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Lights and shadows in the Report on world health. Many new health-related challenges

"Global Burden of Diseases, Injuries, and Risk Factors Study" (GBD), the most comprehensive worldwide epidemiologic observational study, signals several lights and some shadows, but on the whole it shows an increase in global life expectancy. The Report contributes to the understanding of new health-related challenges that deserve major attention in the coming decades such as obesity, substance abuse and high blood-pressure.

Lights and shadows characterise the latest “Global Burden of Diseases, Injuries, and Risk Factors Study” (GBD) report for the year 2015 released by the Institute for Health Metrics and Evaluation in Seattle (USA), recently published by The Lancet magazine. As known, the GBD is the most comprehensive worldwide observational epidemiological study to date. It describes mortality and morbidity of major diseases (namely the number of cases of disease reported during a given period compared to the overall number of those examined), injuries and risk factors to health at global, national and regional levels. Examining trends from 1990 to the present and making comparisons across populations GBD enables understanding of the new health-related challenges world population is forced to face in the 21st century.

As said, lights and shadows whose GDB conclusions enable to summarise as follows: annual mortality rates steadily declined from 1990 to 2015, especially because of improved health and sanitation services, of the massive use of vaccinations and of decreased indoor pollution (better air quality inside homes). To this must be added a dramatic decrease in mortality rates due to HIV/AIDS and malaria registered in many countries in sub-Saharan Africa. However, such improvements are currently threatened by widespread health disorders caused by obesity and hyperglycemia, (typical of Western, opulent societies), in addition to substance use (alcohol, narcotic drugs, etc.) In detail

Worldwide life expectancy in the period 1980 – 2015 has increased by 10 years (currently at 72),

While several countries of sub-Saharan Africa are rebounding from an era of exceedingly high loss of life due to HIV/AIDS. In fact in only ten years – from 2005 to i 2015 – mortality rates due to HIV/AIDS have decreased by 42%. Similarly, efforts aimed at the eradication of another infectious disease such as malaria, which in many cases is lethal, have been equally successful. The Report shows a 43% decrease in death rates for malaria.

Another comforting “light” of the GBD 2015 Report is the drop in deaths during pregnancy, although unacceptable rates are still registered in 24 countries (resulting in over 400 deaths per 100,000 live births). Among these the worst figures were registered in the Central African Republic (1.074 deaths every 100.000 l.b.), Afghanistan (789 per 100.000 l.b.) and Sierra Leone (696 out of 100.000 l.b.).

Infant mortality has also recorded a significant decline: in 2015 under-5 mortality amounted to 5.8 million children, signalling a 52 percent decrease compared to 1990. The decline in neonatal mortality was not as strong (2.6 million in 2015), dropping by 42 percent, highlighting the persistence, in many countries, of a widespread difficulty in neonatal care.

The state of health of the world population is largely determined by risk factors, many of which could be controlled. This aspect is another “light” brought to the fore by the GBD 2015 Report. In fact, figures show that, in the period 1990-2015, global exposure to unsafe sanitation, indoor air pollution and child malnutrition has declined more than death rates. However, the reasons for satisfaction over the achieved results are overshadowed by the fact that in the same period exposure to a various occupational risk factors, high body mass index (linked to obesity) and the use of addictive drugs, have increased by over 25 percent. Similarly, other risk factors – such as nutritional deficiencies or low physical exercise – have grown. Let it suffice to consider that a health disorder like hypertension alone contributes to over 9% of decreased global health, followed by smoking (6.3 percent), hyperglycemia (6.1%) and increased body mass index (5%).

“The level of economic growth is important – said Christopher Murray, Director of the Institute for Health Metrics and Evaluation, who coordinated the research -, but it does not determine the state of health of the population. Some countries have improved their situation far more rapidly than could be explained by several factors such as income, education or fertility-rates. While there are Countries such as the United States that are far less healthy than they could be, given their available resources.”

Thus the global picture is rather clear: improved or worsened world health is not the result of random factors or circumstances. It is the outcome of political and health-related decisions at global level that require ever-increasing responsibility and sharing among world populations.

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