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

Decision-makingLow- and middle-income countriesHigh-income countriesCause Deaths Cause Deaths(millions)(millions)1 Perinatal conditions 2.49 20.7% 1 Perinatal conditions 0.03 33.9%2 Lower respiratory infections 2.04 17.0% 2 Congenital anomalies 0.02 20.0%3 Diarrhoeal diseases 1.61 13.4% 3 Road traffic accidents 0.01 5.9%4 Malaria 1.10 9.2% 4 Lower respiratory infections 0.00 2.5%5 Measles 0.74 6.2% 5 Endocrine disorders 0.00 2.4%6 HIV/AIDS 0.44 3.7% 6 Drownings 0.00 2.4%7 Congenital anomalies 0.44 3.7% 7 Leukemia 0.00 1.9%8 Whooping cough 0.30 2.5% 8 Violence 0.00 1.8%9 Tetanus 0.22 1.9% 9 Fires 0.00 1.2%10 Road traffic accidents 0.18 1.5% 10 Meningitis* 0.00 1.2%Table 4: The 10 leading causes of death in children aged 0–14, by broad income group, 200160 and over in all regions. Globally, 60-year-olds have a 55%chance of dying before their 70th birthday. Regional variationsin the risk of death are smaller at older ages than at youngerages, ranging from around 40% in the developed countries ofWestern Europe to 60% in most developing regions and 70%in sub-Saharan Africa. Historical data from countries such asAustralia and Sweden show that life expectancy at age 60changed slowly during the first six to seven decades of the20th century, but started to increase substantially sincearound 1970. Life expectancy at age 60 has now reached 25years in Japan. In Eastern Europe from 1990 onwards,Hungary, and Poland started to experience similarimprovements in mortality for older people, but Russia hasnot, and is actually experiencing a worsening trend.Regional variations in causes of deathThe 10 leading causes of mortality differ greatly betweenregions (Table 6). IHD and cerebrovascular disease areamong the top four causes of death in all low- and middleincomeregions except sub-Saharan Africa, where they are8th and 7th, respectively. Cerebrovascular disease is theleading cause of death in East Asia and the Pacific, unlike inmost other regions, where IHD causes more deaths thancerebrovascular disease. In sub-Saharan Africa, 6 of the top10 causes are communicable diseases, with HIV/AIDS beingthe leading cause of death, followed by malaria and lowerrespiratory infections.South Asia (mainly India) and Latin America and theCaribbean are the only two other low- and middle-incomeregions where HIV/AIDS is one of the top 10 causes of death.Lower respiratory infections, primarily pneumonia, are thethird leading cause of death, especially among childrenunder five, who account for 60% of these deaths. Chronicobstructive pulmonary disease kills more people (1.4 million)in the East Asia and Pacific region, primarily China, thananywhere else in the world, with 50% of global mortalityfrom the disease occurring there.Europe and Central Asia differs from all other low- andmiddle-income regions in the size of the CVD epidemic (withalmost 60% of deaths due to CVD), followed by trachea,bronchus, and lung cancers in third place. Self-inflicted injuries(suicide) are the fifth leading cause of death in this region.South Asia is the only other region where suicide is in the top10 causes of death. Latin America and the Caribbean isdistinguished as the only region where violence falls in the top10 causes of death, responsible for 1 in 25 deaths. In all lowandmiddle-income regions apart from Europe and Central Asia,road traffic accidents are included among the top 10 causes ofdeath, reaching fifth position in the Middle East and NorthAfrica, where they are responsible for 1 in 20 deaths.Global burden of disease in 2001The 20 leading causes of burden of disease for both sexestogether are shown in Table 7. While the two leading causesLow- and middle-income countriesHigh-income countriesCause Deaths Cause Deaths(millions)(millions)1 HIV/AIDS 2.05 14.1% 1 Ischaemic heart disease 0.13 10.8%2 Ischaemic heart disease 1.18 8.1% 2 Self-inflicted injuries 0.09 7.2%3 Tuberculosis 1.03 7.1% 3 Road traffic accidents 0.08 6.9%4 Road traffic accidents 0.73 5.0% 4 Trachea, bronchus, lung cancers 0.08 6.8%5 Cerebrovascular disease 0.71 4.9% 5 Cerebrovascular disease 0.05 4.4%6 Self-inflicted injuries 0.58 4.0% 6 Cirrhosis of the liver 0.05 4.4%7 Violence 0.45 3.1% 7 Breast cancer 0.05 4.0%8 Lower respiratory infections 0.33 2.3% 8 Colon and rectum cancers 0.04 3.1%9 Cirrhosis of the liver 0.32 2.2% 9 Diabetes mellitus 0.03 2.1%10 Chronic obstructivepulmonary disease 0.32 2.2% 10 Stomach cancer 0.02 2.0%Table 5: The 10 leading causes of death in adults aged 15–59, by broad income group, 2001170 ✜ Global Forum Update on Research for Health Volume 4