It is largely because of the spotty progress in increasing life expectancy at birth that we live in a world where an estimated 14 million people die before they turn fifty each year; including 5 million children under five years of age, according to the Global Burden of Disease. Men and boys make up 60% of early deaths, with gender gaps widest for 15 to 49 year old men. Of the total 2.7 million extra male deaths, 2.2 million occur among 15-49 year olds, 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 (largely in China and India), the gender gap shrinks but is not eliminated. If we include female deaths from sex selection during pregnancy and the estimated 2.6 million stillbirths that occur every year we have a population of 18 million whose lives are cut short every year.
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 5.7 million early deaths, or 40% of the global total. In many of these countries early deaths represent a large proportion of overall deaths, above the global average of 26%, and far above Japan’s 3.2% – the world’s best. For example, in Nigeria, home to the world’s third largest concentration of early deaths, 77% of all deaths occur among people under fifty. In the Democratic Republic of Congo it is 62%, in Ethiopia 48%, in Pakistan 42%, in Bangladesh 33%, in India 30%, and in Indonesia 28%.
A handful of causes account for the vast majority of early deaths, including pneumonia, road injuries, HIV/AIDS, heart disease, diarrhea, preterm birth, malaria, birth trauma, self-harm, and congenital defects. The major causes of death vary by age and by gender. Children aged under five years are much more likely to die from newborn causes and infectious diseases (especially pneumonia, diarrhea, and malaria).
Infectious diseases are also leading causes of death among children aged five to 14 (especially malaria, typhoid, HIV/AIDS, pneumonia, diarrhea, and meningitis), but road injuries and drowning are also big killers.
HIV/AIDS is the largest cause of death among 15 to 49 year olds, but deaths from road injuries, self-harm, and interpersonal violence are also a major problem. Other leading killers for this group include heart disease, tuberculosis, and stroke. The leading causes of death for men and women under fifty are similar, but road injuries, heart disease, and interpersonal violence claim the lives of many more young men. For females, death in pregnancy and childbirth is also a major killer, claiming 230,000 lives.
The leading risk factors for death before 50 years include high blood pressure, tobacco smoking, household air pollution, poor diet, and alcohol use. Obesity, diabetes and child underweight are also major risks. Leading risk factors vary by geography and by gender. For example, in Sub-Saharan Africa, low birth weight/short gestation, child growth failure, unsafe sex, unsafe water, and poor sanitation are leading risk factors for early death. In South Asia, low birth weight/short gestation, high blood pressure, ambient air pollution, child growth failure, and high cholesterol are the top five risk factors.
The leading risk factors for early death among females are low birth weight/short gestation, child growth failure, unsafe sex, ambient air pollution, and household air pollution. In contrast, low birth weight/short gestation, alcohol, smoking, child growth failure, and high blood pressure are the leading risks for early death among males.