing the overall number of health workers will be important for many countries, it’s vital that this growth ensures a varied workforce composition,” said lead study author Professor Rafael Lozano, of the Institute for Health Metrics and Evaluation at the University of Washington, US.

Further findings included: emerging adverse trends (such as conflict, terrorism and the opioid crisis) could lead to negative shifts over time without appropriate action; half of all global deaths in 2017 were caused by just four risk factors – high blood pressure, smoking, high blood glucose and high body mass index (BMI); and low back pain, headache disorders and depressive disorders were the three leading causes of disability globally in 2017, and have prevailed as leading causes for nearly three decades.

An accompanying editorial from The Lancet stated: “GBD 2017 is disturbing. Not only do the amalgamated global figures show a worrying slowdown in progress but the more granular data unearths exactly how patchy progress has been. GBD 2017 is a reminder that, without vigilance and constant effort, progress can easily be reversed. But the GBD is also an encouragement to think differently in this time of crisis. By cataloguing inequalities in healthcare delivery and patterns of disease geography, this iteration of the GBD presents an opportunity to move away from the generic application of UHC and towards a more tailored precision approach to UHC. GBD 2017 should be an electric shock, galvanising national governments and international agencies not only to redouble their efforts to avoid the imminent loss of hard-won gains but also to adopt a fresh approach to growing threats.”