South Africans are living longer lives than they were 10 years ago, according to an analysis in The Lancet of more than 300 diseases and injuries in 195 countries. However, this progress is threatened by increasing numbers suffering from serious health challenges.
Health-e News reports that these and other significant health findings are being published in a dedicated issue of The Lancet as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). The study draws on the work of more than 1,800 collaborators in nearly 130 countries and territories.
“The evolving burden of disease in South Africa illustrates the importance of political commitment and evidence-informed policies. Life expectancy plummeted by about 9 years to below 52 years in 2005, during an era of Aids denialism,” said Dr Charles Shey Wiysonge, a GBD collaborator from South Africa who serves as a professor of clinical epidemiology at the faculty of medicine and health sciences, Stellenbosch University.
“However, with greater political commitment and expanding access to antiretroviral therapy, this trend has reversed and life expectancy is close to where it was in 1990,” Wiysonge added. “Policymakers need to build on the current momentum and use GBD findings and other available evidence to increase access to quality health care for all South Africans.”
In South Africa, HIV/Aids was the leading killer, resulting in 112,243 deaths in 2015. The second and third top causes of death were ischemic heart disease and tuberculosis related to HIV/Aids, killing 45,119 and 42,943, respectively.
But the conditions that kill are not typically those that make people sick in South Africa. In 2015, while the top nonfatal cause of health loss was also HIV/Aids, the second and third causes were diabetes and low back pain.
Globally, life expectancy increased from about 62 years to nearly 72 from 1980 to 2015, with several nations in sub-Saharan Africa – including South Africa – rebounding from high death rates due to HIV/Aids. Child deaths are falling fast, as are illnesses related to infectious diseases. But each country has its own specific challenges and improvements, from fewer suicides in France, to lower death rates on Nigerian roadways, to a reduction in asthma-related deaths in Indonesia.
Findings for South Africa include: a child born in South Africa in 2015 can expect to live to the age of 61, while a child born ten years earlier in 2005 had a life expectancy of 55; while the world has made great progress in reducing deaths of young children, globally 5.8 million children under the age of 5 died in 2015. Of that global figure, 42,540 of those children were in South Africa; and the number of under-age-5 deaths in South Africa in 1990 was 81,794.
The study was established in 1990 with support from the World Bank. This year, researchers analysed each country using a socio-demographic index, examining rates of education, fertility, and income. This new categorization goes beyond the historical “developed” versus “developing” or economic divisions based on income alone.
The six papers provide in-depth analyses of causes of death, maternal mortality, deaths of children under age 5, overall disease burden and life expectancy, years lived with disability, and the risk factors that lead to health loss.
In much of the world, giving birth is safer for mothers and new-borns than it has been over the past 25 years. The number of maternal deaths globally dropped by roughly 29% since 1990, and the ratio of maternal deaths fell 30%, from 282 per 100,000 live births in 1990 to 196 in 2015.
“Development drives, but does not determine health,” said Dr Christopher Murray, director of the institute for health metrics and evaluation (IHME) at the University of Washington in Seattle, the coordinating centre for the GBD enterprise. “We see countries that have improved far faster than can be explained by income, education, or fertility. And we also continue to see countries – including the US – that are far less healthy than they should be given their resources.”
Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritize investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.
Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.
Findings: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardized DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardized DALY rates due to NCDs declined. Nonetheless, age-standardized DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9–3.0) for men and 3.5 years (3.4–3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78–0.92) and 1.2 years (1.1–1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in Central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs.
Interpretation: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
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Global Burden of Disease Study
The Lancet Global Burden of Disease issue