Changing disease burdens and risks of pandemics (GMT 3)

Briefing Published 18 Feb 2015 Last modified 15 Nov 2016, 11:30 AM

The global burden from non-communicable disease now outweighs that from communicable disease. However, the threat of global pandemics continues, partly driven by increasing mobility. Around 25 % of the burden of disease and deaths is attributable to environmental causes. Urban air pollution is set to become the main environmental cause of premature mortality worldwide in 2050.

Europe has achieved major improvements in public health. However, an ageing population and the impacts of climate change, including new vector-borne diseases, may necessitate additional public health interventions and adjusted environmental policies.

Drivers

Environmental degradation, climate change, and increased urbanisation, mobility and migration all influence public health,[1][2] for example by raising the risk of the global transfer of infectious disease and exposing people to environmental hazards (GMTs 12810).[3][4] Elderly and poor people are particularly vulnerable.

Environmental health risks include particulate matter; ozone; indoor air pollution; unsafe water and sanitation; contamination from waste, including from research activities; exposure to chemicals, lead, mercury and other heavy metals;[3][5] and noise. Overall, 24 % of the global burden of disease and 23 % of premature deaths are attributable to environmental causes.[6] Urban air pollution, especially ambient particulate matter and ozone, are set to become the main environmental cause of mortality worldwide by 2050.[7][8] The Organisation for Economic Co-operation and Development (OECD) forecasts that the number of premature deaths from exposure to particulate matter in urban areas could more than double to 3.6 billion in 2050, most in China and India. Premature deaths from indoor air pollution, however, are likely to fall in coming years.[6] Ozone has a marked effect on human health (Figure 1) and is the most damaging air pollutant to vegetation, including crops.

Although economic growth and improved social conditions have reduced poverty, improved nutrition and widened access to safe drinking water, basic sanitation and education, they have encouraged unhealthy lifestyles in the developed world and increasingly among the developing world’s rapidly growing middle class. As a result, non-communicable disease (NCD) and medical conditions, including cardiovascular disease, cancers, diabetes, mental disorders and obesity, now outweigh communicable ones.[9]

By 2011, global average life expectancy reached 70 in 2011[12][13] and is expected to rise to 75 by 2045–2050 (GMT 1).[10] Older people, however, are more vulnerable to environmental hazards, spend more years living with injury and illness[11] and are susceptible to conditions of ageing, notably dementia.

Economic inequality, poverty and food insecurity continue to affect health outcomes and shorten lives within and across countriesToday 1.2 billion people still live in extreme poverty while in 2011–2013, 842 million peoples did not get enough food to live active lives.[14][15]

Rapid technological development creates both benefits and risks. Health services have and will benefit from bio-, nano- and information technologies (GMT 4), but their novelty means that the effects of their application on human and ecosystem health are little understood. Their wastes and emissions are of particular concern – for example, while the individual effects of the increasing number of chemicals, including pesticides, are relatively well-known, their impacts in combination remain largely unknown.[4]

Figure 1: World premature deaths due to urban pollution from particulate matter and ground-level ozone (2000–2050)[7]

Source: OECD environmental outlook to 2050 - [a] and [b]
Note: BRIICS countries are: Brazil, Russia, India, Indonesia, China, South Africa

Growing antibiotic resistance, partly due to evolution though overuse and over prescription, and the widespread use of antibiotics in intensive animal rearing are also culpable, is increasingly of concern, but research is lagging.[4][16] Concerns exist over the profitability of developing narrow-, rather than broad-spectrum drugs, and of a rich-country bias preventing medical spending that benefits the developing world.

Competition for global resources is expected to indirectly impact health. Continued exploitation of global fish stocks, for example, and increased ocean acidification could remove this critical food source from vulnerable populations – marine fish currently provide 6 % of global protein (GMTs 910).[17]

Trends

Non-communicable disease. In 2008, NCDs accounted for 36 million premature deaths, and are likely to cause 55 million by 2030.[18] Long predominant in developed countries, NCDs became the leading disease burden in developing countries in 2010 (Figure 3). Cardiovascular disease and cancers are the biggest cause of mortality worldwide[19] and diabetes, to which the socially disadvantaged are most vulnerable, is projected to affect 471 million by 2035.[20] Senile dementia currently affects 44 million people and is projected to rise to 135 million worldwide by 2050, with 96 million of them in developing countries.[21]

Lifestyle NCDs are increasing but are preventable – tobacco accounts for almost 6 million premature deaths a year, projected to rise to 8 million by 2030; around 3.2 million annually are attributable to insufficient physical activity and about 1.7 million to low fruit and vegetable consumption.[22]

Currently 10 % of the world’s adults are obese, and, in 2012, more than 40 million children under the age of 5 were either overweight or obese. In developing countries with emerging economies, particularly in urban areas, the rate of increase in these problems is 30 % higher than in developed ones.[23]

Communicable disease. In spite of the ongoing decline of communicable diseases (Figure 2), they still pose a significant threat to human health and international health security, especially in developing countries.[26] Even in developed countries, communicable diseases have not been completely eradicated, and in some cases their incidence is growing, mainly due to the emergence of drug-resistant disease strains. For example, tuberculosis has re-emerged in some developed countries where it had historically been reduced to very low levels.[27] In 2012, 8.6 million people globally were living with tuberculosis, and 1.3 million people died from it. In the same year, there were 35.3 million people living with HIV/AIDS worldwide, and 1.7 million people died of AIDS-related illnesses, including 230 000 children. Due to better access to therapy, the number of new HIV infections and deaths due to AIDS is decreasing globally, while the number of people living with HIV/AIDS is increasing.[28]

HIV/AIDS has received much attention in the developing world, but many developing countries face ‘neglected tropical diseases’, a group of parasitic and bacterial diseases such as dengue and leprosy. Vaccination programmes and other health responses for these diseases do exist, but they are often poorly and inadequately administered. Additionally, several contagious diseases persist despite the availability of an effective vaccine for over 50 years. One example is measles, a highly contagious disease that remains one of the leading causes of death among young children, particularly in developing countries.

Figure 2: The change in the global burden of disease and share of non-communicable diseases by world regions (1990–2030)[24][25]

Source: IHME Global health data exchange database (left panel); WHO Global health estimates - [c] and [d] (right panel)
Note: DALY refers to Disability Adjusted Life Years, defined by WHO as “the sum of Years of potential life lost due to premature mortality and the years of productive life lost due to disability”.

Pandemics. Some infections have the potential to cause pandemics – made more likely by high levels of international travel and migration;[29] the ability of some viruses to mutate rapidly and jump from animals to humans; and antibiotic resistance.[30] The World Health Organization (WHO) warns that the world is 'ill-prepared to respond to severe pandemics … threatening public health emergency'.[31]

Health inequalities. Although life expectancy and health have improved globally over the last decades, significant differences still exist between and within countries, urban and rural areas, and different income-level groups. Indeed, about 75 % of all premature deaths in 2010 occurred in developing countries.[4]

Health care services also vary: there are 33 physicians per 10 000 people in Europe, 5.5 in southeast Asia and 2.5 in Africa. The high cost of medical care is another cause for concern – WHO suggests that around 150 million people face financial ruin each year from having to pay for medical services.[32]

Implications

Changes in disease burden could strain health systems and costs, deepen inequalities and increase poverty. If current demographic, urbanisation and health trends continue (GMTs 12) developing countries will have to deal with a multiple burden of NCDs, communicable disease and pandemics, especially in slums of burgeoning urban areas.[33]

The finances of developing countries may be threatened by NCDs – in countries in all income groups, productivity losses from NCDs are already greater than public health spending. In 2013, WHO warned that business-as-usual will increase productivity losses and health care costs everywhere, with the cost of inaction far outweighing that of taking action.[7][33]

In developed countries, costs related to ageing populations and health could increase fiscal pressure and affect social cohesion and well-being (GMT 1).[34]

An integrated approach to health encompassing health inequalities, social, economic and environmental factors is key. Both WHO[33] and the United Nation Development Programme[35] agree that improving human development requires increased investment in health as well as infrastructure, education, and governance.

With more than 70 % of people projected to live in cities by 2050, good governance in urban areas will benefit both the environment and public health.[3] In rural areas, the interactions of wildlife, domesticated animals and human health pose growing risks of disease, which should be tackled by addressing the connections between them and ecosystem health.[36]

European countries improved public health in recent decades, and have relatively strong social safety nets and public healthcare systems. Nonetheless, significant health inequalities remain within and across countries – and have increased since 2006[37], with poor families disproportionally affected by the recent economic crises.[4]  In Europe, including Russia, NCDs cause 86 % of premature deaths,[38] with ambient air and noise pollution and antibiotic resistance of particular concern.[3][39]

The health impacts of climate change are of particular concern for the elderly and vulnerable[40] while rising temperatures are also likely to bring new vector-borne diseases.[4] These factors, coupled with the increasing cost of long-term care and the decline in informal care for the elderly, threaten the affordability of technical advances, unless the EU addresses the underlying causes of ill health, including the influence of an ageing population, globalisation and environmental degradation.[4][36][41]

References and footnotes

[1] IPCC (2007), 'Climate Change 2007: Impacts, Adaptation and Vulnerability', Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Human Health. Intergovernmental Panel on Climate Change, Geneva, Switzerland.

[2] IPCC (2014), 'Climate Change 2014: Impacts, Adaptation and Vulnerability', Vol. I Global and Sectoral Aspects.Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Human Health. Intergovernmental Panel on Climate Change, Geneva, Switzerland.

[3] EEA and JRC (2013), Environment and human health, EEA Report No. 5/2013, European Environment Agency, Copenhagen, Denmark and European Commission Joint Research Centre, Brussels, Belgium.

[4] Kuipers, Y. and Zamparutti, A. (2014), Global Megatrend 3: Disease burdens and the risk of new pandemics, With contributions from Baker, J., Hernández, G., Sheate, W. and White, O. Figures prepared by Bournay, E. Prepared under Framework Contract No. EEA/IEA/09/003. European Environment Agency, Copenhagen, Denmark.

[5] WHO (2013), 'Reducing health risks through sound management of pesticides: project report', World Health Organization, Geneva, Switzerland.

[6] Lim, S., Vos, T., Flaxman, A.D. et al. (2012), 'A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010', The Lancet 380(9859), 2 095–2 128.

[7] OECD (2012), 'OECD Environmental Outlook to 2050', Organisation for Economic Co-operation and Development, Paris, France.

[8] UN (2013), Statistical Annex: Millennium Development Goals, Targets and Indicators, United Nations, New York, NY, US, accessed 24 March 2014.

[9] Communicable diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans, WHO.

Non-communicable diseases (NCDs), also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression. The four main types of non-communicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes, WHO.

[10] UN (2013), 'World Population Prospects: The 2012 Revision', United Nations Department of Economic and Social Affairs, New York, NY, US.

[11] Di Cesare, M., Khang, Y.H., Asaria, P., Blakely, T., Cowan, M.J., Farzadfar, F., Guerrero, R., Ikeda, N., Kyobutungi, C., Msyamboza, K.P., Oum. S., Lynch, J.W., Marmot, M.G., Ezzati, M. (2013), Inequalities in non-communicable diseases and effective responses. Lancet NCD Action Group, The Lancet, 381(9866), 585–97. 

[12] UN (2002), 'World Ageing 1950-2050', United Nations Department of Economic and Social Affairs, New York, NY, US, accessed 22 September 2014.

[13] WB (2014), 'World Development Indicators, Data for 2011', World Bank, Washington, DC. US.

[14] MDG (2014), Millennium Development Goal 1, United Nations, New York, NY, US, accessed 11 September 2014. 

[15] FAO (2013), 'State of Food Insecurity in the World 2013', Food and Agriculture Organization of the United Nations, Rome, Italy.

[16] WEF (2013), 'Insight Report: Global Risks 2013, Eight edition', World Economic Forum, Cologny, Switzerland.

[17] EMB (2014), 'Linking Oceans and Human Health: A Strategic Research Priority for Europe', Position Paper 19, European Marine Board, Ostend, Belgium.

[18] WHO Europe (2014), Noncommunicable diseases, World Health Office Regional Office for Europe, Copenhagen, Denmark, accessed 12 September 2014.

[19] WHO (2014), Cardiovascular Diseases, World Health Organization, Geneva, Switzerland, accessed 12 September 2014.

[20] IDF (2013), IDF Diabetes Atlas, International Diabetes Federation, Brussels, Belgium, accessed 12 September 2014.

[21] Alzheimer’s Disease International (2013), 'The Global Impact of Dementia 2013–2050', Alzheimer’s Disease International, London, UK.

[22] WHO (2013), Noncommunicable diseases, Factsheet, World Health Organization, Geneva, Switzerland, accessed 4 September 2013.

[23] WHO (2014), Obesity and overweight, Factsheet, World Health Organization, Geneva, Switzerland, accessed 4 September 2014.

[24] GHDx (2014), Global Health Data Exchange (GHDx) database, accessed 6 November 2014.

[25] WHO (2014), WHO Global Health Estimates (GHE)World Health Organization, Geneva, Switzerland, accessed 6 November 2014.

[26] WHO, 2011, 'The Global Burden of Disease', World Health Organization, Geneva, Switzerland.

[27] WHO, 2013, 'Global Tuberculosis Report 2013', World Health Organization, Geneva, Switzerland.

[28] WHO, 2014, 'Global Health Observatory Data Repository', World Health Organization, Geneva, Switzerland, accessed 21 March 2014.

[29] IOM (2013), 'World Migration report 2013', International Organization for Migration, Geneva, Switzerland.

[30] Borer, A., Saidel-Odes, L., Riesenberg, K., Eskira, S., Peled, N., Nativ, R., Schlaeffer, F., Sherf, M. (2009), Attributable Mortality Rate for Carbapenem-resistant Klebsiella pneumoniae bacteremia, Infection Control and Hospital Epidemiology, 30(10), 972–6.

[31] WHO (2011), 'Implementation of the International Health Regulations (2005)', Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009. Report by the Director-General, World Health Organization, Geneva, Switzerland.

[32] WHO (2013), 'Research for Universal Health Coverage, The World Health Report 2013', World Health Organization, Geneva, Switzerland.

[33] WHO (2013), 'Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020', World Health Organisation, Geneva, Switzerland.

[34] De La Maisonneuve, C. and Oliveira Martins, J. (2013), A projection method for public health and long-term care expenditures. Economics Department Working Papers No. 1048, Organisation for Economic Co-operation and Development, Paris, France.

[35] UNDP (2013), 'Human Development Report 2013', United Nations Development Programme, New York, NY, US.

[36] Choffnies, E.R., Relman, D.A., Olsen, L., Hutton, R. and Mack, A. (2012), 'Improving Food Safety Through a One Health Approach: Workshop Summary', US Institute of Medicine, National Academies Press, Washington DC, US.

[37] EC (2013), 'Health inequalities in the EU', Final report of a consortium (lead: Sir Michael Marmot) Directorate-General for Health and Consumers, European Commission, Brussels, Belgium.

[38] WHO Europe (2014), Prevention and Control of Noncommunicable Diseases in the European Region: A Progress Report, World Health Office Regional Office for Europe, Copenhagen, Denmark, accessed 12 September 2014.

[39] EEA (2014), Air Quality in Europe, EEA Report No. 5/2014, European Environment Agency, Copenhagen, Denmark.

[40] Lung, T., Lavalle, C., Hiederer, R., Dosio, A. and Bouwer, L.M. (2013), 'A multi-hazard regional level impact assessment for Europe combining indicators of climatic and non-climatic change', Global Environmental Change 23, 522–536.

[41] Kickbusch, I. and Lister, G. (eds.) (2006), 'European perspectives on global health', European Foundation Centre AISBL, Brussels, Belgium.

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