Shifts in Country-Specific Health Trends, Growth in Chronic Disease

(March 2013) Global health trends have undergone a dramatic shift since 1990: Chronic diseases such as heart disease, cancer, and diabetes have replaced infectious diseases and malnutrition-related childhood illnesses as the leading causes of death and disability outside of sub-Saharan Africa.

The Global Burden of Disease (GBD) Study 2010, which documented this health shift with extensive data for 21 world regions, now has released detailed interactive data for 187 individual countries. The tools are designed to make analyzing disease and mortality trends widely accessible. Web-based visualization software allows users to graphically view health trends and create customized charts, graphs, and maps. Some of these visualizations can be shared via email, Twitter, or Facebook.

Global Burden of Disease webcast introducing the country-level data

Among the aims of this comprehensive effort to quantify global health problems is to “help people make sense of the patterns of disease in their own countries,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which coordinates the GDB study. “With these new ways of making the data understandable, people everywhere for the first time can see the incredible progress being made in health and the daunting challenges that remain.”

The country-level results (summarized in the new publication The Global Burden of Disease: Generating Evidence, Guiding Policy) show that the most rapidly growing threat to U.S. health is Alzheimer’s disease, that HIV/AIDS and alcohol abuse are taking a huge toll in Russia, and that murder is cutting short the lives of a large share of young men in parts of Latin America.

Some of the findings surprised health experts. In Zambia, for example, malaria was thought to mainly cause infant deaths, but the GBD study revealed that malaria-related adult mortality remains a problem.

“Our biggest contribution to national policy debates is to put things in a comparative light,” said Murray. “The data can show that [a country has] much more of a problem with protein energy malnutrition than neighboring countries, allowing us to ask, ‘what is going on, why is that?’ “

In his view, the online tools allow nonspecialists to explore comparisons with neighboring countries and “trigger a whole series of discussions that would not occur otherwise.”

The data are extensive, showing trends for about 350 diseases, injuries, and risk factors for 20 age groups by gender, country, and region. The GBD study involved researchers at more than 300 institutions in 50 countries and generated 1 billion estimates.

With ongoing support from Bill & Melinda Gates Foundation, the GBD team plans to continuously update the data so the impact of health investments can be tracked. “We will not have to wait for five to 10 years to see where the numbers are changing,” noted Murray.

The Lancet published the GBD’s analysis of global and regional trends in a special triple issue in late 2012. The report documented how life expectancy increased worldwide along with the incidence of disability as a result of chronic disease, injuries, and mental health conditions. More people live longer but are in poor health, the GBD researchers concluded. Obesity and high blood sugar have overtaken lack of food as the top health risks.

The study also quantified the widening gap between sub-Saharan Africa and the rest of the world. Despite enormous progress, “child mortality, maternal mortality, HIV, tuberculosis, and malaria remain the dominant source of disease burden in sub-Saharan Africa,” Murray said. From his perspective, the UN Millennium Development Goals’ concrete and measurable benchmarks were successful at focusing global attention on reducing infectious disease and child and maternal mortality, and this success underscores the role the accessible GBD data can play.