Over the past 10 years, the Global Burden of Disease Study has, in the words of an editorial this month in the medical journal The Lancet, delivered “a reassuring message” about the progress of humankind. Revised three times in a decade, this massive ongoing global healthcheck, the work of 1,800 researchers from 127 countries, has “portrayed an ever-healthier world,” in which mortality rates have been dropping and lifespans increasing dramatically.
GBD 2017, published this month as a series of papers in The Lancet, delivers “an urgent warning signal from a fragile world.” In some unexpected, wealthy parts of the globe, decreases in adult mortality rates have abruptly plateaued and, in a few countries, have actually increased.
First, the success story. Globally, life expectancy at birth has risen from just 48.1 years in 1950 to 70.5 in 2017 for men and from 52.9 years to 75.6 for women. The largest gains since 1950 have been in the Middle East and North Africa, where life expectancy has increased from 42.4 years to 74.2 years. The lowest lifespan in the world in 2017 was in Sub-Saharan Africa, where the 63.9 years for men and women combined is the same as the global average in the mid-1980s. But even here it has been steadily increasing.
Globally, life expectancy for men has risen by 35 years or more since 1950 in 13 countries, including Iran, Jordan, Oman, Tunisia and Turkey. Women have experienced similar gains in 11 countries, including Iran, Jordan and Oman.
But, unexpectedly, the improvement in life expectancy is stalling, and well short of the ceiling of 90 years or more that scientists believe is achievable.
The authors of GBD 2017 celebrate global successes, such as the large decline in under-five mortality, down from 216 deaths for every 1,000 births in 1950 to 39 – a vast improvement that is the product of “significant national … and global commitment and investment over several decades.”
But in many countries progress for adults has been less pronounced. This, say the authors, is “a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries … and in some cases are increasing.”
The US is an example of a wealthy nation where life expectancy has actually gone into reverse – for men it has been declining since 2012. In the UK, life expectancy has stalled since 2015, sticking at 79.2 years for men and 82.9 for women. In other parts of the world, the cause of increasing mortality rates is all too obvious – “conflict and terrorism,” The Lancet reports, “have become two of the fastest growing causes of death globally,” rising by 118 percent between 2007 and 2017.
GBD 2017 singles out countries such as Syria and Yemen, where “civil war has effectively erased – and reversed – years of steady gains” in life expectancy. Since 2007, conflicts have caused over a million deaths in the Middle East and North Africa. Such “fatal discontinuities,” as the dry academic language terms hundreds of thousands of untimely deaths, mean that life expectancy for males born in Syria or Yemen today is just 65 years, compared with an average of 72 throughout the Middle East and North Africa. In Saudi Arabia, and even Iraq, boys born today can expect to live to 75, and in Kuwait up to 80 years.
But even in the wealthy Gulf states “continued reductions in age-specific mortality should not be taken for granted,” the authors caution. Unless urgent public health action is taken, what is happening in the US may be a portent of what lies in store for the Middle East.
In the US, obesity and diabetes are the chief culprits for the plateauing of life expectancy. In almost every country around the world – and especially in the wealthy Gulf states – obesity, heart disease and diabetes are on the rise, threatening to undo decades of advances.
There are troubling signs the tide may already have turned. According to the World Health Organization, in 2016 life expectancy at birth in the UAE was 76.5 years for men and 78.7 for women. The latest figures, for 2017, show that these numbers have fallen back, to 71.65 for men and 76.94 for women.
These setbacks contrast with continued success in Saudi Arabia, where between 2016 and 2017 life expectancy from birth increased from 73.5 years to 75.29 for men and from 76.5 to 79.43 for women, but rising public health concerns in the Kingdom could yet see these positive trends reversed.
GBD 2017 amounts to a stark warning. In 2017, just four killers were responsible for half of all 28.8 million global deaths, and we’ve invited all four of them into our lives: high blood pressure, smoking, high blood glucose and high body-mass index.
The coming year, says The Lancet, will be a crucial one in the battle against non-communicable diseases. In 2011 the World Health Organization’s Political Declaration on the Prevention and Control of NCDs was adopted by all nations, in recognition that “chronic diseases were a critical force influencing human development.” Since then, however, “despite much exclamatory rhetoric, momentum … has stalled.”
Two statistics best illustrate the dramatic story of life and death in the modern world. In the past decade the number of deaths from communicable, maternal, neonatal and nutritional causes decreased by 22.2 percent. Over the same period, deaths from non-communicable diseases increased by 22.7 percent.
Humankind has largely fought off the curse of communicable diseases – the plagues that for centuries cut vast swaths through our numbers. Now the epidemics that threaten us are sloth and plenty.
Jonathan Gornall is a British journalist, formerly with The Times, who has lived and worked in the Middle East and is now based in the UK. He specializes in health, a subject on which he writes for the British Medical Journal and others.
AFP PHOTO/KARIM SAHIB