The theory of epidemiologic transition states that there is a change in the distribution of deaths by cause away from communicable diseases towards non-communicable diseases.
There are large differences between countries and these differences are increasing. However, these are the major causes of mortality today.
The figures of the Foundation for AIDS Research are as follows:
- In 2016, 36.7 million people were living with HIV.
- In 2016, 1.8 million people became newly infected with HIV; 160,000 were under the age of 15.
- About 4,932 people will become infected with HIV each day—about 205 every hour.
- Since the beginning of the pandemic, 76.1 million people have contracted HIV and 35 million have died of AIDS-related illnesses, including 1 million in 2016.
- In 2016, 19.5 million people living with HIV were accessing antiretroviral therapy.
Persons diagnosed with HIV are prone to suffer from tuberculosis, accounting for 13% of all cases worldwide.
Prevention is taking the upper hand today. In the US, the government is encouraging populations at risk to take a daily pill of a product called Truvada, as a preventive measure, replacing the use of condoms. This is expected to increase the risk of contamination by other sexually transmitted diseases such as gonorrhoea or syphilis.
Alcohol can harm all and any part of the human body as well as increasing the risks to the drinker by increasing the chances of incurring accidents and indulging in violent behavior. People other than the drinker can also be put in danger, again mostly through an accident-prone or a violent behavior. Fetus and child development are also affected. In Europe, up to 80% of crimes and 70% of violence, both intentional and unintentional, against partners or children has been associated with drunken behaviour. Alcohol consumption has also been associated with high suicide rates. Over 7% of premature deaths have been ascribed to alcohol consumption. Alcohol consumption is estimated to be responsible for 90 extra deaths per 100 000 men and 60 per 100 000 women.
The World Health Organizations estimates that the total number of deaths due to alcohol consumption if, worldwide, of 2.5 million people, or 4% of all deaths. It is a bigger killer than AIDS, violence or tuberculosis; is the world’s third largest risk factor for disease and disability (after childhood underweight and unsafe sex) and the greatest risk in mid-income level countries. Alcohol is deemed to be a causal factor in 60 types of diseases and injuries and a component cause in 200 others. Alcohol is also responsible for a number of social issues such as child neglect and absenteeism.
Men, particularly, suffer from the effects of alcoholism. For males aged 15 to 59, it is the main cause of death. 6.2% of all male deaths are attributed to alcohol against only 1.1% for women. Men with lower socioeconomic and educational levels are particularly prone to alcoholism.
Europeans are the biggest consumers, with an annual consumption of 9 liters per year, hence twice the global average. Consumption is, however, declining – in France and Italy, for instance, two countries which were the largest alcohol consumers, adult consumption has decreased by one third. It is particularly wine drinking that has been reduced. The proliferation of fast food appears to have been a contributing factor in this slowdown.
Alcohol-related deaths remain low in Western Europe while this is not the case in Eastern Europe. In Russia, particularly, binge drinking is a major problem.
Of increasing concern, particularly because this behaviour is typical of young adults, is binge drinking. While there is no agreed definition, one can say that it is the heavy consumption of alcohol in a short period of time – figures of 60 to 70 grams of alcohol in a period of two hours can be found in the literature. Up to 80 million Europeans have been reported to practice binge drinking with 25 million indicating this is a usual pattern of behaviour. Ireland and the UK are the countries that report the largest number of binge drinkers, and men outperform women by a ratio of 3 to 1. France, Germany and Italy are the countries with the lowest number of binge drinkers.
Data from the WHO:
- Cancer is one of the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases in 2012.
- The number of new cases is expected to rise by about 70% over the next 2 decades.
- Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer.
- Approximately 70% of deaths from cancer occur in low- and middle-income countries.
- Around one third of deaths from cancer are due to the 5 leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.
- Tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths..
- Cancer causing infections, such as hepatitis and human papilloma virus (HPV), are responsible for up to 25% of cancer cases in low- and middle-income countries.
- Late-stage presentation and inaccessible diagnosis and treatment are common. In 2015, only 35% of low-income countries reported having pathology services generally available in the public sector. More than 90% of high-income countries reported treatment services are available compared to less than 30% of low-income countries.
- The economic impact of cancer is significant and is increasing. The total annual economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion.
- Only 1 in 5 low- and middle-income countries have the necessary data to drive cancer polic
As it often remains undetected, it is a cause of early mortality.
Diseases of the circulatory system
They account for 50% of deaths in Europe with men being more affected than women. The incidence varies by country, sex and age. Men are predominantly affected. High blood pressure is the main culprit. (WHO, 2012)
The use of preventive drugs has been shown to lower this incidence. A reduction in the consumption of salt and tobacco has also contributed to these improvements. (Rapsomaniki et al, 2014)
The reduction of deaths due to cardiovascular diseases has been a major contributor to longevity. (Mathers et al, 2014)
Diseases of the digestive system
These include chronic liver disease and cirrhosis as well as ulcers. They have been associated with viruses, toxins and drug use, particularly alcohol. (WHO, 2012)
Diseases of the respiratory system
These diseases affect mostly children and older persons and are due to environmental exposures. (WHO, 2012)
Cannabis is the most commonly used drug in Europe, followed by cocaine, opioids and ATS. In Western and Central Europe, 7.6% of the population is believed to be addicted to cannabis.
Britain has the worst level of drug abuse in Europe, and the second highest level of drug-related deaths, a report said Wednesday.
Overall, Britain has the highest number of addicts with 0.85 percent of the population — more than twice that of European countries such as France and Sweden (0.4 percent) or Germany and the Netherlands (0.3 percent).
The lowest rates of drug abuse are in Poland and Germany, said the study. In terms of deaths linked to drug abuse, Britain comes second only to Denmark — although both are well behind the United States and Australia. France has the lowest number of acute drug-related deaths.
Eastern and South-Eastern Europeans are bigger users of heroin with 1.2% of the adult population being addicted. Russians, who find it increasingly difficult to procure heroin, also use local substances such as desomorphine. Injections are a frequent carrier of the HIV virus. (Patten, 2008)
Crack cocaine and opiates are among the most dangerous drugs. (Centre for Social Justice, 2013)
Some authors claim that drug consumption has been reduced if one compares present consumption to that of a century ago. Thus, in spite of a sharp population increase in this interval, opium production has fallen from 30 000 metric tons to 9000, including the quantities devoted to medicinal use.
The total number of drug users is estimated to be 200 million with cannabis the most used drug, being the favourite of 165 million people.
45% of the British population has used cannabis at one point or another of their life.
Cocaine is mostly used in North America where the 7 million consumers represent half the total number. The reverse effect is taking place in Europe where Britain and Spain are the main consuming countries.
The number of opium consumers in China has decreased from 450 million to 9.3 million.
The main production and distribution centers are the so-called ‘Golden Triangle’ in South-East Asia (Myanmar and Laos) and the ‘Golden Crescent’ (Afghanistan and the neighboring countries). (Patten, 2008)
The financial flows from the drug trade to the legal economy are so large, that a major disruption of the drug trade would lead to an international crisis.
The value of trade in illegal drugs is estimated at five billion pounds a year, according to the study by Professor Peter Reuter of Maryland University in the US and Alex Stevens of Kent University in Britain.
New drugs are entering the market every week. (Centre for Social Justice, 2013)
These include living conditions, road safety, quality of the air and water, climatic conditions, etc. in 2012, 7 million died from air pollution alone making it the world’s number one environmental risk. WHO estimates at 1.2million the number of children that die every year due to polluted environments – in other words, 1 in 4 deaths of children under 5 years of age.
More specifically, the deaths occur due to air pollution, diarrhoea, malaria, etc.
There is a relationship between air pollution and cardiovascular diseases and cancer. (WHO, 2012)
Injuries and poisoning
This is the third cause of death representing 8% of all deaths. This category includes accidents, suicides and homicides. (WHO, 2012)
There have been considerable efforts in many countries to reduce accident fatality rates. Thus, over the period 1995 to 2009, these were reduced by 50% on average in high-income countries, with a reduction in France of 52%.
This reduction has been achieved through good planning and management of resources, implementation of specific measures both regulating driving behaviour and emergency response and finally through the provision of sufficient resources.
The driver’s behaviour most responsible for accidents are speeding, drunk behavior and failure to use seat belts. (Transportation Research Board, 2010)
An increasing number of children are obese and will be carrying their obesity into adulthood. As their number increases, the increased lifespan trend may falter and even be reduced by two or three years. (Roberts, 2008)
Obesity is an independent risk factor for diabetes, cardiovascular disease and some forms of cancer. (Sulston, 2012)
Road traffic accidents, not Aids, cancer or any other disease, are the biggest killer of young people worldwide, experts warn.
Nearly 400,000 young people under the age of 25 are killed in road traffic crashes every year. Millions more are injured or disabled.
Most occur in low income countries, such as Africa, and are avoidable.
These include lowering speed limits, cracking down on drink-driving, promoting and enforcing the use of seat-belts, child restraints and motorcycle helmets, as well as creating safe areas for children to play.
Very important determinants of health are income level – particularly disposable income -, employment status and the attained level of education. There is an established relationship between income level and mortality due to circulatory diseases.
Low socioeconomic determinants in childhood – when children are exposed to chronic stressors – lead to inflammatory reactions, and later to cardiovascular diseases in adulthood, even if later in life there is a marked improvement in these determinants. High maternal warmth may, however, shield children from these determinants. (Waite and Plewes, 2013)
Social pressure due to population increase is leading to curtailing of funds to treat the aged and the introduction of euthanasia, and in some countries, not only for patients with terminal diseases but also as a means to control population.
Another mortality factor of growing importance is suicide which represents 2% of the deaths worldwide, a nearly 60% higher than 50 years ago, having become the second most important cause of death for the 15-35 age bracket.
It is only recently that it has been accepted that the causes of suicide have social roots in spite of the fact that the pioneering work of the French sociologist Emile Durkheim can be traced back to the end of t nineteenth century.
Nearly one million people commit suicide annually and the World Health Organization forecasts the figure to grow to 1.5 million by 2020.
In 2001, the number of suicides overtook the combined total of deaths by homicide (500 000) and war (230 000). The highest suicide rates are noticed in Eastern Europe with the lowest in Latin America, in Moslem countries and in some Asian countries. In Western Europe, suicides have overtaken deaths by car accidents. The rates of suicide are three times higher for people over 75 years of age than for the 15 – 24 age range. Men commit suicide three times more frequently than women except in China were the rate is identical for both sexes.
The number of suicide attempts is estimated by the WHO to be 10 to 20 times that of accomplished suicide, even though data is not precise. Women attempt suicide more frequently than men.
The most commonly used suicide methods are pesticides, fire arms and pharmaceuticals, in particular analgesics. (Perez M: Le suicide tue plus que les guerrres, Le Figaro, September 10, 2004)
Suicidal behaviour is a major health concern in many countries, developed and developing alike. At least a million people are estimated to die annually from suicide worldwide. Many more people, especially the young and middle-aged, attempt suicide.
Over the last few decades, while suicide rates have been reported as stable or falling in many developed countries, a rising trend of youth suicide has been observed. In 21 of the 30 countries in the World Health Organization (WHO) European region, suicide rates in males aged 15-19 rose between 1979 and 1996. For females, suicide rates rose less markedly in 18 of the 30 countries studied. Various possible explanations for these rising suicide trends – loss of social cohesion, breakdown of traditional family structure, growing economic instability and unemployment and rising prevalence of depressive disorders – have been presented.
Some worldwide analyses of suicide trends and rates in the world have been published (4-7), but very little is known worldwide about the causes of death and suicide rates among young people aged 15-19.
The purpose of this study was to present an overall picture of suicide among adolescents worldwide using available data from the WHO database, and to evaluate the role of suicide as a cause of death in the 15-19 age group.
Suicide data are still not available in many countries. In the present study, data from only 90 countries (areas) out of the world’s 192 nations were available for the 15-19 age group in the WHO Mortality Database, which is the largest database in the world on this topic. The WHO mortality statistics are commonly broken down by gender and age. However, some countries do not report deaths broken down for the 15-19 age group, and there are only 130 member states of WHO.
The reliability of suicide statistics is often questioned. Suicides are underreported for cultural and religious reasons, as well as owing to different classification and ascertainment procedures. Suicide can be masked by many other diagnostic categories of causes of death.
Unfortunately, in cases of young people, death due to suicide is often misclassified or masked by other mortality diagnoses. This makes the global picture of death by suicide even graver.
The mean suicide rate of 7.4/100,000 (10.5 for males and 4.1 for females) may be perceived as a reasonable estimate for the 15-19 age group and used as a basis for evaluating suicide rates among adolescents in different local communities.
In the calculation of suicide rates, the numbers of suicides in two large countries with more than 1,000 suicides in the 15-19 age group (Russia, with 2,883 cases in 2002 and USA with 1,616 in 2000) accounted for 37.3% of the total, thus heavily influencing the mean rate.
Interestingly, these two countries’ suicide rates were markedly different. The Russian rate was 23.6/100,000, more than 3 times the mean (7.4), whereas that in the USA was 8.0, fairly close to the mean. Sri Lanka had an extraordinarily high suicide rate in the 15-19 age group: at 46.5/100,000, it was more than six times the mean rate. Unfortunately, data for recent years are not available for Sri Lanka.
Suicide rates for young people in the 15-19 age group are, as for other age groups, higher in males than in females. Young males’ overall suicide rate was 2.6 times that of females. Exceptions were found in a number of non-European countries, like Sri Lanka, El Salvador, Cuba, Ecuador and China, where suicide rates for females 15-19 years old exceeded those of males in the same age group. This fact urgently calls for further investigations.
Data from the latest 35-year period (1965-1999) show a marked difference in suicide rates between European and non-European countries. The high rates in non-European countries call for more attention. One reason for the lower suicide rates in European countries (although suicide rates in this region also vary widely from one country to another), beside cultural and psychosocial factors, may possibly be the physicians’ awareness of the importance of adequately treating people with psychiatric disorders, psychosocial problems and harmful stress. However, this does not apply to the whole European region, since countries in transition show very high suicide rates, both for adults and for young people.
The fact that suicide rates are higher in males than in females has long been widely recognised. However, this study shows that suicide as a cause of death in the 15-19 age group is very similar in both sexes: 9.5% in males and 8.2% in females.
Suicide is one of the leading causes of death among young persons of both sexes. It is the leading cause of death in this age group after transport and other accidents and assault for males, and after transport and other accidents and neoplasms for females. (Wasserman D, Cheng Q and Jiang G: Global suicide rates among young people aged 15-19, World Psychiatry, 4, 2, pp 114-120, 2005)
Statistics show that approximately 50% of all smokers will die of a smoking-related pathology.
Annual tobacco-induced deaths are estimated to be of 6 million people per year. Included in this figure are the 600 000 who are passive smokers. (WHO, 2011)
95% of all lung cancer deaths occur in smokers. This, in spite of all the warnings given to smokers. These warnings seem to be taken more seriously the higher the status of the smoker. A possible explanation is that the higher the social status, the more oriented towards the future and therefore the need to remain alive and in good health.
In the 1950s smoking was prevalent whatever the social class. The fist anti-tobacco campaigns had a bigger effect on the middle class than on the lower-income class. Lower classes became more sensitive to higher taxes on cigarettes. (Marmot, 2004)
Nevertheless, large graphic health warnings on tobacco packaging as well as mass media campaigns, particularly on television, reduce tobacco use by inducing smokers to quit and youngsters not to start smoking.
Providing assistance in quitting smoking habits is also an important measure.
While smokers seem to be indifferent to the dreadful images on the packages, banning of tobacco advertising, and promotion generally, also yields positive results. A complete ban would result in a 7% decrease in consumption.
These measures must be accompanied by tax increases on tobacco products. This is possibly the most effective means of reducing consumption by younger people. Each 10% increase in retail prices leads to a 4 – 8% reduction in consumption. (WHO, 2011)
Nevertheless, in certain countries, price increases has simply led consumers to smoke cheaper cigarettes.
While twice as many men smoke as women, the latter are catching up quickly.
Nations at advanced stages of cigarette diffusion, where women have had a longer time to catch-up with the earlier adoption of men, showed convergence in female and male smoking-attributed mortality, whereas nations at the early stages, where women have not adopted smoking in large numbers, showed divergence in female and male smoking-attributed mortality.
This argument about the source of national differences views cigarette use and smoking mortality as a type of epidemic or diffusion process that rises slowly at first, accelerates to a peak, begins to abate, and falls to levels below the peak. The pattern of change occurs among both men and women, but, because men adopt cigarettes in large numbers earlier than women, the male changes precede the female changes by a decade or two. With men affected by the epidemic first, the sex differential initially grows. Later, as smoking mortality among men peaks and begins rising among women, the differential stops growing. Still later, as smoking mortality declines among men, it grows among women (just as it had earlier among men). Therefore, the differential begins to narrow. The lag in the process for women means, in short, that the more advanced the stage of the epidemic (i.e., the earlier the diffusion process begins and the farther it proceeds), the closer the smoking mortality rates of men and women.
The harm of cigarette use on male and female mortality emerges most clearly in the traditionally high rates of lung cancer mortality among men and the movement toward convergence between men and women in recent decades. With around 90 percent of lung cancer deaths stemming from cigarette use, the trends in this form of death directly reflect trends in smoking. However, identifying the full harm of cigarette use and the whole influence it has on the sex differential in mortality requires attention to causes of death other than lung cancer. According to estimates of the U.S. Surgeon General, only 28 percent of tobacco-related deaths involve lung cancer. The risks of lung cancer mortality among current smokers ages 35 and over relative to nonsmokers are 22.4 times higher for men and 11.9 times higher for women. In addition, the relative risks of mortality to smokers from bronchitis and emphysema are 9.7 (males 35+) and 10.5 (females 35+), from cerebrovascular disease are 3.7 (males 35-69) and 4.8 (females 35-69), and from ischemic heart disease are 2.8 (males 35-69) and 3.0 (females 35-69). Similarly, in a 40-year study of British doctors, smoking raised the rate of death from lung cancer by a factor of 14.9, but also raised the rate of death from other cancers by 1.5, respiratory diseases by 2.9, ischemic heart disease by 1.6, and all causes combined by 1.8.
Given the declining contribution of smoking mortality to the relative mortality rates overall, the contribution of trends in non-smoking mortality becomes critical. Having risen steadily over the past two to three decades, the sex differential in non-smoking mortality will likely continue to rise in the near future, perhaps at a slower rate. If so, the sex differential for all causes will, on average, also rise. This prediction depends on the assumed continuation of increases in the female advantage in causes of death unrelated to smoking, and past patterns obviously do not guarantee the same in the future. If instead, the past growth in the female advantage in non-smoking mortality is assumed to immediately cease or even reverse direction, it would lead to different predictions: The total sex differential would show no growth or decline.
Will relative trends in male and female non-smoking mortality change in the future? On one hand, a reversal in past growth of the female advantage as yet seems unlikely. Despite movement toward equality in other areas of social life, norms of male and female health behavior remain sufficiently distinct to continue favoring women. Moreover, female longevity (at least among non-smokers) has not yet come close to a ceiling that would slow future growth, allow male longevity to catch up, and reduce the sex differential. As a result, deaths from suicide, homicide, accidental injury, cancer, COPD, stroke, and heart disease that have little direct relationship to smoking do not indicate convergence between men and women. On the other hand, reductions in the use of tobacco by men may reflect a broader and growing concern with good health that may soon bring rewards in other areas of health. Such trends may narrow the gap in non-smoking mortality between men and women. (Pampel F: Forecasting sex differences in mortality in high income nations : the contribution of smoking, Demographic Research, Volume 13, Article 18, Pages 455 – 484, November 2005)
There is a strong price elasticity and price increases of cigarettes could be used to curb smoking. (WHO, 2012)
In France, smoking is the preventable disease causing the greatest number of deaths – 70’000 which represents eighteen times more than road accidents. 59’000 of these deaths are masculine. It is thus 22% of the male deaths and 11% of the female. 60% of these deaths are cancer-related.
One third of all deaths of men between 35 and 69 years of age are related to smoking.
The health costs are of 12 billion Euros. The total cost of smoking (direct and indirect costs) amounts to 47 billion Euros, or 3% of GDP.
Every third Frenchman smokes and since 2005 tobacco sales are no longer decreasing. In fact, there has been an increase in smoking in women and younger persons.
Taxes related to tobacco represent approximately 15 billion Euros. Another important financial issue is the revenue of the owners of newspapers come tobacco kiosks.
It has been suggested by a number of state-affiliated bodies that the costs of anti-smoking cures, under the supervision of doctors or pharmacists, should be financed, at least partially, by the state. (Cour des comptes, 2012)
One of the best ways to reduce smoking has been shown to be banning smoking at home or in the city.
The decrease, essentially by men, of smoking habits has led to an extension of longevity. (Mathers et al, 2014)
Tuberculosis, abbreviated TB, is a treatable bacterial disease. Today, however, we have multi-drug resistant tuberculosis essentially in the BRIC countries with the notable exception of Brazil due to easy access to health care and to the poverty alleviation programs in that country. (Olson et al, 2014)
Russia and Eastern Europe, in particular, are countries with a large number of drug-resistant cases. The high incidence of HIV renders those individuals more susceptible to TB infections.
Due to the high cost of treating these cases, they are often left untreated and contamination then spreads through the population. Treatment costs of multi-drug resistant TB are of the order of USD 10’000 and therefore out of reach of the majority of the population. (Stratfor, 08.09.14)
OTHER FACTORS ASSOCIATED WITH MORTALITY
European governments are increasingly passing laws decriminalizing assisted suicide. Switzerland has probably the most liberal law, allowing persons who are neither ill nor even residing in the country, to have access to assisted suicide without even requiring the authorization of a medical doctor.In Belgium, the law condones assisted suicide even for children if they are terminally ill and there is no chance of medical relief. In the Netherlands, the law applies to anyone over 12 years of age who have unbearable suffering and no chance of relief. (The Economist, July 19, 2014)
Several studies have shown that men and women having completed only the minimum mandatory education had a higher mortality that men or women having completed their doctoral thesis. These studies have shown that there is a gradient of mortality directly associated with the number of years spent studying. (Marmot, 2004)