NCDs now make up 7 of the world’s top 10 causes of death, according to WHO’s 2019 Global Health Estimates, published today. This is an increase from 4 of the 10 leading causes in 2000. The new data cover the period from 2000 to 2019 inclusive .
The estimates reveal trends over the last 2 decades in mortality and morbidity caused by diseases and injuries. They clearly highlight the need for an intensified global focus on preventing and treating cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, as well as tackling injuries, in all regions of the world, as set out in the agenda for the UN Sustainable Development Goals.
“These new estimates are another reminder that we need to rapidly step up prevention, diagnosis and treatment of NCDs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “They highlight the urgency of drastically improving primary health care equitably and holistically. Strong primary health care is clearly the foundation on which everything rests, from combatting NCDs to managing a global pandemic.”
Heart disease remains the number 1 killer; diabetes and dementia enter the top 10
Heart disease has remained the leading cause of death at the global level for the last 20 years. However, it is now killing more people than ever before. The number of deaths from heart disease increased by more than 2 million since 2000, to nearly 9 million in 2019. Heart disease now represents 16% of total deaths from all causes. More than half of the 2 million additional deaths were in the WHO Western Pacific region. Conversely, the European region has seen a relative decline in heart disease, with deaths falling by 15%.
Alzheimer’s disease and other forms of dementia are now among the top 10 causes of death worldwide, ranking 3rd in both the Americas and Europe in 2019. Women are disproportionally affected: globally, 65% of deaths from Alzheimer’s and other forms of dementia are women.
Deaths from diabetes increased by 70% globally between 2000 and 2019, with an 80% rise in deaths among males. In the Eastern Mediterranean, deaths from diabetes have more than doubled and represent the greatest percentage increase of all WHO regions.
People are living longer – but with more disability
The estimates further confirm the growing trend for longevity: in 2019, people were living more than 6 years longer than in 2000, with a global average of more than 73 years in 2019 compared to nearly 67 in 2000. But on average, only 5 of those additional years were lived in good health.
Indeed, disability is on the rise. To a large extent, the diseases and health conditions that are causing the most deaths are those that are responsible for the greatest number of healthy life-years lost. Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease were collectively responsible for nearly 100 million additional healthy life-years lost in 2019 compared to 2000.
Injuries are another major cause of disability and death: there has been a significant rise in road traffic injuries in the African region since 2000, with an almost 50% increase in both death and healthy life-years lost. Similar but slightly smaller increases (at around 40%) were also observed for the Eastern Mediterranean region. Globally, deaths from road traffic injuries are 75% male. In the Americas, drug use has emerged as a significant contributor to both disability and death.
In the Americas, drug use has emerged as a significant contributor to both disability and death. There was a nearly threefold increase in deaths from drug use disorders in the Americas between 2000 and 2019. This region is also the only one for which drug use disorder is a top 10 contributor to healthy life-years lost due to premature deaths and disability, while in all other regions, drug use does not make the top 25.
Global decline in deaths from communicable diseases, but still a major challenge in low- and middle-income countries
In 2019, pneumonia and other lower respiratory infections were the deadliest group of communicable diseases and together ranked as the fourth leading cause of death. However, compared to 2000, lower respiratory infections were claiming fewer lives than in the past, with the global number of deaths decreasing by nearly half a million
This reduction is in line with a general global decline in the percentage of deaths caused by communicable diseases. For example, HIV/AIDS dropped from the 8th leading cause of death in 2000 to the 19th in 2019, reflecting the success of efforts to prevent infection, test for the virus and treat the disease over the last two decades. While it remains the fourth leading cause of death in Africa, the number of deaths has dropped by more than half, falling from over 1 million in 2000 to 435 000 in 2019 in Africa.
TB is also no longer in the global top 10, falling from 7th place in 2000 to thirteenth in 2019, with a 30% reduction in global deaths. Yet, it remains among the top 10 causes of deaths in the African and South-East Asian regions, where it is the 8th and 5th leading cause respectively. Africa saw an increase in tuberculosis mortality after 2000, though this has started to decline in the last few years. The new estimates also emphasize the toll that communicable diseases still take in low-income countries: 6 of the top 10 causes of death in low-income countries are still communicable diseases, including malaria (6th), TB (8th) and HIV/AIDS (9th). Meanwhile, in recent years, WHO reports highlight an overall concerning slow-down or plateauing of progress against infectious diseases like HIV, TB and malaria.
Data sources and methodology
WHO’s Global Health Estimates present comprehensive, comparable and transparent time-series data for population health, including life expectancy, healthy life expectancy, mortality and morbidity, and burden of disease at global, regional and country levels disaggregated by age, sex and cause, from 2000 onwards.
“These estimates are produced using data from the best available sources from countries and the international community,” said Dr Bochen Cao, the technical lead for WHO’s Global Health Estimates. “They are based on robust scientific methods for the processing, synthesis and analysis of data. These updated estimates also benefited from the valuable contributions of WHO’s Member States through active country consultation and dialogue.”
The availability of services to prevent, diagnose and treat disease is key to reducing death and disability, influencing where different conditions are ranked. These new estimates clearly indicate where additional investments in services are most urgently needed.
“Robust health data are critical to address inequalities, prioritize policies and allocate resources to prevent disability and save lives,” adds Dr Samira Asma, Assistant Director-General for the Division of Data, Analytics and Delivery for Impact at WHO. “The WHO Global Health Estimates are a powerful tool to maximize health and economic impact. We call upon governments and stakeholders to urgently invest in data and health information systems to support timely and effective decision-making.”
As of today, COVID-19 has tragically claimed more than 1.5 million lives. People living with pre-existing health conditions (such as heart disease, diabetes and respiratory conditions) are at higher risk of complications and death due to COVID-19.
Health authorities worldwide depend on timely, reliable and actionable data to make informed decisions – this is especially true during a global pandemic. The next update to these estimates will include an assessment of the direct and indirect impact of the COVID-19 pandemic on mortality and morbidity.
Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance says, “People living with NCDs believe it’s a health right to have proper access to care and medicines, especially now during a time of pandemic. Before COVID-19, the NCDs group of conditions killed most South Africans and remained neglected within government policy and budgets. For so long the many millions of people living with NCDs have lamented, ‘it would be better if I had HIV, then I would get access to quality care and medicines.”
NCDs, called underlying conditions during COVID-19, cause most deaths in South Africa. Diabetes kills more women than any other single illness for many years. (1) Government media acknowledge that 90% of those who die following COVID-19 infection had one or more NCD. (2)
Act on NCDs Now – Accountability
The early figures coming out of Wuhan showed that NCDs increased the risk of complications and dying. It was clear that survival depended on well-managed conditions such as diabetes. It immediately exposed the fault lines in NCDs care.
The aim is to get government to implement ongoing care for those living with NCDs by health workers during and beyond COVID-19. This includes ensuring adequate supply of medications that don’t involve travel and visits to facilities and making use of online and tools for consultations to minimise physical interaction and exposure.
The Alliance further proposes performance indicators to assess government’s response to COVID-19 and ongoing NCDs care such as maintenance of food and medicine supply chains, protection and support for vulnerable and neglected people and maintenance of usual health services.
“As South Africans went into lockdown in March, the SA NCDs Alliance initiated online support, counselling and information services to keep people healthy such as the diabetes care line. Those of us living with diabetes soon learned that optimal blood sugar control is the best way to survive a COVID-19 infection. However, getting care and a regular supply of medicines in the public sector involved a stark choice; get your medications or get the virus. Unlike for HIV and TB, a remote non-clinic supply point is a rare option. Insulin, absolutely critical to sustain life in diabetes, is only available at a hospital-level even if there is a clinic next door,” elaborated Pinkney-Atkinson.
Zodwa Sithole, Head of Advocacy for CANSA added, “Patients are feeling frustrated and despondent as they struggle to access vital support services. A cancer patient’s low immunity and high infection risk for COVID-19, results in anxiety and physical distancing and hygiene measures add to a feeling of isolation even as lockdown levels are eased. Part of the response was the launch of our CANSA Tele Counselling service offering free, confidential cancer-related telephonic counselling available in seven languages.”
Nosipho (3) puts the human face on the access issue. In late pregnancy, she always needs insulin and asthma medication. Being a savvy diabetic, she knows she is at risk and tries to avoid the minimum five-hour round trip to get her insulin in central Cape Town during the COVID-19 surge. She knows that the risk of infection is high by using public transport and the long waiting lines at the hospital. When asked, the government sectors were unable to offer a solution.
For other NCDs like cancer, there are implications of delaying any screening that can result in cancers being detected at a later stage and affecting treatment outcomes.
Pinkney-Atkinson concludes, “What works to keep diabetics and other people living with NCDs safe, is not a mystery. There is plenty of evidence, we need action to provide ongoing NCDs care during COVID-19. (4) During the COVID-19 pandemic and beyond, we must go beyond stopping the virus and our right to get our ongoing essential services safely. We need these drugs and supplies (needles and syringes) to stay alive.”
For more information, please contact Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance at email [email protected]
Call 083 38 38-159. Alternate contact is Lucy Balona, Head: Marketing and Communication at CANSA at email [email protected].
Call 011 616 7662 or mobile 082 459 5230.
References:
(1) Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notification [Internet]. Pretoria; 2018 [cited 2018 Mar 28]. Available from: http://www.statssa.gov.za/publications/P03093/P030932016.pdf
(2) SA Government News Agency. SA COVID-19 cases rise to 3 034. SANews.gov.za. 2020;2
(3) Not her real name
(4) Young T, Schoonees A, Lachman A, Kalula S, Mabweazara S, Musa E, et al. Taking stock of the evidence. Cape Town: Better Health Programme South Africa; 2020. 50 p
About NCDs+
NCDs are a large group of health conditions that are generally not spread from person to person and used to be called chronic illness until 2000 when the Millennium Develop Goals force a new definition. Often the 5 main NCDs groups of conditions are noted: diabetes, circulatory disorders, mental health, cancer, and chronic respiratory illnesses. However, there are many more conditions that do not get a mention. Globally NCDs conditions are responsible for 41 million deaths annually and they are leading cause of death in South Africa since 2013. Diabetes is the leading cause of death of South African women.
However, the NCDs agenda is not just about illness it goes to a whole of society and whole of government response and for this we need an expanded understanding, meaning, NCDs+. The expanded NCDs+ advocacy agenda includes prevention, vulnerable populations, stigma control and disability. NCDs+ has many determinants (social, economic, and commercial) that disproportionately impact poor people. The Sustainable Development Goals (SDGs) address NCDs+ and its inclusion as an equal part of universal health coverage. (National Health Insurance in South Africa).
About the SA NCDs Alliance
The SA NCDs Alliance, established in 7 years ago, is a civil society partnership between three trusted NCDs advocacy organisations: CANSA, Diabetes SA and the Heart & Stroke Foundation SA.
Its mission is for the people of South Africa have equitable access to quality NCDs+ prevention and management within universal health coverage/ NHI.
For this important COVID-19 and NCDs+ advocacy project nearly 90 civil society organisations are collaborating:
The SA NCDs Alliance’s goal in this programme it to ensure that the policy window of opportunity opened by the COVID-19 pandemic is used to make NCDs a priority in government policy through collaboration with NCDs civil society to put it on a par with HIV & TB. www.sancda.org.za
20 civil society alliances in mainly low- and middle-income countries, including the South African Non-Communicable Diseases Alliance, were awarded grants to accelerate the response to the COVID-19 pandemic. The grants, made by the first Civil Society Solidarity Fund on Non-communicable Diseases (NCDs) and COVID-19, were announced today by the global NCD Alliance during a high-level online event.
Todd Harper, President of the global NCD Alliance, said: “The COVID-19 pandemic shows many intersections between COVID-19 and NCDs. People living with NCDs are more vulnerable to COVID-19, with a substantially higher risk of becoming severely ill or dying from the virus. The pandemic also impacts the poorest communities around the world and the most vulnerable people in every country. The civil society solidarity fund was born out of the need to tackle NCDs as fundamental to health security and to prevent a reversal of gains made in NCDs prevention and control around the world”.
The fund, totalling $300,000, competitively awarded grants of up to US$15,000 to national and regional NCD alliances. The purpose of the grants is to support alliances to address the critical needs of people living with NCDs during COVID-19 via advocacy and communication activities that will support stronger organisational stability and resilience.
Dr Vicki Pinkney-Atkinson, Director of SA NCDs Alliance, states: “Until the COVID-19 pandemic exposed the inequitable fault lines in the health system, NCDs+ are a neglected priority in South Africa. In South Africa, 99% of the people who have died because of COVID-19 are those of us living with NCDs+. The funding is a cause for celebration in an otherwise dark time with record daily number of new infections and deaths. It will allow the participation of people living with NCDs+ to building back a better health system with equity for NCDs prevention and treatment. We can work alongside the government to ensure that NCDs public health plans are equal to those for HIV and meet our needs.”
Katie Dain, CEO of NCD Alliance, added: “This is a first-of-its-kind fund to support NCD civil society organisations (CSOs) response to COVID-19. During pandemics, momentum in several health and sustainable development issues, notably HIV/AIDS, Ebola and climate change, have repeatedly reinforced the critical role of CSOs and community-led efforts in accelerating action from local to global levels. Civil society are proven campaigners, change agents, experts, implementers and watchdogs”.
The millions of South Africans living with NCDs+ are a critical at-risk, vulnerable group during COVID-19. No community is spared from the impacts of COVID-19 or NCDs, affecting rich and poor alike. The COVID-19 pandemic, despite its huge negative impact, offer a policy window of opportunity to work together to build a better health system and society free from the preventable suffering, disability, and death caused by NCDs.
The NCD Alliance Civil Society Solidarity Fund on NCDs and COVID-19 is possible thanks to generous financial contributions of global NCD Alliance’s supporters: The Leona M. and Harry B. Helmsley Charitable Trust, Access Accelerated, Takeda, AstraZeneca and Upjohn (Pfizer). The Fund received 45 submissions from national and regional alliances across all regions, which were reviewed by a selection committee. The Fund recognises the essential work of NCD advocates, which now becomes even more critical than ever to ensure political and media attention to the needs of people living with NCDs as one of the most vulnerable groups to COVID-19.
The recipients of the Civil Society Solidarity Fund are from Africa, Asia, Europe, Eastern Mediterranean and Latin America:
It is our third week of hosting the #diabetes helpline. One clear message is that access to #insulin and other supplies are problematic in the public sector for those with #type1diabetes or #type2diabetes.
Insulin is injected and must be administered as prescribed and on time. Skipping doses or cutting back can have fatal consequences within a short time. The chronic neglect of #NCDs in the South African public health sector means that inulin is seldom available at a primary health care clinic. Meaning one has to go to a higher level of care to get supplies. This means a trip to a community health centre or hospital. Let’s just make it difficult for diabetics.
For the patient, this involves greater risks of lengthy taxi trips and waiting periods in crowded hospitals. What a way to treat people with pre-existing “underlying” health problems! Also known as #NCDs ! We are at the greatest risk of dying from severe #covid19 illness.
I am in awe of the creative ways that our empowered patients are getting medicines without standing in queues or travelling for a day. Pure survival instincts at work. We salute the private #phamacies that filled prescriptions in the national lockdown. And then, there are the unsung heroes who shared their meds because they know what happens if … #equity
The National Department of Health’s central chronic medicines dispensing and distribution programme, #CCMDD, must be urgently extended to all common #NCDs including insulin. For over a year we have asked the statistics for NCDs medicines supply using CCMDD. #transparency #equity #accountability
What does proof of concept for CCMDD NCDs look like? A verifiable table showing:
NCDs conditions treated
NCDs medicines and supplies formulary
Clinics and district involved
The number of NCDs patients registered by the clinic.
Timelines for full rollout.
Insulin is at the top of that list. We are still waiting. #COVID19 pandemic shows just why the health systems strengthening goes beyond #TB and #HIV
WHY? PLWD -People living with diabetes- who are infected have a higher chance of getting a serious form of COVOD-19. So we want you to stay healthy, on stay on your treatment plan and stay at home.
WHAT? We offer support to PLWD so that you can best self manage while preventing diabetes complications
WHO? A person with diagnosed diabetes on a management plan involving “lifestyle” +/or oral medicine +/or insulin.
HOW? Telehealth using text messages, email, phone +/or video consultations. To start the process message us: Email: [email protected] or text or voice +27-81-578-6636 (text or voice and WhatsApp or other messaging service)
TELL US: Your name, cell number or email, where you are staying, a few words about your diabetes challenge
WE REPLY: within 24 hours of getting your message and between 8am – 5pm 7 days a week.
Don’t use this service for emergencies or a sudden worsening of your health. Follow local instructions.