In most places around the world, too much food is a bigger problem than too little.

Kirsty Wigglesworth, Associated Press

Improvements in medicine and public health also have made a difference in the world’s health profile.

Marcio Jose Sanchez, Associated Press

High blood pressure is now the leading health risk for disease, followed by smoking and alcohol.

Thomas Kienzle, Associated Press

Diabetes claimed 1.3 million lives in 2010, doubling from 1990, said the report by 486 researchers.

Bikas Das, Associated Press

People worldwide are living longer

  • New York Times
  • December 13, 2012 - 9:39 PM


A decline in deaths from malnutrition and diseases like measles and tuberculosis has caused a shift in global mortality patterns over the past 20 years, said a new report, with far more of the world's population now living into old age and dying from diseases more associated with rich countries, like cancer and heart disease.

The shift reflects improvements in sanitation, medical services and access to food, as well as the success of vaccine programs. The results are dramatic: Infant mortality has declined by more than half between 1990 and 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 1990, has fallen to No. 8.

But chronic diseases like cancer now account for about two out of every three deaths worldwide, up from just more than half in 1990. Eight million people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million lives in 2010, double the number in 1990.

"The growth of these rich-country diseases, like heart disease, stroke, cancer and diabetes, is in a strange way good news," said Ezekiel Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. "It shows that many parts of the globe have largely overcome infectious and communicable diseases."

In 2010, 43 percent of deaths occurred at 70 and older, compared with 33 percent in 1990, the report said. And fewer child deaths have brought up the mean age of death, which in Brazil and Paraguay jumped to 63 in 2010, up from 30 in 1970, the report said. The measure, an average of all deaths in a given year, is different from life expectancy and is lower when large numbers of children die.

While developing countries made strides, the United States stagnated. U.S. women registered the smallest gains in life expectancy of all high-income countries' female populations between 1990 and 2010. The slow increase caused U.S. women to fall to 36th place in the report's global ranking of life expectancy, down from 22nd in 1990. Life expectancy for U.S. women was 80.5 years in 2010, up from 78.6 in 1990.

"It's alarming just how little progress there has been for women in the United States," said Christopher Murray, director of the Institute for Health Metrics and Evaluation, a research organization financed by the Bill and Melinda Gates Foundation at the University of Washington that coordinated the report.

Rising rates of obesity and the legacy of smoking are among the factors contributing to the stagnation, he said. U.S. men gained in life expectancy, to 75.9 years from 71.7 in 1990.

All comprehensive estimates of global mortality rely heavily on statistical modeling because only 34 countries -- representing about 15 percent of the world's population -- produce quality cause-of-death data. Experts from more than 300 institutions in 50 countries contributed to the report, which was published Thursday in the journal The Lancet.

Sub-Saharan Africa was an exception to the trend. Infectious diseases, childhood illnesses and maternity-related causes of death still account for about 70 percent of the region's disease burden, a measure of years of life lost due to premature death and to time lived at less than full health. In contrast, they account for just one-third in South Asia and less than a fifth in all other regions.

But more and more, people are surviving to die of diseases that occur only in old age. These include Alzheimer's disease, deaths from which tripled from 1990 to 2010, and Parkinson's, whose deaths doubled.

But the time people are gaining isn't entirely time with good health. For every year of life expectancy added since 1990, about 9 1/2 months is time in good health. The rest is time in a diminished state -- in pain, immobility, mental incapacity or medical support. For people who live to age 50, the added time is "discounted" even further. For every added year they get, only seven months are healthy.

"We are in transition to a world where disability is the dominant concern as opposed to premature death," Murray said. "The pace of change is such that we are ill prepared to deal with what the burden of disease is now in most places."

The Washington Post contributed to this report.

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