Abstract

Understanding the leading causes of death and disability and how these are changing, is fundamental for informing health policy debates. The first Global Burden of Disease Study published 15 years ago suggested that non-communicable diseases had overtaken communicable diseases as leading causes of burden, causing twice as many DALYs worldwide. The extent and pace of epidemiological transition varied across major world regions, being most advanced in East Asia and Latin America and least advanced in South Asia and Sub-Saharan Africa. The study identified major vascular diseases such as ischaemic heart disease and stroke as being among the leading causes of death globally and also in the top 10 causes of disease burden, along with HIV/AIDS, lung cancer and COPD. Depression and injuries also ranked among the leading causes of health loss in both rich and poor countries, with significant non-fatal contributions to estimated DALYs.

Global mortality and disability trends over the past 2 decades suggest that disease control priorities will continue to evolve over the next 2 decades and argue for a much greater emphasis on developing reliable mortality surveillance and health information systems to better understand comparative health sector priorities, particularly in developing countries. Child survival has accelerated over the past decade, including in Sub-Saharan Africa, due largely to the success of vaccine programs and technologies to reduce diarrhoea and pneumonia deaths in children. Treated bednets have had a more recent impact, although it is likely that malaria deaths in children remain high and represent an increasing proportion of child deaths. Adult mortality has been declining, but important reversals to this trend are possible unless major risks to adult health, particularly tobacco, excess body weight and HIV, are more rapidly brought under control.