To live and die like L.A.: researchers predict the American way of life - and death - awaits the rest of the world

0 Comments | Insight on the News, Oct 21, 1996 | by Phil Berardelli

Researchers predict the American way of life -- and death -- awaits the rest of the world.

As more societies around the world strive to achieve the American way of life, with reduced rates of childbirth and increased income, so too will they be affected by the American way of death. In the next 25 years, says a new study, heart attacks, strokes and even traffic accidents will outpace traditional worldwide killers such as pneumonia, diarrhea and newborn diseases. The fastest growing cause of mortality in the next century: depression.

Noncommunicable diseases are expected to account for 73 percent of deaths and disabilities by the year 2020, compared with 56 percent in 1990, predicts the study, "The Global Burden of Disease." The four-year effort was supervised by the U.N.'s World Health Organization and the World Bank and sponsored by a consortium of six national governments five major foundations and more than 100 other collaborators. The goal was to gain the first understanding of disease trends on a worldwide basis and try to redirect public-health research and development efforts accordingly.

"Right now, the allocation of funds ... is often irrational and based on inadequate information," says Tore Godal, one of the study's codirectors. "Some of the gravest health problems receive only pitiful resources, while comparatively small problems receive large shares." Godal points to current research and development spending devoted to tuberculosis, pneumonia and diarrheal diseases, which amounts to only 0.2 percent of the total, while those diseases account for nearly 20 percent of deaths and disabilities.

The study finds that in many developing nations, an "epidemiological transition" is under way, the result of falling birth rates and general aging. The study warns, for example, that "tobacco-related health problems are growing more rapidly than the HIV epidemic." By 2020, they will kill more people than any single disease.

In addition, the burdens of mental illnesses such as depression, as well as alcoholism and schizophrenia, have been "seriously underestimated." The study's projections show that psychiatric and neurological conditions will grow by 50 percent, a bigger proportionate increase than for heart disease.

This phenomenon is occurring in China and other parts of Asia as well as in Latin America, and it is "already much further advanced than many public-health specialists appreciate." One of the most shocking statistics to emerge is the epidemic of suicides among women in some of these countries. In China, about 180,000 cases were reported in 1990, accounting for 4.5 percent of all adult female deaths.

Other disturbing findings: Adults in sub-Saharan Africa already face a higher probability of death from noncommunicable diseases than adults in the industrialized nations. Men living in the former Soviet Union have a "disturbingly poor, and deteriorating, health status," including an astounding 28 percent risk of death between ages 15 and 60, the highest in the world.

All of this is extremely important for policy planning. Current priorities are based on a long-standing emphasis on infectious diseases, but noncommunicable diseases, accidents and self-inflicted conditions are emerging as "the coming epidemic in low-income and middle-income countries," notes Christopher J.L. Murray of Harvard University's School of Public Health, coauthor of the study.

What's needed, Murray says, is a new approach to worldwide health policies based not only on the number of deaths but also on the impact of premature deaths and disabilities. With this in mind, researchers attempted to take a fresh look at mortality rates without accepting at face value government statistics or the estimates of "well-meaning epidemiologists" who, according to the study, tend to act as advocates for affected populations.

"If the currently available epidemiological estimates for all conditions were right, some people in a given age group or region would have to die twice to account for all the deaths that are claimed," states the report. Even when mortality data are available and accurate -- which they frequently are not -- they usually do not include nonfatal outcomes of disease or injury, such as dementia and blindness. And most health statistics don't allow policymakers to compare the cost effectiveness of various treatments.

Yet there are many reasons for optimism. Overall, world health is improving. Average life expectancy in the industrialized nations will increase to 88 years for women. Men's life expectancy also will grow, though more slowly. The extra years will tend to be healthier, but there will be a substantial advantage enjoyed by people in the developed world. China, despite its plague of suicide, emerges as the most relatively healthy of developing nations, with one-fifth of the world's population but only 15 percent of the disease burden.

No one should become too jubilant, however. The study cautions that if new, drug-resistant strains of microbes emerge, and if research cannot react quickly enough, "the gains of the present century could be halted or even reversed."