Are we ready for longer lives … and more years of bad health?

Paul Yip says society must adapt to the changing face of killer diseases

PUBLISHED : Wednesday, 19 December, 2012, 12:00am
UPDATED : Wednesday, 19 December, 2012, 2:41am

Last week, The Lancet medical journal published a series on the global burden of disease. One paper was an analysis of global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010. This was the result of the efforts of 500 authors from 50 countries, and I am pleased to have been part of it.

The report highlights the change of disease and mortality patterns worldwide, from communicable to non-communicable diseases, over the past two decades. In 2010, there were 52.8 million deaths globally. Communicable, maternal, neonatal and nutritional causes accounted for 24.9 per cent of the deaths worldwide, down from 34.1 per cent in 1990 (15.9 million of 46.5 million deaths). The decrease was largely due to a decrease in mortality from diarrheal diseases, lower respiratory infection, neonatal disorders and tetanus.

Meanwhile, deaths from non-communicable diseases rose by nearly 8 million between 1990 and 2010, accounting for two of every three deaths worldwide in 2010. Heart disease and stroke together killed 12.9 million people in 2010, one in four deaths worldwide, compared with one in five in 1990. Some 1.3 million deaths were due to diabetes, twice as many as in 1990.

There was also a dramatic rise - 46 per cent - in deaths worldwide due to road traffic accidents (1.3 million in 2010) and a rise in deaths from falls and suicide as well. The rapid rate of urbanisation and change of lifestyle of urban populations are mainly to blame for more people dying from non-communicable diseases.

The increase in the number of cars on the road, especially in developing countries such as India and China, has outpaced infrastructure and road development, thus making the roads more dangerous.

Our stressful city lifestyles are also partly responsible for the increase of some chronic illness, such as diabetes and heart disease.

We are living longer but not necessarily healthier lives. Many diseases today can linger for years, for example, heart disease, diabetes, mental illness and dementia. All these non-communicable diseases are usually related to age, unhealthy diet, stressful lifestyle and physical inactivity.

Globally, our life expectancy has increased by almost five years in the past two decades, but only four of those years are "healthy years". The remaining additional year is expected to be a year of bad health.

Are our medical and health systems prepared for this? As the population ages, the burden of disease is likely to increase faster than the increase in our medical and health budget. Consequently, the standard of our health care is likely to be compromised.

Also, the papers highlighted the increased prevalence of suicide as a cause of death. It ranked No 12 in 1990, with 786,000 deaths, but by 2010 had moved up to No 10, with almost one million deaths.

However, our public heath preventative measures worldwide or locally are not keeping pace with the changes in the causes of death.

Projects for the promotion of mental health, for example, have not attracted sufficient funding or government commitment. The stigma relating to mental illnesses and depression prevents some people from seeking help, and is also one reason for persistent community opposition to siting rehabilitation centres in their area. Education is crucial.

The Global Burden of Disease report is a wake-up call - to the world and locally.

There needs to be genuine discussion and deep soul-searching about how to improve the health and well-being of our community, and what our priorities are.

I hope the report can spur dialogue in Hong Kong. The city ranks very high in life expectancy - 81 for men, 87 for women. But perhaps the most important question is not, "Are we living longer?" but "Are we healthier and happier?"

Paul Yip is a professor in social work and social administration at the University of Hong Kong and a member of the task force of the global disease burden study