SEATTLE – Ninety-one nations do not produce enough children to maintain their current populations, while the opposite is true in 104 countries where population growth is rising, according to a new scientific study.
Total fertility rates (TFR), a summary measure of the average number of children a woman would bring in their entire life, have fallen since 1950. In 2017, the lowest TFR was in Cyprus, where on average , the child throughout her life, unlike the highest one, in Niger, where a woman would give birth to seven children.
In addition to Niger, Mali, Chad and South Sudan are among the 104 nations with fertility rates that exceed two births per woman, compared with 91 countries, including Singapore, Spain, Portugal, Norway and South Korea, less than two.
These statistics are both a "baby boom" for some nations and a "baby booze" for others, said Dr. Christopher Murray, director of the Institute of Metrology and Health Assessment (IHME) at the University of Washington. "Low women's fertility rates clearly reflect not only the access and availability of reproductive health services, but also many women who choose to delay or give up birth and have more opportunities for education and employment."
The findings are included in the Global Task Force (GBD) study, with 3,676 contributors from 146 countries and territories. This year's study includes over 38 billion estimates of 359 diseases and injuries and 84 risk factors in 195 countries and territories.
This version of the GBD study, published today in the international medical journal Lancet, marks the first time the study produced its own estimates of population and fertility. The global population has risen by 197% since 1950, from 2.6 billion to 7.6 billion in 2017.
"From our knowledge, this is the first study to provide transparent and replicable population and fertility estimates that can be used to inform decision-making and monitor the economic progress of nations," Murray said. "Although overall fertility rates are declining, the global population continues to grow as mortality rates are declining and the population's impulse in recent decades."
From 2007 to 2017, the world's population grew annually by 87.2 million people, compared to 81.5 million annually between 1997 and 2007. In 1950, high-income countries accounted for 24% of the global population, but in 2017 the population countries accounted for 14%.
Among countries whose population grew by more than 2% annually between 2010 and 2017, 33 were in Sub-Saharan Africa. Besides Niger, these nations include Nigeria, Ethiopia and Mali. Outside Africa, India, Pakistan, Papua New Guinea and Haiti are, among other things, growing populations. In comparison, 33 countries had declining populations between 2010 and 2017, most of which were in Central, Eastern and Western Europe – including Georgia, Poland, Romania, Greece, Spain, Portugal – as well as Japan, Cuba and Puerto Rico.
In addition to population and fertility, this year's GBD, with results described in seven scientific papers, covers mortality and life expectancy, causes of death and healthy life years lost, life years with disabilities, global disease burden, risk factors and the chances of meeting each nation 41 of the health indicators that are part of the United Nations Sustainable Development Goals (SDG) for 2030.
Analysis of the goals of sustainable development of the UN
Among the findings on SDGs:
- Among the highest scores for the availability of health workers – doctors, nurses, midwives and pharmacists – were in Cuba, Qatar and many European countries, while the lowest in Sub-Saharan Africa.
- Several Latin American nations had the worst scores for sexual violence than non-intimate partners, while many countries in Central Asia, Eastern Europe and South Asia had the best scores.
- Most nations have a 95% probability of reaching SDG targets for malaria, as well as deaths for children under 5, neonatal mortality and maternal mortality.
- Most nations will not be able to achieve their goals of reducing deaths from non-communicable diseases such as diabetes or stroke or suicide.
- No nation has yet met the SDG target for overweight children, which is at least 0.5% of children aged 2 to 4 years old.
- Men are more prone than females to die from non-communicable diseases and smoking, among other health problems.
- Male suicide rates far exceed women rates (13.8 per 100,000 versus 4.0 per 100,000).
- The goal of eliminating new HIV infections is unlikely to be met.
"HIV remains a massive threat to public health, especially as global funding has reached a ceiling, national health spending has remained low among high-burden countries, and its incidence has not fallen so fast for young people , as in the elderly, "said Murray. "The best way to galvanize accelerated action against HIV as well as other major health challenges in the world is not clear at all. The GBD annual study provides international organizations, national health officials and other stakeholders with a platform through which strategies and programs can be tested and analyzed. "
Major causes of death and health risk factors
The study finds that in 2017 each caused more than 1 million deaths worldwide: ischemic heart disease, neonatal disorders, stroke, lower respiratory infections, diarrhea, road injuries and chronic obstructive pulmonary disease (COPD ).
- The highest rates of death of ischemic disease were in Uzbekistan, Ukraine and Azerbaijan; the smallest in South Korea, Japan and France.
- The highest rates for neonatal disorders were in the Central African Republic, Pakistan and Mali; the smallest in Singapore, Japan and Iceland.
- The highest rates of stroke were in the Marshall Islands, Papua New Guinea and Montenegro; the smallest in Switzerland, France and Singapore.
- The highest rates of lower respiratory infections were in the Central African Republic, the Solomon Islands and Chad; the smallest in Austria, Finland and Macedonia.
- The highest rates for diarrheal diseases were in the Central African Republic, Chad and South Sudan; the smallest in Montenegro, Belarus and Estonia.
- The highest rates of road deaths were in the Central African Republic, Somalia and the United Arab Emirates; the smallest were in Switzerland, Singapore and Sweden.
- The highest rates for COPD were in Papua New Guinea, North Korea and India; the smallest in Kuwait, Iraq and Japan.
In addition, there have been rapid increases in mortality rates for which antibiotic use or resistance is a major factor, such as tuberculosis and cellulitis, a common skin infection.
An unintended consequence of increased access to global healthcare is the dramatic increase in mortality from disease and drug-related disorders, particularly antibiotic resistance and opiate use, Murray said.
He noted that over the last decade, deaths from global opioid use have increased by more than 75%, from 61,859 in 2007 to 109,520 in 2017.
With regard to the loss of health (measured in disability-adjusted or DALY), due to other risk factors, many of the most common, such as hypertension and smoking, have changed slightly in the rankings of the first 15 between 2007 and 2017, looking 27 years ago to the peak risk in 1990, there are major differences, when children are squandered, short pregnancy for birth weight and low birth weight are in third place. The three are ranked ninth, fifth and sixth in 2017.
Other important issues regarding the classification of risk factors based on the number of all DALYs include:
- High blood pressure in 1990 was fifth; in 2017 was the first
- Smoking in 1990 was the fourth; in 2017 it was the second
- The high blood sugar in 1990 was in 11th place; in 2017 it was the third
- The body mass index raised in 1990 was ranked 16th; in 2017 it was the fourth
- The unsafe water source in 1990 ranks sixth; in 2017 it was the 14th
- Household air pollution in 1990 was seventh; in 2017 it was 16
- Unhealthy sanitation in 1990 was ranked No. 9; in 2017 it was the 20th
"The world has seen several success stories in health," Murray said. "Investments made in poor countries that address prenatal care and water and sanitation problems have made clear a significant difference in people's lives. Instead, combining increased metabolic risk and aging will continue to lead problematic trends in non-communicable diseases. and opportunity, and highlights the value of the GBD study to inform decisions about good policy and strategic health planning.
Years of lost life and nations with the hope of a healthy life
These decisions and health planning efforts are also based on DALY analyzes, which are the sum of lost years of life (YLL) plus years of disability (YLD).
As risk factors, there were significant differences in the rankings and percentages of DALY cause changes in the 1990s compared to 2017:
- Drug use deficit increased by 71%
- Diabetes increased by 117%
- Alzheimer's disease and other dementias increased by 115%
- Pain in the neck increased by 75%
- Age related hearing loss increased by 80%
- Depressive disorders increased by 53%
- Tetanus dropped by 90%
- Torn rupture decreased by 86%
In 2017, there were several differences in the ranking of all DALYs between men and women, including:
- Road injuries were the fifth leading cause of DALY for men, compared with 16 for women.
- Headaches were the 18th for males and eight for women.
- Lung cancer was ranked 12th for males, and for 27th for females.
- The self-harm was 16 for males and 31 for women.
The GBD study also identifies nations with a high and low healthy life expectancy, measured by years, a person can expect to live in good health, taking into account both death and disability. In 2017, the top three countries were Singapore (74.2 years), Japan (73.1 years) and Spain (72.1 years); the lowest was the Central African Republic (44.8 years), Lesotho (47.0 years) and South Sudan (50.6 years).
With an increase in life expectancy in many countries, the question for all of us in the health policy arena is whether extra years are spent in good health or poor health, Murray said. The task of disabling the conditions has serious implications for health care systems and healthcare spending. Global trends in non-communicable diseases indicate that more effort is needed to increase healthy life expectancy.
Nations with the highest fertility rates (the average number of children a woman offers over the lifetime):
Niger – 7.1; Chad – 6.7; Somalia – 6.1; Mali – 6.0; Afghanistan – 6.0; South Sudan – 5.9; Burkina Faso – 5,4; Burundi – 5.3; Uganda – 5.2; Democratic Republic of Congo, Angola, Nigeria (all 5.1)
Top 10 nations with the largest populations:
China – 1,412,480,000; India – 1,380,560,000; United States – 324, 839,000; Indonesia 258,134,000; Pakistan – 214,287,000; Brazil – 211,812,000; Nigeria – 206,087,000; Bangladesh – 156,981,000; Russia – 146,189,000; and Japan – 128, 363,000
Top 10 global health risks related to DALYs of all ages (both sexes):
High blood pressure, smoking, high blood sugar, high body mass index, short pregnancy for birth weight, low birth weight for gestation, alcohol consumption, high cholesterol, child waste and air pollution
Top 10 causes of all DALY men's ages for 2017:
Ischemic heart disease, neonatal disorders, stroke, lower respiratory tract infections, road injuries, COPD, diarrhea, diabetes, congenital birth defects and low back pain
Top 10 causes of all DALY women's ages for 2017:
Neonatal disorders, ischemic heart disease, stroke, lower respiratory infections, diarrhea, COPD, low back pain, headache, diabetes and congenital birth defects.
Top 10 and Lower Hope for Healthy Living (HALE):
Singapore – 74.2 years; Japan – 73.1 years; Spain – 72.1 years; Switzerland – 72 years old; Italy – 71.9 years old; France – 71.7 years old; South Korea – 71.7 years old; Israel – 71.4 years old; Bermuda – 71.4 years old; Iceland – 71.3 years
Central African Republic – 44.8 years; Lesotho – 47.0 years; South Sudan – 50.6 years; Mozambique – 50.6 years old; Papua New Guinea – 50.8 years; Somalia – 51.2 years old; Swaziland – 51.3 years old; Chad – 51.5 years; Guinea-Bissau – 52 years old; and Sierra Leone – 52.1 years
IHME: Kelly Bienhoff, + 1-206-897-2884 (office); + 1-913-302-3817 (mobile); [email protected]
IHME: Dean Owen, + 1-206-897-2858 (office); + 1-206-434-5630 (mobile); [email protected]
About the Institute of Metrology and Health Assessment
The Institute of Metrology and Health Assessment (IHME) is an independent worldwide health research organization at the University of Washington that provides rigorous and comparable assessment of the most important health problems in the world and evaluates the strategies used to approach them. IHME makes this information widely available so that policy makers have the evidence they need to make informed decisions on how to allocate resources to improve the health of the population.