Geneva, 14 March 2024– A major new study released by The Lancet Neurology shows that, in 2021, more than 3 billion people worldwide were living with a neurological condition. The World Health Organization (WHO) contributed to the analysis of the Global Burden of Disease, Injuries, and Risk Factor Study (GBD) 2021 data.
Neurological conditions are now the leading cause of ill health and disability worldwide. The overall amount of disability, illness and premature death (known as disability-adjusted life years, DALYs) caused by neurological conditions has increased by 18% since 1990.
Over 80% of neurological deaths and health loss occur in low- and middle-income countries, and access to treatment varies widely: high-income countries have up to 70 times more neurological professionals per 100 000 people than low- and middle-income countries.
“Neurological conditions cause great suffering to the individuals and families they affect, and rob communities and economies of human capital,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This study should serve as an urgent call to action to scale up targeted interventions to allow the growing number of people living with neurological conditions to access the quality care, treatment and rehabilitation they need. It is more important than ever to ensure brain health is better understood, valued and protected, from early childhood to later life.”
The top ten neurological conditions contributing to loss of health in 2021 were stroke, neonatal encephalopathy (brain injury), migraine, dementia, diabetic neuropathy (nerve damage), meningitis, epilepsy, neurological complications from preterm birth, autism spectrum disorder, and nervous system cancers.
Overall, neurological conditions cause more disability and health loss in men compared to women, but there are some conditions like migraine or dementia where women are disproportionately affected.
Since 1990, the absolute number of individuals living with, or dying from, neurological conditions has increased, while age-standardized DALY rates have dropped. This means that increases in absolute numbers are mainly driven by demographic change and people living longer.
Diabetic neuropathy was the fastest growing neurological condition. The number of people with diabetic neuropathy has more than tripled globally since 1990, rising to 206 million cases in 2021. This increase is in line with the worldwide increase in diabetes. Other conditions such as neurological complications from COVID-19 (for example, cognitive impairment and Guillain-Barré syndrome) did previously not exist and now account for over 23 million cases.
At the same time, neurological burden and health loss due to other conditions decreased by 25% or more since 1990 as a result of improved prevention (including vaccines), care and research: tetanus, rabies, meningitis, neural tube defects, stroke, neurocysticercosis (parasitic infection that affects the central nervous system), encephalitis (inflammation of the brain), and neonatal encephalopathy (brain injury).
The study also examined 20 modifiable risk factors for potentially preventable neurological conditions such as stroke, dementia and idiopathic intellectual disability.
Eliminating key risk factors – most importantly, high systolic blood pressure and ambient and household air pollution – could prevent up to 84% of stroke DALYs. Similarly, preventing exposure to lead could reduce the burden of idiopathic intellectual disability by 63.1%, and reducing high fasting plasma glucose levels could reduce the burden of dementia by 14.6%. Smoking significantly contributed to stroke, dementia and multiple sclerosis risk.
More investments needed to improve treatment, care and quality of life
“The Intersectoral Global Action Plan 2022–2031 sets out a roadmap for countries to improve prevention, early identification, treatment and rehabilitation of neurological disorders. To achieve equity and access to quality care, we also need to invest in more research on risks to brain health, improved support for the healthcare workforce and adequate services,” said Dévora Kestel, Director, WHO Department of Mental Health and Substance Use.
IGAP sets out strategic objectives and targets to improve access to treatment, care and support for people with neurological disorders; implement strategies for brain health promotion and disease prevention; strengthen research and data; and emphasize a public health approach to epilepsy and other neurological disorders.
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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.
“We cannot rest if even a single one of our citizens is a victim of discrimination and prejudice on account of having a disability.” This is the message from President Cyril Ramaphosa on International Day of Persons with Disabilities.
Delivering his message on Thursday, President Ramaphosa warned that there can be no sustainable growth and development in any society if there are members who are excluded from being active citizens on account of disability.
The President said the COVID-19 pandemic has exposed the difficulties people with disabilities face in a number of sectors – from accessing healthcare to using public transportation and seeking employment.
“In line with our commitment to building towards an inclusive, accessible and sustainable post COVID-19 world, we must ensure that persons with disabilities are not left behind.
“The social, economic and political inclusion of persons with disabilities is included in the UN Agenda 2030 and Sustainable Development Goals (SDGs), as well as our own National Development Plan (NDP). Now that we are in the final decade of implementation of both the NDP and Agenda 2030, we must increase the pace of change,” President Ramaphosa said.
Presidential Working Group on Disability
The President said through the work of the Presidential Working Group on Disability, government is making sure disability is mainstreamed in all government plans and programmes, along with the necessary budgets.
“Disability has been included in the work streams of the National Coronavirus Command Council. We are striving to ensure that the legal, social, economic, health care and containment work streams include disability in their work.
“A process is underway to finalise a report on the impact of the Coronavirus pandemic on persons with disabilities, which will guide not only our approach to disability in the economic recovery plan, but also our preparation for future crises of this nature,” he said.
As government works to implement the Economic Reconstruction and Recovery Plan, it is making sure that people with disabilities are prioritised when it comes to job opportunities under the Presidential Employment Stimulus, and that businesses owned and managed by people with disabilities have access to opportunities in the key growth sectors.
End gender-based violence against disabled people
As South Africa marks 16 Days of Activism for No Violence against Women and Children, President Ramaphosa challenged every citizen to work to end gender-based violence (GBV) against persons with disabilities, and ensure that survivors get the necessary support.
“According to numerous studies, women with disabilities are more likely to suffer abuse at the hands of partners. Women and children with cognitive disabilities may be taken advantage of due to their perceived inability to report the crime,” the President said.
Disability Rights Awareness Month 2020
The International Day for Persons with Disabilities is observed annually on 3 December to promote the full and equal participation of persons with disabilities in society and the economy, and to take action for the inclusion of persons with disabilities in all aspects of society and development.
The United Nations has themed this year’s commemoration ‘Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World”.
The International Day for Persons with Disabilities also brings to a close government’s Disability Rights Awareness Month 2020 (DRAM 2020).
The DRAM, which run from 3 November to3 December 2020, aims to raise awareness to the harmful effects stigmatisation, prejudice and stereotypes have on the disability sector. The campaign also aims to celebrate individuals who have overcome prejudice, societal barriers, and hardship to excel in their chosen fields.
“We cannot rest if even a single one of our citizens is a victim of discrimination and prejudice on account of having a disability.” This is the message from President Cyril Ramaphosa on International Day of Persons with Disabilities.
Delivering his message on Thursday, President Ramaphosa warned that there can be no sustainable growth and development in any society if there are members who are excluded from being active citizens on account of disability.
The President said the COVID-19 pandemic has exposed the difficulties people with disabilities face in a number of sectors – from accessing healthcare to using public transportation and seeking employment.
“In line with our commitment to building towards an inclusive, accessible and sustainable post COVID-19 world, we must ensure that persons with disabilities are not left behind.
“The social, economic and political inclusion of persons with disabilities is included in the UN Agenda 2030 and Sustainable Development Goals (SDGs), as well as our own National Development Plan (NDP). Now that we are in the final decade of implementation of both the NDP and Agenda 2030, we must increase the pace of change,” President Ramaphosa said.
Presidential Working Group on Disability
The President said through the work of the Presidential Working Group on Disability, government is making sure disability is mainstreamed in all government plans and programmes, along with the necessary budgets.
“Disability has been included in the work streams of the National Coronavirus Command Council. We are striving to ensure that the legal, social, economic, health care and containment work streams include disability in their work.
“A process is underway to finalise a report on the impact of the Coronavirus pandemic on persons with disabilities, which will guide not only our approach to disability in the economic recovery plan, but also our preparation for future crises of this nature,” he said.
As government works to implement the Economic Reconstruction and Recovery Plan, it is making sure that people with disabilities are prioritised when it comes to job opportunities under the Presidential Employment Stimulus, and that businesses owned and managed by people with disabilities have access to opportunities in the key growth sectors.
End gender-based violence against disabled people
As South Africa marks 16 Days of Activism for No Violence against Women and Children, President Ramaphosa challenged every citizen to work to end gender-based violence (GBV) against persons with disabilities, and ensure that survivors get the necessary support.
“According to numerous studies, women with disabilities are more likely to suffer abuse at the hands of partners. Women and children with cognitive disabilities may be taken advantage of due to their perceived inability to report the crime,” the President said.
Disability Rights Awareness Month 2020
The International Day for Persons with Disabilities is observed annually on 3 December to promote the full and equal participation of persons with disabilities in society and the economy, and to take action for the inclusion of persons with disabilities in all aspects of society and development.
The United Nations has themed this year’s commemoration ‘Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World”.
The International Day for Persons with Disabilities also brings to a close government’s Disability Rights Awareness Month 2020 (DRAM 2020).
The DRAM, which run from 3 November to3 December 2020, aims to raise awareness to the harmful effects stigmatisation, prejudice and stereotypes have on the disability sector. The campaign also aims to celebrate individuals who have overcome prejudice, societal barriers, and hardship to excel in their chosen fields.
