Saturday , October 23 2021

The latest global disease estimates a shortage of health workers, suggesting that progress is not inevitable


The latest global estimates of global health from the Global Burden of Disease (GBD) study estimate that:

  • The improvement in global mortality rates was generally less pronounced and in some countries these rates stagnated or deteriorated in 2017.
  • Fertility rates have declined worldwide since 1950. In 91 countries fertility rates are not high enough to maintain the current population, and in 104 countries, a high fertility rate drives population growth.
  • Half of the countries have a shortage of health workers – 47% of them have less than 10 doctors to service 10,000 people, and 46% have less than 30 nurses or midwives to serve 10,000 people.
  • Emerging unfavorable trends (such as conflict and terrorism and the opioid crisis) can lead to negative shifts over time if no action is taken.
  • Half of all deaths in the world were caused by only four risk factors in 2017 – hypertension, smoking, high blood glucose and high body mass index (BMI).
  • The pain of the cross, headaches and depressive disorders were the three main causes of disability in the world in 2017. And for over thirty years they have been the leading causes of disability.

The latest global global health estimates from the Global Burden of Disease (GBD) study, published in the special edition of The Lancet, emphasize that global health progress is not inevitable.

This year's GBD study estimates that improvements in adult mortality rates were less pronounced and stagnant or deteriorated in some countries in 2017. In addition, no country is aiming to achieve the United Nations Sustainable Development goals to improve health 2030

Total fertility rates, which represent the average number of children a woman provides during her life, have decreased since 1950. In 2017, 91 countries (including Singapore, Spain, Portugal, Norway, South Korea and Cyprus) had rates lower than two and they do not maintain their current population numbers, while 104 countries have an increase in population due to their high fertility rate (total fertility rate above two).

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

"These statistics are both a" boom for children "for some nations, and a" bust for children "for others – says Dr. Christopher Murray, director of the Institute of Metrology and Health Assessment (IHME) at the University of Washington in the US." Lower fertility rates for women they clearly reflect not only the access and availability of reproductive health services, but also many women who decide to delay or give up their childbirth, and have more opportunities for education and employment. " [1]

The emerging unfavorable trends may lead to negative shifts over time, if no action is taken – for example, conflict and terrorism pose a growing threat to global health (the number of deaths related to it increases by 118% in 2007-2017), and the period of the era is still undergoing the epidemic of opiate addiction – with over 4 million new cases and around 110,000 deaths in 2017. In addition, half of all deaths in the world (51.5%, 28.8 million from 55.9 million deaths) were caused by only four avoidable risk factors in 2017 (high blood pressure [10.4 million deaths]smoking [7.1 million deaths]high blood glucose [6.5 million deaths]and a high body mass index [4.7 million deaths]), presenting a challenge to public health and the ability to act.

GBD is the only annual, comprehensive, assessed by researchers assessment of global health trends, providing global and national estimates for approximately 280 causes of deaths, 359 diseases and injuries, and 84 risk factors in 195 countries and territories around the world.

The study is coordinated by the Institute of Health Metrology and Assessment (IHME) at the University of Washington in Seattle (USA) and includes over 3,500 colleagues from over 140 countries and territories. The study was presented in 7 new works in The name of the scientific medical journalranging from population and fertility estimates, causes of deaths and disabilities, and measuring progress towards sustainable development goals.

Global disproportions in the number of health professionals

For the first time, estimates include a global analysis of the health workers' density using surveys and census data on human occupations. The authors note that numbers are not able to estimate the quality of care, but only the number of health professionals.

Historically, in 2006, the World Health Organization (WHO) estimated that there should be at least 23 doctors, nurses or midwives per 10,000 inhabitants. However, these estimates have not been updated and the study authors expect that a larger, more diversified health workforce is needed to provide a wider range of services and achieve universal healthcare. Although no objective has been established, the United Nations has pledged to increase the number of health workers in developing countries under the Sustainable Development Goal (SDG) 3.c.1.

The authors estimate that having over 30 physicians, 100 nurses and midwives and 5 pharmacists for every 10,000 people in the population has less and less impact on the access and quality of healthcare.

In total, in 2017, estimates indicate that only 41 out of 195 countries had more than 30 physicians per 10,000 inhabitants, while only 28 had more than 100 nurses or midwives. Almost half (47.2% – 92 of 195 countries) from the countries included had less than 10 physicians per 10,000 people, and 46.2% (90/195 countries) had less than 30 nurses or midwives for every 10,000 people.

In assessing countries where healthcare systems had adequate resources from 0 (lowest) to 100 (the highest), the authors rated 15 countries as 100 and one as 0. [2]

"The balance between doctors, nurses, midwives and pharmacists in the country is the basis for the types of care available to the public, and increasing the total number of health workers will be important for many countries, which is why it is so important to increase the composition of the workforce" – says the main author , Professor Rafael Lozano, Institute of Metrology of Health and Evaluation at the University of Washington, USA. [1]

The authors note that this study does not include doctors and nurses with a specialty that may be relevant to understanding labor shortages for the various disease burden of each country. In the future, the GBD study will improve the estimates of healthcare professionals using more up-to-date occupational data.

Global Burden of Disease 2017 – other key findings

Non-communicable diseases (NCDs) accounted for the largest share of deaths in the world in 2017 (contributed to 73.4% of the total number of deaths, corresponding to approximately 41.1 million deaths). The total number of deaths from non-communicable diseases increased from 2007. By 2017, by 22.7% (from 33.5 million in 2007 to 41.1 million in 2017), which represents an additional 7.6 million deaths. in 2017. While the age-standardized death rate due to NCD decreased in the world compared to 2007 -2017 by 7.9%, this change was smaller in the recent period – a slowdown from the 7.8% decline in 2003 -07 to a decline of 2.1% in 2013-17. The largest number of deaths due to NCD came from cardiovascular diseases (17.8 million deaths), cancer (9.6 million deaths) and chronic respiratory diseases (3.9 million deaths).

The prevalence of obesity continues to grow in almost every country in the world, with over one million deaths estimated for type 2 diabetes, nearly half a million (426.90 deaths) due to chronic kidney disease associated with diabetes and more than 180,000 deaths from liver cancer and cirrhosis associated with Alcohol-free fatty steatosis (NASH) in 2017.

Cross-pain, headaches and depressive disorders were the three main causes of disability in the world in 2017. And for more than thirty years they have been dominating as the leading cause, while diabetes has become the fourth leading cause of disability in the world. In 2017, 245.9 million new cases of low back pain, 915.4 million new cases of pain disorder, 258.2 million new cases of depressive disorders and 22.9 million new cases of diabetes were reported.

"The world has seen several health successes," says Murray. "Investments made in poor countries regarding prenatal care and problems related to water and sanitation have clearly led to a significant change in people's lives, while combining the growing metabolic risk and population aging will continue to cause problematic trends in non-communicable diseases." Challenge and opportunity and underlines the value of the GBD study to inform about good policy decisions and strategic health planning. " [1]

Half of all deaths in the world (51.5%, 28.8 million from 55.9 million deaths) were caused by only four risk factors in 2017 – hypertension, smoking, high blood glucose and high body mass index (BMI ). High blood pressure was a leading risk factor, accounting for 10.4 million deaths, followed by smoking (7.1 million deaths), high fasting plasma glucose (6.5 million deaths) and high body mass index (4, 7 million deaths).

In most tropical and subtropical countries, the burden associated with dengue fever increased over time, and the number of deaths worldwide increased by 65.5% between 2007 and 2017 (from 24,500 to 40,500 deaths), and the standardized death by age increased by 40 , 7% (from 0.4 to 0.5 deaths per 100,000). In addition, in 2017, 104.8 million new cases of dengue were estimated. This disease is a significant exception in the estimated improvement of infectious diseases and may reflect changes in its original vector, Aedes aegypti.

Women have a longer life, but they live for more years in poor health. At the global level, in the years 1950-2017, life expectancy increased from 48.1 to 70.5 for men and from 52.9 to 75.6 for women. In 180 of 195 countries, women were expected to live longer than men in 2017, and additional years would be from 1.4 years in Algeria to 11.9 in Ukraine. With additional years gained, the percentage spent in poor health was different in different countries. In Bosnia and Herzegovina, Burundi and Slovakia, less than 20% of additional years were spent in poor health, while in Bahrain all additional years were spent in poor health.

Accompanying editorial from The name of the scientific medical journal says: "The GBD 2017 is disturbing. Not only are the aggregated global numbers showing a worrying slowdown, but more detailed data reveals exactly how difficult the progress was." GBD 2017 reminds that without vigilance and continuous effort, progress can be easy to be reversed, but GBD is also an incentive to think differently in times of crisis, by cataloging inequalities in the provision of health care and geographic patterns of disease, this GBD iteration is a chance to move away from the UHC's general application towards a more precise approach to UHC, GBD 2017 should be an electric shock, stimulating national governments and international agencies not only to redouble their efforts to avoid the inevitable loss of hard earned profits, but also to adopt a new approach to growing threats . "


Reviewer / modeling

Available data at the national level

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