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 according to the new Global Burden of Disease estimates, we live in a world where 16 million people die before they turn fifty; 6.3 million of whom are children under the age of five. Men and boys make up 60% of early deaths with gender gaps widest for 15 to 49 year old men. In total, 2.7 million more males than females die young, largely due to excess male deaths from accidental injuries, heart disease and cirrhosis. If we add into this picture 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 20 million whose lives are cut short every year.
A handful of causes account for the vast majority (over 80%) of the 16 million early deaths, including newborn, accidental injuries, heart disease, pneumonia, cancer, AIDS, malaria, diarrhea, diabetes, congenital birth defects, tuberculosis, malnutrition, cirrhosis, violence and deaths in pregnancy and childbirth. The leading risk factors for death include high blood pressure, tobacco smoking, household air pollution, poor diet and alcohol use. The majority (60%) of early deaths occur in just twenty countries, including India, China, Nigeria, Pakistan, the Democratic Republic of Congo, Indonesia, Ethiopia, Bangladesh, Russia, Brazil, Tanzania, the United States, Mozambique, Uganda, Kenya, Afghanistan, Philippines, Angola, Sudan, and Mexico. Four countries - India, China, Nigeria and Pakistan - together account for a massive 5 million early deaths, or one third of the global total. Moreover in many of these countries deaths before the age of fifty represent a large proportion of overall deaths, above the global average of 29% and far above Japan’s global best of 3.4%.
All countries should make reducing early deaths (0-49 years) the focus of their national health goals by maintaining early deaths at <30% of all deaths by 2020 and <15% by 2030. Countries who are already below these levels should aim for a rate below 15% in 2020 and below 7% in 2030, with Japan 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, country efforts should prioritize the prevention of pregnancy termination related to sex selection and stillbirths. In addition to investing to improve the 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, especially child underweight and household air pollution in Africa and household air pollution and tobacco smoking in South Asia.
The United Nations, its agencies and development partners should reinforce this focus on reducing early deaths under the Sustainable Development Goals and support the reframing of national and international health investments to target 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 risk factors associated with them, 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 targeting the leading causes of early death and associated risk factors.