Combining health and social protection measures to reach the ultra ...

Decision-makingLow- and middle-income countriesHigh-income countriesCause Deaths Cause Deaths(millions)(millions)1 Ischaemic heart disease 5.70 11.8% 1 Ischaemic heart disease 1.36 17.3%2 Cerebrovascular disease 4.61 9.5% 2 Cerebrovascular disease 0.78 9.9%3 Lower respiratory infections 3.41 7.0% 3 Trachea, bronchus, lung cancers 0.46 5.8%4 HIV/AIDS 2.55 5.3% 4 Lower respiratory infections 0.34 4.4%5 Perinatal conditions 2.49 5.1% 5 Chronic obstructive pulmonarydisease 0.30 3.8%6 Chronic obstructivepulmonary disease 2.38 4.9% 6 Colon and rectum cancers 0.26 3.3%7 Diarrhoeal diseases 1.78 3.7% 7 Alzheimer and other dementias 0.21 2.6%8 Tuberculosis 1.59 3.3% 8 Diabetes mellitus 0.20 2.6%9 Malaria 1.21 2.5% 9 Breast cancer 0.16 2.0%10 Road traffic accidents 1.07 2.2% 10 Stomach cancer 0.15 1.9%Table 2: The ten leading causes of death, by broad income group, 2001responsible for 21 to 36% of deaths. Such a shift in thecause of death pattern has not occurred in sub-SaharanAfrica, where perinatal conditions rank in fourth place andmalaria, lower respiratory infections, and diarrhoeal diseasescontinue to be the leading causes of death in children,accounting for 53% of all deaths.About 90% of all HIV/AIDS and malaria deaths in childrenin developing countries occur in sub-Saharan Africa, whichaccounts for 23% of the world’s births and 42% of the world’schild deaths. The immense surge of HIV/AIDS mortality inchildren in recent years means that HIV/AIDS is nowresponsible for 332 000 child deaths annually in sub-SaharanAfrica and nearly 8% of all child deaths in the region.Some progress has been made against diarrhoeal diseasesand measles. While the incidence of diarrhoeal diseases isthought to have remained stable, mortality from diarrhoealdiseases has fallen from 2.5 million deaths in 1990 to about1.6 million deaths in 2001, and now accounts for 13% of alldeaths of children under age 15. Deaths from measles havedeclined modestly, although more than 0.5 million childrenunder five still died from this disease in 2001. Malaria causesmore than a million child deaths per year or nearly 11% of alldeaths of children under five.Leading causes of death in adultsTable 5 shows the leading causes of deaths among adults age15 to 59 worldwide in 2001. Despite a global trend ofdeclining communicable disease burden in adults, HIV/AIDShas become the leading cause of mortality and the singlemost important contributor to the burden of disease amongadults in this age group.Nearly 80% of the 2.1 million adult deaths from HIV/AIDSin 2001 occurred in sub-Saharan Africa. In this region,HIV/AIDS is the leading cause of death, resulting in more than6000 deaths every day and accounting for almost 1 in 5deaths for all ages and 1 in 2 deaths of adults age 15 to 59.HIV/AIDS has reversed mortality trends among adults in theregion, and in many countries, life expectancies havedeclined since 1990.The 4.5 million adult injury deaths in 2001 were heavilyconcentrated among young adults, particularly men. In the15 to 59 age group, road traffic accidents and suicide wereamong the 10 leading causes of death in high-income andlow- and middle-income countries, and violence (homicide)was also among the 10 leading causes in low- and middleincomecountries. Among adults age 15 to 44 worldwide,road traffic accidents were the leading cause of death for menafter HIV/AIDS, followed by TB and violence. Suicide was thethird leading cause of death for women in this age group,after HIV/AIDS and TB, with road traffic accidents in fifthplace.The risk of death rises rapidly with age among adults agedMalesFemalesCause Deaths Cause Deaths(millions)(millions)1 Ischaemic heart disease 3.01 11.8% 1 Ischaemic heart disease 2.69 11.8%2 Cerebrovascular disease 2.17 8.5% 2 Cerebrovascular disease 2.44 10.7%3 Lower respiratory infections 1.72 6.7% 3 Lower respiratory infections 1.68 7.4%4 Perinatal conditions 1.38 5.4% 4 HIV/AIDS 1.18 5.2%5 HIV/AIDS 1.38 5.4% 5 Chronic obstructivepulmonary disease 1.17 5.1%6 Chronic obstructivepulmonary disease 1.21 4.7% 6 Perinatal conditions 1.11 4.9%7 Tuberculosis 1.04 4.1% 7 Diarrhoeal diseases 0.85 3.7%8 Diarrhoeal diseases 0.93 3.6% 8 Malaria 0.63 2.8%9 Road traffic accidents 0.78 3.1% 9 Tuberculosis 0.55 2.4%10 Malaria 0.58 2.3% 10 Diabetes mellitus 0.42 1.8%Table 3: The 10 leading causes of death, by sex, low- and middle-income countries, 2001Global Forum Update on Research for Health Volume 4 ✜ 169