The World Health Organization (WHO) defines health as a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity. This, on face value, therefore implies that a vast majority of humans are basically unhealthy, as it is going to be a rarity to see an individual without one infirmity or the other. But taking a virtual look at the WHO constitution, the second tenet indicates “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political inclination, economic or social condition”. Hmmm… What a contrasting reality as it were. This piece is aimed at understanding healthcare today and seeing how much progress we have made thus far. The actual question is… Are we really getting healthier as a people?
To picture how much of humanity is indeed healthy, we need to understand how diseases have progressed from what it was to what it actually is at present. Today, less emphasis is placed on the mortality that arises from the plethora of diseases that plagues humankind, as much more focus is rather on the impact of the disease on humanity.
In a bid to better understand the health of a population, public health scientists now use factors such as Disability Adjusted Life Years (DALY). This time removing focus from life expectancy and mortality (death) but focusing on the amount of the burden or effect of a disease on a population. DALYs have been measured in the Global Burden of Disease (GBD) study by the Institute of Health Metrics and Evaluation (IHME) since 1990, and by the “Disease Burden Unit” which was created in 1998 at the World Health Organization (WHO).
Looking at the data timeline above we sing “kumbaya” and say we are making tremendous progress regarding our health, with obviously less burden of disease, and this implies people are getting healthier. But, shouldn’t it be evident in our healthcare systems today? Is there any form of palpable progress at all? With the influence of technology in our healthcare system, so much so that we now have computer technologies that can read scans, interpret results and give us diagnosis with an attendant prognosis that has reduced the elements of human error. We also now have scientists and researchers churning out discoveries in healthcare and research papers published at an astounding rate.
Why do we still have overcrowding at our hospitals, and why the long queues and waiting time to see a healthcare practitioner, regardless of the number of qualified physicians are annually produced on a regular basis from medical schools? What is actually the problem with healthcare? And why are we experiencing diseases like we never used to?
Before the past 20 years, infectious diseases have been the major cause of death all over the world but today the rate of infectious diseases has dramatically fallen. All thanks to our healthcare as indicated by the WHO and I quote “The estimates further confirm the growing trend for longevity: in 2019, people were living more than 6 years longer than in 2000, with a global average of more than 73 years in 2019 compared to nearly 67 in 2000. But on average, only 5 of those additional years were lived in good health. A 2020 report indeed indicates that disability is on the rise and to a relatively large extent, the diseases and health conditions that are causing the most deaths are those that are responsible for the greatest number of healthy life-years lost. Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease were collectively responsible for nearly 100 million additional healthy life-years lost in 2019 compared to 2000”.
According to a report by the Global health observatory, the following can be deduced:
- DALYs due to communicable diseases such as HIV/AIDS and diarrhoeal diseases have dropped by 50% since 2000.
- DALYs from diabetes increased by more than 80% between 2000 and 2019.
- DALYs from Alzheimer’s disease have more than doubled between 2000 and 2019.
Humanity is living “longer”, but at what cost?
Alzheimer’s disease, Diabetes, Cancers are diseases that found their way to our leading causes of deaths and disabilities in the 2000s while cardiovascular diseases found its way to the very top since the 1990s and has remained there ever since. Infectious diseases are steadily on the decline thanks to improved healthcare service delivery including diagnostics and routine vaccinations. And going back to the definition of health by the WHO, these individuals who are disabled by these conditions can be considered healthy as long as ……… (your guess is as good as mine).
As seen above in 2019, a whopping 74% of deaths all over the world were as a result of Non-Communicable diseases (NCDs – indicated in blue) and heart diseases account for approximately 1 in every 3 deaths. It is important to note that the deaths and disability from communicable (infectious) diseases are basically in Low- and Middle-Income Countries (LMICs). For example, Alzheimer’s disease was first described in the 1970s and has less than a hundred thousand people living with the disease in the late 1990s. It was estimated in 2020 that there are over 55 million people living with the disease and estimated 139 million by 2050, with an estimated 10 million new cases yearly.
We have exchanged the red pill (Infectious Diseases) for the blue pill (NCDs) and we seem to be living fine with it. But it begs the question. How did these diseases become part of our “healthy” state? Where did we miss the mark? Are we getting healthier or just more dependent on medications? And as long as we are fine living on medications (dependency), we are healthy. Away with the days when for infectious diseases we could just have a few days to weeks of medication and hospital stay and we are back to vibrant health, but today, we seemingly have to depend on medications for our everyday existence just to stay “healthy”.
Questions abound that cannot all be answered at one go. Not today, not anytime soon. But it’s high time we re-engaged this conversation.
As it stands, humans simply moved from acute infections to better managed chronic infections!!!
Feel free to share your thoughts in the comment section.
This piece is written by Dr. Jonah IRABOR (B.Pharm, PharmD, MPH) and edited by Dr. Jocelyn OKOH (DVM, MSc, MPH). This newsletter is free but will greatly appreciate your support to keep the good work going. This edition has contributions from.
