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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 lowandmiddle-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
Decision-makingEurope and Central AsiaLatin America and Caribbean1 Ischaemic heart disease 29.7% 1 Ischaemic heart disease 10.9%2 Cerebrovascular disease 18.2% 2 Cerebrovascular disease 8.2%3 Trachea, bronchus, lung cancers 2.9% 3 Perinatal conditions 5.0%4 Chronic obstructivepulmonary disease 2.3% 4 Diabetes mellitus 5.0%5 Self-inflicted injuries 2.1% 5 Lower respiratory infections 4.8%6 Hypertensive heart disease 1.9% 6 Violence 4.0%7 Poisonings 1.9% 7 Chronic obstructive pulmonary disease 3.0%8 Lower respiratory infections 1.8% 8 Road traffic accidents 2.7%9 Cirrhosis of the liver 1.8% 9 Hypertensive heart disease 2.7%10 Stomach cancer 1.8% 10 HIV/AIDS 2.5%Sub-Saharan AfricaMiddle East and North Africa1 HIV/AIDS 19.0% 1 Ischaemic heart disease 16.9%2 Malaria 10.1% 2 Cerebrovascular disease 6.8%3 Lower respiratory infections 10.0% 3 Lower respiratory infections 5.6%4 Diarrhoeal diseases 6.6% 4 Perinatal conditions 5.5%5 Perinatal conditions 5.3% 5 Road traffic accidents 5.1%6 Measles 4.1% 6 Hypertensive heart disease 3.9%7 Cerebrovascular disease 3.3% 7 Diarrhoeal diseases 3.9%8 Ischaemic heart disease 3.2% 8 Congenital anomalies 2.4%9 Tuberculosis 2.9% 9 Nephritis and nephrosis 2.2%10 Road traffic accidents 1.8% 10 Chronic obstructive pulmonary disease 2.1%South AsiaEast Asia and Pacific1 Ischaemic heart disease 13.6% 1 Cerebrovascular disease 14.6%2 Lower respiratory infections 10.4% 2 Chronic obstructive pulmonary disease 10.8%3 Perinatal conditions 8.0% 3 Ischaemic heart disease 8.8%4 Cerebrovascular disease 6.8% 4 Lower respiratory infections 4.2%5 Diarrhoeal diseases 5.1% 5 Tuberculosis 4.1%6 Tuberculosis 4.5% 6 Perinatal conditions 3.8%7 Chronic obstructivepulmonary disease 4.3% 7 Stomach cancer 3.4%8 HIV/AIDS 2.0% 8 Trachea, bronchus, lung cancers 3.0%9 Road traffic accidents 1.8% 9 Liver cancer 2.9%10 Self-inflicted injuries 1.7% 10 Road traffic accidents 2.8%Table 6: Leading causes of death in low- and middle-income countries, by region, 2001of death, IHD and cerebrovascular disease, remain among thetop four causes of the burden of disease, four nonfatalconditions are also among the top 20 causes of burden:unipolar depressive disorders, adult-onset hearing loss,cataracts, and osteoarthritis. This once again illustrates theimportance of taking nonfatal conditions into account, as wellas deaths, when assessing the causes of loss of health inpopulations.In 2001, the leading causes of the burden of disease inlow- and middle-income countries were broadly similar tothose for the world as a whole (Table 8), and included sixGroup I causes among the top 10, but the leading causes inhigh-income countries consisted entirely of Group IIconditions, including three (unipolar depressive disorders,adult-onset hearing loss, and alcohol use disorders) for whichdirect mortality is low.Age and sex differences in the burden ofdiseaseChildren younger than 15 accounted for 36% of the world’stotal burden of disease and injury in 2001 and adults age 15to 59 accounted for almost 50%. Low- and middle-incomecountries accounted for the vast majority of the diseaseburden for children (Figure 3). While the proportion of theLow- and middle-income countriesHigh-income countriesCause DALYs Cause DALYs(millions)(millions)of yearsof years1 Perinatal conditions 90.48 5.9% 11 Road traffic accidents 35.06 2.3%2 Lower respiratory infections 85.92 5.6% 12 Hearing loss, adult onset 29.99 2.0%3 Ischaemic heart disease 84.27 5.5% 13 Cataracts 28.64 1.9%4 Cerebrovascular disease 72.02 4.7% 14 Congenital anomalies 24.95 1.6%5 HIV/AIDS 71.46 4.7% 15 Measles 23.11 1.5%6 Diarrhoeal diseases 59.14 3.9% 16 Self-inflicted injuries 20.26 1.3%7 Unipolar depressive disorders 51.84 3.4% 17 Diabetes mellitus 20.00 1.3%8 Malaria 39.97 2.6% 18 Violence 18.90 1.2%9 Chronic obstructivepulmonary disease 38.74 2.5% 19 Osteoarthritis 17.45 1.1%10 Tuberculosis 36.09 2.3% 20 Alzheimer and other dementias 17.11 1.1%Table 7: The 20 leading causes of burden of disease, DALYs, world, 2001Global Forum Update on Research for Health Volume 4 ✜ 171
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Editorial Advisory Board:Luis Gabri
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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Introductionmaking), takes account
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Access to healthStrengthening healt
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Access to healthTraining more healt
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Access to healthimperative for acti
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Access to healthReferences1.Further
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Access to healthDeterminantsAvailab
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Access to healthThe authors are inv
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Access to healthCombining health an
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Access to health100%Availability of
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Access to healthMandatory clinical
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Access to healthWhile there are som
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Access to healthReferences continue
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Access to healthintegrating individ
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Access to healthA social determinan
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Access to healthemployment conditio
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Access to healthMaking human rights
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Access to healthResources outsideth
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Access to healthReferences1.McCoy D
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Access to healthand financial burde
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Access to healthDiscrimination as a
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Access to health“Two months ago I
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Access to healthsocio-cultural and
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InnovationTowards the development o
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Innovation60% of enterprises5040302
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InnovationFinancing of vaccine R&D-
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InnovationChild immunization:accele
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Innovationare revealing previously
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InnovationDeveloping countries % De
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Innovationwhere he was a programme
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Research resourcesResearch impact o
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Research resourcesBiotechnologists6
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