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Latest global disease estimates health worker shortfall, suggest progress not inevitable



The latest global health status estimates by the Global Burden of Disease (GBD) study estimate that:

  • Improvements in overall mortality rates were less pronounced overall, and rates remained stagnant or worsened in some countries in 2017.
  • Globally, fertility rates have declined since the 1950s. In 91 nations, fertility rates are not high enough to maintain the current population, and in 104 nations fertility rates are driving population growth.
  • Half of the estimated countries in deficit in the health workforce – with 47% having less than 10 doctors to serve 10,000 people and 46% have less than 30 nurses or midwives to serve 10,000 people.
  • Emerging adverse trends (such as conflict and terrorism and the opioid crisis) could lead to adverse changes over time if no action is taken.
  • Half of all deaths worldwide were caused by only four risk factors in 201
    7: high blood pressure, smoking, high blood sugar and high body mass index (BMI).
  • Low back pain, headache disorders and depressive disorders were the three main causes of disability globally in 2017 and prevailed as main causes for nearly three decades.

The latest global health status estimates by the Global Burden of Disease (GBD) study, published in a special issue of The Lancet, highlights that healthy global progress is not inevitable.

The GBD study of this year estimates that improvements in adult mortality rates were overall less pronounced and stagnant or worsened in some countries in 2017. Furthermore, no country is in line with development goals UN Sustainable Health Improvement by 2030.

The total fertility rates, which represent the average number of children delivered by a woman during her lifetime, have decreased since 1950. In 2017, 91 countries (among Singapore, Spain, Portugal, Norway, South Korea and Cyprus) had rates of less than two and did not maintain the current size of the population, while 104 nations saw population increases due to their high fertility rates (higher total fertility rate) two).

The lowest rate was in Cyprus, where, on average, a woman would give birth to a child throughout her life, in contrast to the highest, in Niger, with a total fertility rate of seven children.

"These statistics represent both a" baby boom "for some nations and a" baby bust "for others," says dr. Christopher Murray, director of the Institute for Metrics and Health Assessment (IHME) at the University of Washington, USA. "Women's low fertility rates clearly reflect not only the access and availability of reproductive health services, but also many women who choose to delay or give up childbirth, as well as having more opportunities for education and employment." [1]

Emerging adverse trends could lead to adverse changes over time if actions are not taken, for example conflicts and terrorism pose a growing threat to global health (with a number of related deaths increasing by 118% between 2007-2017) and an ongoing epidemic of opioid dependence – with over 4 million new cases and about 110,000 deaths in 2017. In addition, half of all deaths globally (51.5%) , 28.8 million deaths out of 55.9 million) were caused only by four preventable risk factors in 2017 (high blood pressure [10.4 million deaths] smoking [7.1 million deaths] high blood sugar [6.5 million deaths] and body mass index [4.7 million deaths]) , presenting a challenge to public health and an opportunity for action.

GBD is the only annual, comprehensive and peer-reviewed assessment of global health trends, providing global and national estimates for approximately 280 causes of death, 359 diseases and injuries and 84 risk factors in 195 countries and territories all over the world.

The study is coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle (USA), and involves over 3,500 employees from more than 140 countries and territories. The study is presented in 7 new articles on The Lancet ranging from population and fertility estimates, causes of death and disability and to measuring progress against the Sustainable Development Goals.

Global disparities in the number of healthcare workers

For the first time, estimates include a comprehensive analysis of the density of health professionals using surveys and census data on occupations of people. The authors note that the numbers can not estimate the quality of care, only the number of health workers available.

Historically, in 2006, the World Health Organization (WHO) estimated that there should be at least 23 doctors, nurses or midwives on 10,000 inhabitants. However, this estimate has not been updated and the study's authors expect that a broader and more varied healthcare staff will be needed to provide a wider range of services and obtain universal health care. Although no targets have been set, the UN has pledged to increase the health workforce in developing countries in the Sustainable Development Goal (SDG) 3.c.1.

The authors estimate that having more than 30 doctors, 100 nurses or midwives, and 5 pharmacists for every 10,000 people in the population have decreasing returns for access to health care and quality.

Overall in 2017, estimates suggest that only 41 out of 195 countries had more than 30 doctors per 10,000 inhabitants, while only 28 countries had more than 100 nurses or midwives. Almost half (47.2% – 92 out of 195 countries) of the included countries had less than 10 doctors per 10,000 people, while 46.2% (90/195 countries) had fewer than 30 nurses or midwives for every 10,000 people.

Country scores on how well equipped their health systems were from 0 (minimum) to 100 (maximum), the authors got 15 countries as 100 and one as 0. [2]

"The balance of doctors, nurses, midwives and pharmacists in the workforce of a country is at the basis of the types of assistance available to the population, while the increase in the overall number of health workers will be important for many countries, it is essential that this growth ensures a composition of the diversified workforce ". Institute for Health Metrics and Evaluation at the University of Washington, USA. [1]

The authors point out that the study does not include doctors and nurses by specialty, which may be important for understanding the labor force shortages for the varying disease burden of each country. In the future, the GBD study will refine health worker estimates using more recent employment data.

Global Burden of Disease 2017 – other key outcomes

Non-communicable diseases (NCDs) accounted for the largest percentage of deaths globally in 2017 (contributing to 73.4% of total deaths, equivalent to about 41, 1 million deaths). The total number of deaths per NCD increased from 2007 to 2017 by 22.7% (from 33.5 million in 2007 to 41.1 million in 2017), with an additional 7.6 million deaths in 2017. While the Age-standardized mortality from NCD decreased globally between 2007 -2017 by 7.9%, this variation was more contained in the most recent period, slowing from a decrease of 7.8% between 2003-07 and a decrease of 2% , 1% for 2013-17. The highest number of deaths from non-communicable diseases was caused by cardiovascular disease (17.8 million deaths), cancer (9.6 million deaths) and chronic respiratory diseases (3.9 million deaths).

The prevalence of obesity continues to increase in almost every country in the world, with more than one million deaths estimated as a result of type 2 diabetes, nearly half a million (426,300 deaths) of deaths due to kidney disease chronic diabetes-related diseases and over 180,000 deaths due to non-alcoholic fatty liver disease (NASH) and liver cancer and cirrhosis in 2017.

Low back pain, headache disorders and depressive disorders were the three main causes of disability globally in 2017 , and have prevailed as main causes for nearly three decades, while diabetes has emerged as the fourth leading cause of disability globally. In 2017 there were 245.9 million new cases of low back pain, 995.4 million new cases of headache disorders, 258.2 million new cases of depressive disorders and 22.9 million new cases of diabetes.

"The world has seen several success stories about health," says Murray. "Investment in poor countries that address prenatal care and water and sanitation issues have clearly made a significant difference in people's lives, while the combination of rising metabolic risks and population aging will continue to drive the problematic trends of people. non-communicable diseases, challenges and opportunities, and emphasizes the value of the GBD study to inform good policy decisions and strategic health planning ". [1]

Half of all deaths worldwide (51.5%, 28.8 million deaths out of 55.9 million) were caused by only four risk factors in 2017: high blood pressure, smoking, high blood sugar and high body mass index (BMI). Arterial hypertension was the main risk factor, with 10.4 million deaths, followed by smoking (7.1 million deaths), by a high fasting blood sugar (6.5 million deaths) and a high body mass index (4.7 million deaths).

The weight of dengue fever has increased over time in most tropical and subtropical countries, with the number of deaths globally increased by 65.5% between 2007 and 2017 (from 24,500 to 40,500 deaths) and the rate of standardized mortality of age increasing 40.7% (from 0.4 to 0.5 deaths per 100,000). Furthermore, there have been estimated 104.8 million new cases of dengue in 2017. The disease is a notable exception in the estimated improvements for communicable diseases and could reflect changes in the range of its primary vector, Aedes aegypti.

Women have a longer life but live more years in poor health. Globally, between 1950 and 2017, life expectancy has increased from 48.1 years to 70.5 years for men and from 52.9 years to 75.6 years for women. In 180 countries out of 195, women were expected to live longer than men in 2017, with an extra years living from 1.4 years in Algeria to 11.9 years in Ukraine. The percentage spent in poor health varies considerably from one country to the next. In Bosnia and Herzegovina, Burundi and Slovakia, less than 20% of additional years have been spent in precarious health, while in Bahrain all additional years have been spent in precarious health

An accompanying editorial of The Lancet [19459009 Says: "The GBD 2017 is disturbing: not only amalgamated global data shows a worrying slowdown in progress, but more detailed data reveal exactly how clear progress has been made." The GBD 2017 reminds us that, without vigilance and constant effort, progress can easily be reversed, but GBD is also an encouragement to think differently in this moment of crisis: cataloging inequalities in healthcare delivery and Disease geography models, this iteration of GBD represents an opportunity to get away from the generic application of UHC and towards a more personalized precision approach for UHC. The GBD 2017 should be an electric shock, galvanizing national governments and international agencies not only to redouble their efforts to avoid the imminent loss of hard-won gains, but also the adoption of a new approach to growing threats. "

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Peer-reviewed / Modeling

Country-level data available


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