WHO says 'Heart disease has been the leading cause of death worldwide for the past 20 years'

CNI Desk: Non-communicable diseases currently make up 7 of the ten leading causes of death in the world, as per WHO's 2019 Global Health Estimates released on Wednesday.

This reflects an improvement from 4 of the 10 leading causes in 2000. The latest data represents the period from 2000 to 2019 inclusive. Estimates indicate trends in deaths and morbidity caused by illnesses and accidents over the past two decades, according to the World Health Organisation (WHO).

Heart disease is the number 1 killer; diabetes and dementia rank in the top 10. Heart disease has been the leading cause of death globally for the past 20 years. Yet now more civilians are killed than ever before. Since 2000, the number of cardiac deaths has grown by more than 2 million to almost 9 million in 2019. Heart disease now accounts for 16% of the estimated number of deaths from all causes.

They specifically stress the need for an increased global emphasis on the prevention and care of cardiovascular disorders, cancer, diabetes and chronic respiratory diseases, as well as the treatment of accidents, in all regions of the world, as set out in the UN Sustainable Development Goals agenda. "These new estimates are yet another reminder that we need to speed up the prevention, diagnosis and treatment of non-communicable diseases," said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

"We emphasise the importance of significantly transforming primary health services equitably and holistically. Good primary health care is obviously the cornerstone on which everything relies, from fighting non-communicable diseases to handling a global pandemic."

More than half of the 2 million additional deaths occurred in the Western Pacific area of the WHO. Conversely, the European region has seen a relative drop in heart disease, with deaths dropping by 15%.

Alzheimer's disease and other manifestations of dementia are also in the top 10 causes of death globally, ranked 3rd in America and Europe in 2019.

Women are overwhelmingly affected: 65 per cent of Alzheimer's and other causes of dementia deaths worldwide are women.

Diabetes deaths rose worldwide by 70 per cent between 2000 and 2019, with an increase of 80 per cent in male deaths. Diabetes deaths in the Eastern Mediterranean have more than doubled and reflect the highest percentage rise in all WHO countries.

Global decline in communicable disease mortality, but still a big problem in low-and middle-income countries

In 2019, pneumonia and other lower respiratory infections were the deadliest group of communicable diseases, emerging as the fourth leading cause of death. However, relative to 2000, lower respiratory diseases took fewer lives than in the past, with almost half a million fewer deaths worldwide.

This drop is in line with the overall global decrease in the number of deaths caused by communicable diseases. For example, HIV/AIDS fell from the 8th leading cause of death in 2000 to the 19th in 2019, showing the effectiveness of efforts to reduce transmission, test the virus and treat the disease over the past two decades. While it remains Africa's fourth leading cause of death, the number of deaths has fallen by more than half, from over 1 million in 2000 to 435 000 in 2019 in Africa. Tuberculosis is now no longer in the world's top 10, slipping from 7th in 2000 to 13th in 2019, with a 30% drop in global deaths. Yet it remains one of the top 10 causes of death in the African and South-East Asian countries, where it is the 8th and 5th leading cause, respectively. Africa has seen an increase in tuberculosis mortality since 2000, but this has began to decrease in the last few years.

The latest figures also show the toll that communicable diseases still have on low-income countries: 6 of the top 10 causes of death in low-income countries are still communicable diseases, including malaria (6th), tuberculosis (8th) and HIV/AIDS (9th). Meanwhile, WHO studies in recent years illustrate the relative stagnation or plateauing of development toward infectious diseases such as HIV, tuberculosis and malaria.

People live longer – but with more disabilities

Estimates also affirm the rising longevity trend: in 2019, people lived more than 6 years longer than in 2000, with a global average of more than 73 years in 2019 compared to almost 67 in 2000. On average, however only five of those extra years have been in good health. In reality, disability is on the rise. To a considerable amount, the illnesses and health problems that cause the most deaths are those responsible for the largest number of healthier life-years lost. Heart disease, asthma, stroke, lung cancer and chronic obstructive pulmonary disease were collectively responsible for almost 100 million extra safe lifetimes missed in 2019 compared to 2000.

Injuries are another big cause of injury and mortality: there has been a substantial rise in road traffic injuries of the African region since 2000, with almost 50 per cent increase in both death and loss of healthy life. Related but somewhat lower rises (about 40 per cent) have also been reported in the Eastern Mediterranean region. Globally, 75 per cent of the deaths from road traffic accidents are male. Drug use has arisen in the Americas as a major contributor to both injury and death. There was almost threefold rise in deaths from opioid use disorders in the Americas between 2000 and 2019. This field is also the only one for which opioid use disorder is the top 10 predictor to stable life-loss due to premature mortality and injury, while substance use is not the top 25 of any other regions.

WHO Public Health Forecasts present detailed, comparative and transparent time-series statistics on public health, including life expectancy, safe life span, mortality and morbidity, and disease burden at global, regional and country levels, broken down by age, sex and source, from 2000 onwards. "These estimates are made using data from the best available sources from countries and the international community," said Dr. Bochen Cao, technical director of the WHO Global Health Estimates. "They are focused on rigorous empirical techniques for data collection, synthesis and interpretation. This revised figures have gained from important feedback from WHO Member States by constructive country consultation and dialogue."

The provision of facilities to avoid, diagnosis and manage illness is essential to minimising mortality and injury, which affect where different diseases are ranked. These recent projections explicitly show that increased expenditure in programmes is most desperately needed. "Robust health data are critical to addressing inequalities, prioritising policies and allocating resources to prevent disability and save lives," adds Dr Samira Asma, Assistant Director-General for the WHO Data, Analytics and Impact Delivery Division. "The WHO Global Health Estimates are a powerful tool for maximising health and economic impact. We call on governments and stakeholders to invest urgently in data and health information systems to support timely and effective decision-making."

As of today, more than 1.5 million lives have been tragically claimed by COVID-19. People living with pre-existing health conditions such as heart disease, diabetes and respiratory disorders) are at higher risk of complications and death due to COVID-19. Health authorities worldwide rely on timely, reliable and actionable data to make informed decisions – especially during a global pandemic. The next update of these estimates will include an assessment of the direct and indirect impact of the COVID-19 pandemic on mortality and morbidity.