UK health performance: findings of the Global Burden of Disease Study 2010

reposted from: The Lancet (full text - free article) via Cancer Research UK

crabsallover highlights, key points, comments / links.

Funding: Bill & Melinda Gates Foundation.

Improvements in the UK's health lag behind many other developed nations, a study published in The Lancet has revealed.

Although life expectancy of Britons has increased thanks to six decades of universal healthcare, vastly increased health spending and widespread anti-tobacco initiatives, the UK has failed to keep pace with the 14 other original members of the European Union, Australia, Canada, Norway, and the USA over the past 20 years

While average UK life expectancy has increased by 4.2 years over the last two decades, the nation's premature death rates have dropped at a slower rate than the rest of the other countries.

Using data from the 2010 Global Burden of Disease study, a team of international experts led by Dr Chris Murray, from the University of Washington's Institute for Health Metrics and Evaluation, analysed patterns of ill health and death in the UK. They then ranked them against other high-income countries with similar levels of health expenditure in 1990 and 2010.

Smoking is a large factor in the UK's poor relative performance, alongside alcohol, drug abuse and obesity, with doctors calling for a more joined-up health policy to help educate the public about health lifestyles.

The eight leading causes of death in the UK have remained relatively consistent over the last 20 years, with ischemic heart disease, chronic obstructive pulmonary disease (COPD), stroke, lung cancer and lower respiratory infections continuing to top the list.

Sarah Woolnough, Cancer Research UK's executive director of policy and information, said the findings underlined the need for action.

"We know that smoking, being overweight or obese, poor diet and alcohol consumption all increase the risk of developing cancer," she said.

"Over 40 per cent of cancers in the UK are preventable; of these, tobacco is the single largest cause of cancer responsible for over 60,000 cases in the UK. It is sadly not surprising that lung cancer remains in the top five causes of death in the UK.

That, said Woolnough, highlighted the need for improved public health and early intervention to tackle premature mortality, and to "achieve mortality rates on a par with the best countries in the world".

"As part of this, we are urging the Government to introduce standardised packaging of tobacco, which would make tobacco less attractive, and help prevent a further generation of young people from starting to smoke," she added.

Dr Edmund Jessop, from the UK Faculty of Public Health, said that despite the overall findings, the UK had done "very well" in some areas over the last two decades, citing reduced mortality rates, improved diet and a drop in disability-adjusted life-years.

This meant that the UK had seen significantly lower premature mortality from diabetes, road injuries, liver cancer and chronic kidney diseases

He also pointed out that the UK has some of the strongest tobacco control policies in Europe.

Copyright Press Association 2013

Reference

• Murray C.J., Richards M.A., Newton J.N., Fenton K.A., Anderson H.R., Atkinson C., Bennett D., Bernabé E., Blencowe H. & Bourne R. & (2013). UK health performance: findings of the Global Burden of Disease Study 2010, The Lancet, DOI: 10.1016/S0140-6736(13)60355-4

Figure 3: Age-standardised YLLs relative to comparator countries and ranking by cause in (A) 1990 and (B) 2010
Numbers in cells indicate the ranks of each country for each cause, with 1 representing the best performing country. Countries have been sorted on the basis of age-standardised all-cause YLLs for that year. Causes are ordered by the 30 leading causes of YLLs in the UK. Colours indicate whether the age-standardised YLL rate for the country is significantly lower (green), higher (red), or indistinguishable (yellow) from the mean age-standardised YLL rate across comparator countries, with 95% confidence. YLLs=years of life lost. COPD=chronic obstructive pulmonary disease.

Figure 4
YLDs in the UK by cause and age in 2010
YLDs=years lived with disability.

Figure 7
Burden of disease attributable to 20 leading risk factors for both sexes in 2010, expressed as a percentage of UK disability-adjusted life-years
The negative percentage for alcohol is the protective effect of mild alcohol use on ischaemic heart disease and diabetes.

WHO (2002) says physical inactivity kills 1.9 million globally a year

reposted from: pg 73, http://www.who.int/whr/2002/en/whr02_en.pdf

PHYSICAL INACTIVITY

Opportunities for people to be physically active exist in the four major domains of their day-to-day lives: at work (especially if the job involves manual labour); for transport (for example, walking or cycling to work); in domestic duties (for example, housework or gathering fuel); or in leisure time (for example, participating in sports or recreational activities).

In this report, physical inactivity is defined as doing very little or no physical activity in any of these domains.

There is no internationally agreed definition or measure of physical activity. Therefore, a number of direct and indirect data sources and a range of survey instruments and methodologies were used to estimate activity levels in these four domains.

Most data were available for leisure-time activity, with fewer direct data available on occupational activity and little direct data available for activity relating to transport and domestic tasks. Also, this report only estimates the prevalence of physical inactivity among people aged 15 years and over.

The global estimate for prevalence of physical inactivity among adults is 17%, ranging from 11% to 24% across subregions. Estimates for prevalence of some but insufficient activity (<2.5 hours per week of moderate activity) ranged from 31% to 51%, with a global average of 41% across the 14 subregions.

Physical activity reduces the risk of cardiovascular disease, some cancers and type 2 diabetes. These benefits are mediated through a number of mechanisms (22). In general, physical activity improves glucose metabolism, reduces body fat and lowers blood pressure; these are the main ways in which it is thought to reduce the risk of cardiovascular diseases and diabetes. Physical activity may reduce the risk of colon cancer by effects on prostaglandins, reduced intestinal transit time, and higher antioxidant levels. Physical activity is also associated with lower risk of breast cancer, which may be the result of effects on hormonal metabolism. Participation in physical activity can improve musculoskeletal health, control body weight, and reduce symptoms of depression. The possible effects on musculoskeletal conditions such as osteoarthritis and low back pain, osteoporosis and falls, obesity, depression, anxiety and stress, as well as on prostate and other cancers are, however, not quantified here.

Overall physical inactivity was estimated to cause 1.9 million deaths and 19 million DALYs globally. Physical inactivity is estimated to cause, globally, about 10–16% of cases each of breast cancer, colon and rectal cancers and diabetes mellitus, and about 22% of ischaemic heart disease. 

Estimated attributable fractions are similar in men and women and are highest in AMR-B, EUR-C and WPR-B. In EUR-C, the proportion of deaths attributable to physical inactivity is 8–10%, and in AMR-A, EUR-A and EUR-B it is about 5–8%.