Global progress in health not inevitable anytime soon

The latest global estimates for the state of the world's health from the Global Burden of Disease study (GBD), published in a special issue of The Lancet, highlight that global progress in health is not inevitable.

This year's GBD study estimates that improvements in mortality rates for adults were less pronounced overall and stagnated or got worse in some countries in 2017. In addition, no countries are on-target to meet the United Nation's Sustainable Development Goals to improve health by 2030.

Total fertility rates, which represent the average number of children a woman delivers over her lifetime, have declined since 1950. In 2017, 91 countries had rates lower than two and were not maintaining their current population size, while 104 nations were seeing population increases due to their high fertility rates (total fertility rates above two).

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

Emerging adverse trends could lead to negative shifts over time if action is not taken – for example, conflict and terrorism is an increasing threat to global health (with numbers of related deaths increasing by 118% between 2007-2017), and an era-defining epidemic of opioid dependence continues – with more than 4 million new cases and around 110,000 deaths in 2017. In addition, half of all global deaths (51.5%, 28.8 million of 55.9 million deaths) were caused by just four preventable risk factors in 2017 (high blood pressure [10.4 million deaths], smoking [7.1 million deaths], high blood glucose [6.5 million deaths], and high body mass index [4.7 million deaths]), presenting a public health challenge and an opportunity for action.

Historically, in 2006, the World Health Organisation (WHO) estimated that there should be a minimum of 23 physicians, nurses, or midwives per 10,000 population. However, this estimate has not since been updated and the study authors expect that larger, more varied health workforces are needed to provide a broader range of services and achieve universal health care. Although no target was set, the United Nations pledged to increase the health workforce in developing countries in Sustainable Development Goal (SDG) 3.c.1.

The authors estimate that having more than 30 physicians, 100 nurses or midwives, and 5 pharmacists for every 10,000 people in the population has diminishing returns for healthcare access and quality.

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

Non-communicable diseases (NCDs) comprised the greatest fraction of deaths globally in 2017 (contributing 73.4% of total deaths, equivalent to approximately 41.1 million deaths). The total numbers of deaths from NCDs increased from 2007 to 2017 by 22.7% (from 33.5 million in 2007 to 41.1 million in 2017), representing an additional 7.6 million deaths in 2017. While the age-standardised death rate from NCDs decreased globally between 2007-2017 by 7.9%, this change was smaller in the most recent period – slowing from a decrease of 7.8% between 2003–07 to a decrease of 2.1% for 2013–17. The largest numbers of deaths from NCDs were from cardiovascular diseases (17.8 million deaths), neoplasms (9.6 million deaths) and chronic respiratory diseases (3.9 million deaths).