43 percent of people worldwide now live into their seventies, up from 33 percent twenty years ago. But just because we're living longer doesn't mean we're living better.
PROBLEM: The world has changed in unfathomable ways since 1990, and one of the most salient ways of visualizing exactly how this is so is by looking at how -- and when -- we're dying now, compared to how we were dying then. Twenty years ago, the last time we took a step back to account for global patterns of this sort, the primary causes of death throughout the world were infectious disease and the consequences of childhood malnutrition. Many of the problems identified then have been addressed and, in some cases, solved by now. A critical look at the new challenges facing humanity, as a whole, can help us to refocus our health efforts for the 21st century.
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METHODOLOGY: As befits a study of the entire world, this was a massive undertaking, with a lot of people analyzing a lot of data. The entire thing results from a collaboration of almost 500 researchers from 50 countries, led by the University of Washington.
RESULTS: Most children now make it to adulthood. Malnutrition has been cut by over 60 percent -- in a complete reversal from 1990, and with the exception of sub-Saharan Africa, kids generally have too much to eat. Poor diet and physical inactivity now contributes to 10 percent of the global disease burden.
And adulthood, once reached, extends beyond the age of 70 for 43 percent of the world's population.
This is great for kids, but not so great for adults, who are suffering from diseases now caused by lifestyle risks instead of by contagion. These "first world" conditions, like heart disease and diabetes, are now a leading cause of death. Cancer, too, is now responsible for about two thirds of global deaths.
And the biggest caveat is that while life expectancy has increased, years spent living with health problems have increased as well. Pain and disability, more than ever, characterize people's final years, which amount to 9.2 years for men and 11.5 years for women of poor health.
IMPLICATIONS: Summing up our global health advances in one pithy, irony-laden sentence, the authors write that as a species, we now "avoid premature death, but live longer and sicker."
The good news is that we're not very creative in how we're dying -- of the more than 300 diseases and risk factors studied, only 50 distinct causes were found to account for over three-quarters of deaths. In theory, the burden of solving these problems should be manageable.
The bad news, however, is that it's relatively easy to get people vaccinated -- implementing significant behavior change is a much a more challenging task for public health advocates.
So maybe the problem should really be, how do we define health, and are our priorities really in line with what we most need? We might debate a potential adjustment in the direction we're taking medicine and public health efforts so that we can focus less on living longer and more on living better. Despite disparities found between nations, this is a question that we all have to consider over the next twenty years.
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