Tackling Major Risk Factors Simultaneously Key To Improving Global Health

Leading public-health scientists highlight in a study in this week’s issue of THE LANCET how confronting major risk factors that lead to poor health could have a substantial effect in reducing premature deaths and morbidity globally-especially in the poorest areas of the world. This preventive approach would also reduce the prevailing health inequalities that exist between the world’s richest and poorest nations.

Majid Ezzati from the Harvard School of Public Health, Boston, USA, Christopher Murray from WHO, Geneva, Switzerland, and colleagues estimate the potential health benefits from the removal of major risk factors that are associated with the main causes of death and disability worldwide. The joint contribution of the main 20 risk factors affecting global health (including malnutrition, poor water and sanitation, tobacco and alcohol use, and elevated blood cholesterol) were assessed in 14 regions of the world divided into three categories: high mortality developing regions; lower mortality developing regions; and economically developed regions.

Around half (47%) of premature deaths worldwide and around 40% of total disease burden in 2000 resulted from the joint effects of the main risk factors assessed. The investigators used comprehensive reviews of data on risk-factor levels and epidemiological studies in their estimates. They reported their results in terms of gain in health life expectancy (HALE) which is a combined measure of premature mortality and non-fatal diseases. Elimination of these 20 risk factors would have the following effects in reducing disease: diarrhoea (over 90%), lower respiratory infections (around 60%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (around 85%), and stroke (just under 75%). Removal of these risks would have increased global healthy life expectancy by over nine years from 56 to 65 years (ranging from 4•4 years (6%) in the developed countries of the western Pacific to 16•1 years (43%) in parts of sub-Saharan Africa).

Majid Ezzati comments: “This study shows that the potential health gains from reducing major known but often over-looked risks are enormous, especially for those societies that currently endure the worst health conditions. The findings highlight the need for our public health system to put greater emphasis on disease prevention by recognizing clusters of risk factors and designing policies and programs for addressing them, rather than merely treating their consequences.” (quote by e-mail; does not appear in published paper)