A life cut short is the greatest injustice of all...
and being able to live a long human life is a critical measure of development, according to Amartya Sen, and the most basic of human capabilities in Martha Nussbaum’s “Ten Central Capabilities”. But we live in a world where 14 million people die before they turn fifty; including 5 million children under the age of five, according to the Global Burden of Disease. Men and boys make up 8.5 million (60%) of early deaths, with gender gaps widest among men aged 15 to 49 years. In total, 2.9 million more males than females die young, largely due to excess male deaths from road injuries, heart disease, and interpersonal violence. If we add in the estimated 1.4 million unborn females who are victims of sex selection every year, the gender gap shrinks but is not eliminated. If we include female deaths from sex selection and the estimated 2.6 million stillbirths that occur, we have a total population of 18 million whose lives are cut short every year.
A handful of causes account for the majority of the 14 million early deaths, including pneumonia, road injuries, HIV/AIDS, heart disease, diarrhea, preterm birth, malaria, birth trauma, self-harm, and congenital defects. The leading risk factors for early death include low birth weight/short gestation, child growth failure, unsafe sex, alcohol use, high blood pressure, ambient air pollution, tobacco smoking, household air pollution, and cholesterol. The majority of early deaths occur in just ten countries, including India, China, Nigeria, Pakistan, Indonesia, the Democratic Republic of Congo, Ethiopia, Brazil, Russia, and Bangladesh. Four countries - India, China, Nigeria, and Pakistan - account for a massive 5.7 million early deaths; 40% of all early deaths. Moreover, in most of these countries, deaths before the age of fifty represent a large proportion of overall deaths, 77% in Nigeria, 62% in the Democratic Republic of Congo, 48% in Ethiopia, 42% in Pakistan, 33% in Bangladesh, 30% in India, and 28% in Indonesia; all above the global average of 26% and Japan’s best of 3.2%.
All countries should make reducing deaths among 0-49 year olds the focus of their national health goals, and maintain early deaths below 30% of all deaths by 2020, and below 15% by 2030. Countries that are already below these levels should aim for a rate below 15% in 2020 and below 7% in 2030, with Japan's rate below 5% as the ultimate standard. National health investments should target both the leading country-specific causes of early death and the leading risk factors. In countries where stillbirths and sex selection at birth are major challenges, preventing pregnancy termination related to sex selection and stillbirths should be priorities. In addition to investing in better diagnosis and treatment of the leading causes of early deaths, governments and other stakeholders should invest heavily in reducing population exposure to the major country-specific risk factors for early death, especially low birth weight/short gestation, child growth failure, unsafe sex, high blood pressure, air pollution, and alcohol use.
The United Nations (UN), its agencies, and development partners should reinforce this focus on reducing early deaths under the Sustainable Development Goals, and target national and international health investments to the leading causes and risk factors associated with early death. Global financing efforts should target the highest-impact interventions that can prevent, diagnose, and treat the leading causes of early death and the associated risk factors, and prioritize the populations with the largest burdens of early death. To model the much-needed integration in the financing and delivery of the products and services with the greatest potential to reduce early deaths, the UN, its agencies and partners should establish flagship multi-sector initiatives in the highest burden countries target leading communicable and non-communicable causes and risks.