Smoking and poor diet still leading killers worldwide

15 September 2017:

The news is mixed as a leading global health report, now in its 20th year, finds less babies are dying but some preventable diseases are on the rise

The Global Burden of Disease study is the only annual, comprehensive peer-reviewed assessment of global health trends. Think of it as a report card for the world’s health. And this year, it’s the preventable diseases associated with smoking and poor diet that are sounding alarm bells.

But there’s also some good news, according to the Global Burden of Disease study (GBD), which marks 20 years in 2017, life expectancy continues to rise and child mortality falls, thanks largely to widespread immunisation programs.

The average global life expectancy is now 75.3 years for women and 69.8 for men. Japan was highest, with 86.9 years for women and 80.8 for men. An Australian man born in 2016 can expect to live 80.5 years, up 1.6 years over the past decade, while females can expect to enjoy 84.6 years, a rise of one year.

Among the study’s 2016 global findings, published in The Lancet:

  • Non-communicable diseases caused 72.3 per cent of global deaths (39.5 million) in 2016.
  • Ischaemic heart disease was the leading cause of premature mortality in most regions. It killed 9.48 million people in 2016, up by 19 per cent since 2006.
  • Poor diet (as distinct from starvation and malnutrition) was associated with one in five deaths globally.
  • Smoking killed 7.1 million people in 2016.
  • Diabetes killed 1.43 million people in 2016, up by 31.1 per cent since 2006.
  • The number of deaths from conflict and terrorism rose by 143 per cent in 2006 to 150,500 in 2016.
  • Deaths among children aged under five dropped under five million for the first time, down from 16.4 million in 1970.
  • Australia’s top five causes of premature death are ischemic heart disease, lung cancer, stroke, self-harm and Alzheimer’s disease.

Australia plays a key role in the Global Burden of Disease study. University of Melbourne Laureate Professor and Director of the Global Burden of Disease Group at the Melbourne School of Population and Global Health, Professor Alan Lopez, helped establish the project in the early 1990s and co-authored the seminal GBD papers published in 1997 with Professor Christopher Murray.

Professor Lopez says the biggest GBD2016 ‘take-aways’ are the public health successes in reducing global child mortality and premature death from infectious diseases such as HIV and malaria. Yet he says there is still much to do to address pressing global health challenges, particularly the unfinished agenda in bringing worldwide child mortality down to levels typical of developed countries such as Australia.

He also lists mental health issues, muscular skeletal problems and the unacceptable number of deaths caused by tobacco and bad diet as particularly urgent.

Professor Lopez says the statistics also need to be seen in context. Fatal heart attacks are not just a ‘Western’ disease; they are prevalent globally and kill people at younger ages in developing countries. So while ischaemic heart disease deaths are up overall, the risk of death from the disease is actually falling, but not fast enough in many, primarily developing, countries.

In many nations around the world, death rates are falling.

“Over the last 40 or 50 years, death rates from heart attack and stroke in countries like Australia and New Zealand have fallen by 80 per cent and they’re still falling,” Professor Lopez says. “With bold public health campaigns to control some of the leading causes, especially tobacco, blood pressure and cholesterol, playing a major role in these impressive reductions”.


While Professor Lopez would like to see child mortality at or very close to zero, he says the reduction in child mortality is a global success story, largely due to the coordinated efforts by the World Health Organization in antenatal care, vaccination rates, public health campaigns and improved health care for conditions such as diarrhoea and pneumonia.

Professor Lopez says immunisation programs have probably contributed around 30-40 per cent to the reduction in childhood deaths since the 1970s, underlining their importance.

Vaccination is “unquestionably, unequivocally and undeniably” working, he says.

“This is a public health success that should be celebrated,” he says. “Measles mortality has gone down by 85-90 per cent since 1970. Individual parents who do not vaccinate their children are making a mistake; children still die from vaccine–preventable diseases.”


While smoking rates continue to decline in the West, Professor Lopez says the fact that the figure remains unacceptably high in many countries and is contributing to an overall global increase in tobacco-caused deaths is absurd. He says global smoking deaths are rising by around one per cent a year and predicts that by 2020, smoking will kill between 7.5 and eight million people annually. “That is absolutely absurd and totally preventable,” he says.

This will include 1.5 million in China, one million in India and one million in Latin America.

“Tobacco does not just kill you in old age,” Professor Lopez says. “It kills you in middle age. It probably takes 15-20 years off a smoker’s life expectancy.”

Professor Lopez says part of the problem is lax advertising laws in parts of Asia, where up to two thirds of men smoke (few women in developing countries smoke).

“We are yet to see the full effects of these very large numbers of men smoking in neighbouring countries in our region,” he says. “Asian men, whether in China, Indonesia, Vietnam or elsewhere will begin to die in large numbers from tobacco use unless efforts to prevent smoking uptake, and rapidly increase cessation rates, are accelerated.”

The situation, Professor Lopez argues, can only be turned around by banning all forms of cigarette advertising and promotion, introducing plain packaging, increasing taxes and running public health campaigns like those seen in Australia.

“People are encouraged more and more to smoke because there’s no ban on promotion or advertising,” he says.


The fact one in five deaths are associated with poor diet, notincluding starvation, is startling.

In most cases, these people could eat properly but don’t get enough vital nutrients through things like fruit and vegetables, and consume far too much sugar and salt. In many cases they are obese.

While public health campaigns have increased awareness about nutrition, and are beginning to have an impact in some countries, there is still a long way to go. Professor Lopez says that if everyone in the world ate a balanced diet, the global disease burden would fall by 10 per cent.

But he adds this won’t happen without industry-supported public health campaigns, similar to Australian campaigns for road safety and wearing seatbelts, and by taxing junk food.

“People will not and often cannot do this by themselves without having adequate support and social reinforcement by civil society and government campaigns,” he says.



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