Chronic diseases and failures in public health “fueled” deaths from covid-19, warns study in “Lancet” | Cheers

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The interaction of covid-19 with the increase in chronic diseases and associated risk factors, such as obesity and pollution, in the last 30 years, created the perfect storm to “feed” deaths from the new coronavirus, the scientists defend.

In a study published in the medical journal The Lancet, experts reveal that increased exposure to major risk factors (including hypertension, high blood sugar and high cholesterol), combined with the growth in cardiovascular disease deaths in some countries, “suggests that the world may be approaching of an inflection point in the gains in average life expectancy ”.

The findings are from the Global Burden of Disease Study (GBD), which involves experts working at more than 1,100 universities, research centers and government agencies in 152 countries and providing a new look at how countries have been prepared in terms of health for the covid-19 pandemic and establish the true scale of the challenge posed by new pandemic threats.

GBD’s work has served to support health policies in several countries, as well as to provide scientific information to international organizations such as the World Bank or the World Health Organization (WHO).

The authors emphasize that the promise of disease prevention through government actions or incentives that lead to healthier behavior and access to health resources is not having the same results worldwide.

“Most risk factors are preventable and treatable and addressing them will bring enormous social and economic benefits. We are failing to change harmful health behaviors, particularly those related to quality of diet, caloric intake and physical activity, partly due to inadequate public health care and funding policy and behavioral research, ”says Christopher Murray, from the University of Washington (USA), who led the work.

The study stresses that several risk factors and non-communicable diseases, including obesity, diabetes and cardiovascular diseases, are associated with an increased risk of serious illness and death by covid-19, and highlights the importance of social factors for the final result.

“Diseases not only interact biologically, they also interact with social factors. Urgent action is needed to address the coexistence of chronic diseases, social inequalities and covid-19 ”, argues Murray, referring to the interaction of several epidemics that exacerbate the burden of disease in populations that are already overburdened and that increase their vulnerability.

The authors stress that there is a belated recognition of the importance of social and economic development for general health and point out the need for a much broader approach, which pays more attention “to all the health drivers of the population”.

“Given the overwhelming impact of social and economic development on health progress, intensifying policies and strategies that stimulate economic growth, expand access to education and improve the status of women should be our collective priority,” says Murray.

According to the study, although the overall healthy life expectancy – the number of years a person can expect to live in good health – has steadily increased (by more than 6.5 years) between 1990 and 2019, it has not grown as much as the expectation of overall life in 198 of the 204 countries assessed in this study and people are living “more years with health problems”.

Disability, more than early death, has become an increasing share of the global disease burden, rising from 21% in 1990 to more than a third (34%) in 2019, he points out.

In 11 countries – including Singapore, Iceland, Norway, Ireland, Australia, New Zealand and Qatar – more than half of all health losses (measured by disability-adjusted life years, or DALY) problems caused by noncommunicable diseases and injuries.

Global health efforts to combat infectious diseases and address prenatal care have been successful in improving the health of children under the age of ten in recent decades (with the overall burden of disease falling by around 55%), “but this it was not matched by a similar response in older age groups ”, underline the experts.

Ten contributors to health losses

According to the study, the top ten contributors to the increase in health losses worldwide in the past 30 years include six causes that largely affect older adults: ischemic heart disease, diabetes, stroke, chronic kidney disease, cancer of the lung and age-related hearing loss. In addition, four causes are common from adolescence to old age: HIV / AIDS, musculoskeletal problems, low back pain and depressive disorders.

Those responsible recall that the increase in health problems “threatens to overburden ill-equipped health systems to deal with the chronic conditions associated with the growth and aging of populations”.

They also indicate that, in the last decade, developing countries have achieved “impressive gains in health”, largely “as a result of successful efforts against infectious, maternal and neonatal diseases”, but stress that the health systems of these countries ” are not well equipped to deal with the growing burden of noncommunicable diseases which rose from about a third of the overall disease burden in 1990 to almost two-thirds in 2019 ”.

In addition, they point out, “while deaths due to infectious diseases have dropped substantially in developing countries, deaths from noncommunicable diseases are on the rise.”

In contrast, “health improvements have begun to stagnate in most developed countries and have even reversed in several countries, particularly in the United States, where the rate of age-standardized health loss has increased by almost 3% in the past decade.”

The authors believe that the reasons for this lack of progress may include increasing rates of obesity, as well as decreasing the potential to reduce smoking and to make further improvements in the coverage of treatments for hypertension and high cholesterol, which will be necessary to maintain the reduction of deaths from cardiovascular diseases.

The study coordinator recalls that, with a rapidly aging global population, “looking for health services to deal with disabling problems and chronic conditions, which increase with age, will require higher levels of funding, strong political commitment, responsibility supported by better data and a coordinated global effort that gives priority to the most vulnerable ”.

The study notes that over the past decade “there have been particularly large and worrying increases (more than 0.5% per year worldwide) in exposure to several highly preventable risks” – obesity, high blood sugar, alcohol use and drugs – which are contributing to the growing burden of noncommunicable diseases.

“The biggest cumulative impact on health comes from the notable increase in metabolic risks (body mass index [IMC] high, high blood sugar levels, hypertension and high cholesterol), which have risen 1.5% per year since 2010 ”, explain the authors, stressing that among the main risks of non-communicable diseases, only smoking has decreased substantially.

The study also notes that the impact of risk factors also varies widely across regions. In much of Latin America, Asia and Europe, hypertension, high blood sugar, high BMI and tobacco use are the major contributors to health problems, while in Oceania the main risks are malnutrition and air pollution.

The most striking differences are in sub-Saharan Africa, which is dominated by malnutrition.

“Simply providing information about the harms of these risks is not enough,” says co-author Emmanuela Gakidou, adding: “Since individual choices are influenced by financial considerations, education and the availability of alternatives, governments must collaborate globally on initiatives to make behavior as healthy as possible for everyone. ”

“And, taking lessons from decades of tobacco control, when there is a great risk to the health of the population, such as obesity, concerted government action through regulation, taxation and subsidies may be necessary”, he stresses.

In an editorial accompanying the study in the magazine The Lancet the warning is still left: “Unless structural inequalities rooted in society are tackled and a more liberal approach to immigration policies is adopted, communities will not be protected from future infectious outbreaks and the health of the population will not achieve the gains that global health advocates seek. ”

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