By Judy Foreman
A massive new study out today shows that around the world, people are living longer than they did 20 years ago, but there’s a catch: many of these extra years are spent in poor health — in some cases with conditions that might be preventable or treatable.
The collaborative project, published in a special issue of The Lancet and led by researchers at the University of Washington and a consortium including the Harvard School of Public Health and the Johns Hopkins Bloomberg School of Public Health, found that some of the old scourges of humankind — infectious disease and childhood illnesses — that were once the leading causes of death have decreased dramatically, even in many developing areas. Deaths among children under five used to be the biggest contributor to the world’s health burden; now it’s chronic diseases that cause severe pain, impair mobility or keep people from seeing, hearing and “thinking clearly,” as the university put it in a statement.
But as childhood deaths have decreased, there has been a troubling increase in deaths among young adults, those aged 15 to 49 – mainly because of violence and HIV/AIDS. And while malnutrition – including starvation – used to be the leading risk factor for death worldwide, now it’s the opposite that’s the big threat: poor diets and physical inactivity. In fact, dietary risk factors and physical inactivity now account for a whopping 10 percent of the world’s health burden, as excess weight and high blood sugar continue to soar.
As some health problems have lessened worldwide between the new study, called the Global Burden of Disease Study 2010 and its predecessor in 1990, others have soared, chief among them lower back pain and road accidents. The latest research, funded by the Bill and Melinda Gates Foundation, was a massive endeavor with 486 authors from 302 institutions and more than 30,000 survey participants in more than 100 countries. It resulted in seven scientific papers being published together.
In statistical terms, what’s happening is that although life expectancy from birth is still increasing all around the world, what might be called the “healthspan” is not keeping pace. In other words, we are living longer, but some of those “extra” years are years of pain, sickness, immobility, depression, anxiety and other forms of poor health.
Worldwide, life expectancy for men is now 67.5 and for women, 73.3, said Joshua Salomon, lead author of two of the seven studies and a professor of global health at the Harvard School of Public Health. Salomon spoke yesterday by telephone from England.
By contrast with life expectancy, his study found, “health expectancy” for men is only 58.3 years, and for women, 61.8. In other words, for the average man, who will live 67.5 years, the equivalent of 9.2 of the total years will be spent in poor health, counting both small and large losses of health, said Salomon. The average woman can expect the equivalent of 11.5 years of poor health.
“We can expect more years of good health, but also more years in poor health,” Salomon said. On average, the world as a whole loses more years of healthy life to various forms of chronic illness and disability today than 20 years ago. The best rates of health expectancy today, for both men and women, are in Japan, as they were 20 years ago as well.
Among the biggest chronic health issues are mental health problems and musculoskeletal problems, including pain and physical disability. Depression was not even viewed as a public health problem until the first global burden of disease study in 1990. The increasing burden of depression is troubling because mental health problems can often be helped with proper diagnosis and treatment.
Indeed, lower back pain, depression, iron-deficiency anemia and neck pain were the top four “sequelae,” or consequences of disease and injury, responsible for the greatest health loss in terms of the number of years lived with a disability.
From both an individual and a societal perspective, these worldwide shifts in health patterns raise major issues. Among the most important is that health care systems in many countries, including the US, are geared more toward acute than chronic care. We’ve gotten very good at handling life-threatening emergencies but much less good at helping people cope with the grinding burden of mental health problems, chronic pain and other forms of disability.
Salomon put it this way: “We have been more successful at finding ways to address things that are potentially fatal than things that cause chronic loss of health. One of our aims is that this study will raise awareness of this imbalance.”
Judy Foreman, a health reporter in Boston, just completed a book about chronic pain: “A Nation in Pain: Healing Our Biggest Health Problem.”