A Snapshot of Global Health- 2014

• Between 2000 and 2012, measles deaths worldwide have been cut by almost 80% ??from 562 000 to 122 000 deaths.
• Human African trypanosomiasis (commonly known as sleeping sickness) is at its lowest level in 50 years, with fewer than 10 000 cases of infection reported in 2009.
• The risk of a child dying before their fifth birthday is 8 times higher in the WHO African Region than a child in the WHO European Region.
• Nearly 800 women die every day due to complications in pregnancy and childbirth.
• More than 2.5 billion people worldwide are estimated to be at risk of dengue infection.
• In the WHO Western Pacific Region, almost one in two adult men smoke tobacco.
• In 2012, more than 140 000 people in high-income countries had pertussis (whooping cough), a serious disease in infants that is preventable by vaccination.
• High-income countries have an average of almost 90 nurses and midwives for every 10 000 people while some low-income countries have fewer than 2 per 10 000 people.

(Source- World Statistical Report, 2014)

Fourteen years into the millennium and we have a range of new developments in each and every aspect of our lives. We are better connected with each other than ever before in history, while local and global exchange of information, technology and manpower are at its peak.

This law of change applies equally to health and disease. The previous major concerns are now replaced with new ones, and despite better health information systems being set up worldwide, certain glaring gaps in health outreach and disease prevalence persist.

2014 saw some alarming and some heartening health news. The Ebola virus, which has been around for many years and endemic to certain parts of Africa suddenly assumed epidemic proportions, throwing the health systems worldwide in a quandary. This challenge made it clear that diseases no longer restrict themselves to known patterns of spread, and epidemics of communicable diseases are still a threat to humanity.

On a brighter note, the known enemies like malaria, and diarrhoea have been brought under some control, with the relevant vaccines and preventive measures being adopted in a planned and systematic way by the various nations of the world.

Maternal Health and Child survival figures were elevated. This too, could be attributed to better immunization coverage and adoption of better health behaviours.

HIV is showing signs of a plateau in its spread and morbidity patterns, while polio is near eradication owing to focused and concerted efforts by the public health agencies of the various governments.

All in all, 2014 has brought some shock and some cheer and a look at the facts will give us a better idea of what to expect and more importantly, what to plan for a healthier 2015 that is just around the corner.

The following is an overview of the health related information that has been made available to us through the different international and national reports that were published in 2014. There have been many large scale and small scale studies, all very crucial to understanding the health and disease scenario, and while all have been reviewed, the present understanding has been based on four major reports-

1. World Health Statistical Report, 2014
2. Global Burden of Disease Report, 2013
3. World Cancer Report, 2014
4. Antimicrobial Resistance- Global Report on Surveillance, 2014

We shall look at each of the important indicators of health and disease through the salient points brought out by each report-

World Statistical Report, 2014-

?A. Life Expectancy- Global

• Life expectancy has increased significantly since 1990. A baby girl born in 2012 can expect to live an average of 72.7 years, and a baby boy to 68.1 years. This is 6 years longer than the average global life expectancy for a child born in 1990.

• Low-income countries have made the most significant progress, with an increase of 9 years of average life expectancy between 1990 and 2012 ??rom 51.2 to 60.2 years for men and 54.0 to 63.1 years for women. (This has been achieved despite the ongoing HIV pandemic affecting many low-income countries in sub-Saharan Africa. An important contributor to increasing life expectancy in low-income countries has been progress in reducing child deaths, as well as reductions in deaths from infectious diseases in adults.)

? B. Child Survival and Infant Mortality- Global

• Between 2000 and 2012, child survival improved significantly. The under-five mortality rate fell from 75 to 48 deaths per 1000 live births. Still, around 6.6 million children died in 2012.

• The first 28 days of life are the most dangerous period, during which 44% of all deaths of children aged less than five occur. Some progress has been made in reducing deaths from birth asphyxia and birth trauma (intrapartum-related complications) (-29%) and complications due to prematurity (-14%).

• However, much more attention is needed to increase access to life-saving interventions to save more newborns. More progress was made in saving children after the first month of life. For example, child deaths declined due to measles (-80%), HIV/AIDS (-51%), diarrhoea (-50%), pneumonia (-40%), and malaria (-37%).

• Globally, preterm-birth complications were the leading cause of under-five deaths in 2012 (17.3% of deaths), followed by pneumonia (15.2%), birth asphyxia and birth trauma (11.4%), non-communicable diseases (10.8%) and diarrhoea (9.5%).

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?India Specific Health Data -

II. The Global Burden of Disease Study (2013) Report published by The Lancet on Dec 18, 2014, has thrown light on the Top Ten Causes of Death in different countries in the world.

The global report, coordinated by the Institute for Health Metrics and Evaluation (IHME) and funded by the Bill & Melinda Gates Foundation, said people live longer worldwide than they did two decades ago as death rates from infectious diseases and cardiovascular disease have fallen.

• Since 1990, India saw marked declines in mortality from a number of diseases that used to take a large toll on the country. For instance, by 2013, mortality from diarrhoeal diseases reduced by 42%.

• Every fifth death in the world is that of an Indian, but Indians are also living at least 8.6 years longer on an average than in 1990, one of the best gains worldwide in life expectancy.?
  

• In 2013, heart, lung or brain problems caused a third of all mortality in the country. Suicides, road accidents and lifestyle disease diabetes muscled into the top 10 killers list.
  

• Tuberculosis and heart diseases have emerged as the largest killers of Indians in the most productive age group of 15 to 49 years, says the first country-specific cause-of-death data for 188 countries published in The Lancet in December 2014.

• A comparison of the data from 1990 and 2013 showed that heart diseases and stroke have increased their death grip on Indians, but TB and pneumonia are no longer the top killers.

• India is going through an epidemiological transition with communicable diseases going down and non-communicable diseases going up. Diseases such as malaria and HIV are down and lifestyle-related diseases such as heart diseases and hypertension are going up.'' The biggest indicator of India's relative better health is the rise in life expectancy.
  

• Life expectancy improved for both men (64.2 years) and women (68.5 years) in India, at an average of 8.6 years gained since 1990. This was a larger increase than the global average, and one of the top 25 biggest gains in life expectancy worldwide

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III. Antimicrobial Resistance-

??ntimicrobial resistance: Global report on surveillance 2014?? produced in collaboration with Member States and external partners, is WHO?? first attempt to obtain an accurate picture of the magnitude of Antimicrobial Resistance (AMR) and the current state of surveillance globally. The report focuses on Antibacterial Resistance (ABR), as the state of surveillance in ABR is not generally as advanced as it is for diseases such as tuberculosis (TB), malaria and HIV.

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Key findings and public health implications of Antibacterial Resistance (ABR) are:

• Very high rates of resistance have been observed in bacteria that cause common health-care associated and community-acquired infections (e.g. urinary tract infection, pneumonia) in all WHO regions.

• There are significant gaps in surveillance, and a lack of standards for methodology, data sharing and coordination.
  

Key findings from Antimicrobial Resistance (AMR) surveillance in disease-specific programmes are as follows:

• Although multidrug-resistant TB is a growing concern, it is largely under-reported, compromising control efforts.

• Foci of artemisinin resistance in malaria have been identified in a few countries. Further spread or emergence in other regions, of artemisinin resistant strains could jeopardize important recent gains in malaria control.

• Increasing levels of transmitted anti-HIV drug resistance have been detected among patients starting antiretroviral treatment.

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?IV. Cancer in the Indian Context-

The World Cancer Report, 2014, states that in India with 700,000 deaths, 1.1 million new cases every year, 3.3 million patients at any given time, cancer has emerged as a leading killer for the first time, snuffing out 70 per cent younger lives. Within the next decade, it will replace heart disease, WHO forecasts.

"Curing cancer has proven difficult because it's not just one disease," says Dr Arvind Kumar, head of Institute of Robotic Surgery at Sir Ganga Ram Hospital, Delhi. "It's a complex group of 100-plus diseases that we call cancer."

Cancer at a glance-

• Cancer is now one of the top causes of death in India, after heart attack, up from seventh position in 2000.
• India has some of the world's highest incidences of cancer: Cervical, gall bladder, oral and pharynx, which are also the most common.
• 70 per cent lives are snuffed out in the first year in India, due to late detection.
• 80 per cent patients consult doctors at a stage when recovery is rare.
• 71 per cent of deaths occur in the productive age band of 30-69 in India; 50 per cent deaths are above 70 in US.
• 15 per cent patients are children and young adults in India, compared to the global average of 0.5 per cent.
• 50 per cent of cancers now caused by lifestyle choices, obesity to tobacco use.

The picture of global and Indian health is diffused. There are some dark parts but there are also silver linings. While we can laud ourselves for the good work done, it is still too early to allow for any toning down of efforts in the areas of reproductive, maternal, and child health, water supply and sanitation, and communicable diseases. Sustained efforts will ensure further reduction in the associated mortality and morbidity figures.

The need of the hour is to accommodate the new and emerging concerns like non-communicable diseases and lifestyle-related ailments into the public health priorities and draw up an appropriate plan of action to carry them out. Antibiotic resistance has to be taken into account while planning a health strategy and Cancer needs a separate plan of action with emphasis on preventive strategy.

Some more related concerns raised by different health experts require attention.

i. India?? public health system needs infrastructure upgrade

???/em>With Indians living longer, their needs have become wider. A health system designed primarily for infectious diseases was finding it difficult to cope with a new and more complicated swathe of illnesses - from high blood pressure to diabetes.

The top killer in India is?death from cardio-vascular diseases. We are still in an economy with an infrastructure which has not progressed yet to meet the needs of someone who comes in with a heart attack, requires an operation, and wants it be done safely and well," saysDr Atul Gawande, internationally acclaimed surgeon and author, in an interview on the BBC Health website.

ii. India has to focus on Research and Surveillance-

??ndia has to spend on research and surveillance. If you don't know what is killing people, how will you plan a health programme to check it???asked Dr Nobhojit Roy , professor from BARC Hospital in Chembur, and co-author, of the Global Burden of Disease Study, 2013, in an article in the Times of India, December 18, 2014

??ll our policies and programmes are based on virtually no data and, therefore, it is difficult to measure effects of policy interventions or initiate effective programmes. There are many other social, economic and political considerations while formulating and implementing a public health policy. For example, among the tobacco consumers (smokers), bidi is probably used by more than 85% of the smokers but there is no tax on the product,??said Kaushalendra Kumar, from the International Institute for Population Sciences, Deonar, Mumbai, another co-author of the Global Burden of Disease Study, 2013, in an article in the Times of India, December 18, 2014

So what is way forward, and what are the interventions that would make for a better health scenario for 2015?

The data from all these reports will assist the health systems- both private and public to review their existing service delivery and introduce changes at every level- from policy to programs to human resource development in order to address the important and urgent issues in the health care universe.

There is a pivotal role that media can play in this entire landscape.

• Currently, a lacuna in correct and authentic health information is evident. Effective dissemination of information to the various levels of society from the individual consumer to organizations and networks in the society will go a long way in ensuring that all the stakeholders are made aware of the different issues and their importance along-with the finer details. Presented in a creative way, this could prove to be a crucial intervention.

• Research is an area that could benefit with the macro-level understanding of the society - a tool which media based interventions have been utilising regularly. An exchange of information and insights between health systems and media groups could go a long way in maximising the impact of any information that could be presented in the most palatable way to the people.

• New and innovative ways of data collection are possible with inputs from those who understand the spread and reach of different types of media. A synergy of media with the health systems where newer, quicker methodologies could be created, would make for effective and easily available data that has a potential to be updated faster than by traditional methods. Thereby, the lag that exists in the understanding of a problem and the actual intervention will be reduced.

• Mainstream media could focus on the issues of priority in the health sector and address them in the different formats available to them. This would ensure current health issues to find a platform and enables media to become one among the strong pillars of social and health related change- a space that it so rightly deserves.

References-

1. World Statistical Report - http://apps.who.int/iris/bitstream/10665/112739/1/WHO_HIS_HSI_14.1_eng.pdf?ua=1
2. Global Burden of Disease Report 2013

http://www.healthdata.org/gbd

3. World Cancer Report, 2014

http://www.iarc.fr/en/publications/books/wcr/wcr-order.php

4. Antimicrobial Resistance- Global Report on Surveillance, 2014

http://www.who.int/drugresistance/documents/surveillancereport/en/

5. Cancer Country by Damayanti Datta- India Today Article, January 14, 2014

http://indiatoday.intoday.in/story/cancer-disease-india-chemotherapy-manisha-koirala/1/340991.html

6. Atul Gawande- What Ails India?? Public Health System, BBC News, India. December 16, 2014

http://www.bbc.com/news/world-asia-india-30490823

7. Current Status of Cancer Burden in India- Global and Indian Scenario, by Dhananjay Sarnath and Aparna Khanna Article, http://www.nmims.edu/docs/science/journal/01-editorial.pdf
8. Life span shows healthy jump even as lifestyle diseases turn top killers- Article in the Times of India, Mumbai edition, Dec 18, 2014

http://epaperbeta.timesofindia.com//Article.aspx?eid=31804&articlexml=Life-span-shows-healthy-jump-even-as-lifestyle-18122014002010