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

Decision-makingEurope and Central AsiaLatin America and Caribbean1 Ischaemic heart disease 15.9% 1 Perinatal conditions 6.0%2 Cerebrovascular disease 10.8% 2 Unipolar depressive disorders 5.0%3 Unipolar depressive disorders 3.7% 3 Violence 4.9%4 Self-inflicted injuries 2.3% 4 Ischaemic heart disease 4.2%5 Hearing loss, adult onset 2.2% 5 Cerebrovascular disease 3.8%6 Chronic obstructivepulmonary disease 2.0% 6 Endocrine disorders 3.0%7 Trachea, bronchus, lung cancers 2.0% 7 Lower respiratory infections 2.9%8 Osteoarthritis 2.0% 8 Alcohol use disorders 2.8%9 Road traffic accidents 1.9% 9 Diabetes mellitus 2.7%10 Poisonings 1.9% 10 Road traffic accidents 2.6%Sub-Saharan AfricaMiddle East and North Africa1 HIV/AIDS 16.5% 1 Ischaemic heart disease 6.6%2 Malaria 10.3% 2 Perinatal conditions 6.3%3 Lower respiratory infections 8.8% 3 Road traffic accidents 4.6%4 Diarrhoeal diseases 6.4% 4 Lower respiratory infections 4.5%5 Perinatal conditions 5.8% 5 Diarrhoeal diseases 3.9%6 Measles 3.9% 6 Unipolar depressive disorders 3.1%7 Tuberculosis 2.3% 7 Congenital anomalies 3.1%8 Road traffic accidents 1.8% 8 Cerebrovascular disease 3.0%9 Whooping cough 1.8% 9 Vision disorders, age-related 2.7%10 Protein-energy malnutrition 1.5% 10 Cataracts 2.3%South AsiaEast Asia and Pacific1 Perinatal conditions 9.2% 1 Cerebrovascular disease 7.5%2 Lower respiratory infections 8.4% 2 Perinatal conditions 5.4%3 Ischaemic heart disease 6.3% 3 Chronic obstructive pulmonary disease 5.0%4 Diarrhoeal diseases 5.4% 4 Ischaemic heart disease 4.1%5 Unipolar depressive disorders 3.6% 5 Unipolar depressive disorders 4.1%6 Tuberculosis 3.4% 6 Tuberculosis 3.1%7 Cerebrovascular disease 3.2% 7 Lower respiratory infections 3.1%8 Cataracts 2.3% 8 Road traffic accidents 3.0%9 Chronic obstructivepulmonary disease 2.3% 9 Cataracts 2.8%10 Hearing loss, adult onset 2.0% 10 Diarrhoeal diseases 2.5%Table 9: Leading causes of burden of disease in low- and middle-income countries, by region, 2001among men. The number of cases of lung cancer increasednearly 30% since 1990, largely reflecting the emergence ofthe tobacco epidemic in low- and middle-income countries.Stomach cancer, which until recently was the leading siteof cancer mortality worldwide, has been declining in all partsof the world where trends can be reliably assessed, and in2001 caused 842 000 deaths, or about two thirds as manyas lung cancer. Liver cancer was the third leading site, with607 000 deaths in 2001, more than 60% of them in theEast Asia and Pacific region. Among women, the leadingcause of cancer deaths was breast cancer. Breast cancersurvival rates have been improving during the past decade,but the chance of survival varies according to the coverage ofand access to secondary prevention. Globally, neuropsychiatricconditions accounted for 19% of the disease burden amongadults, primarily from nonfatal health outcomes.Injuries: the hidden epidemicInjuries, both unintentional and intentional, primarily affectyoung adults, and often result in severe, disabling sequelae.In 2001, injuries accounted for 16% of the adult burden ofill-health and premature death worldwide. In parts of LatinAmerica and the Caribbean, Europe and Central Asia, and theMiddle East and North Africa more than 30% of the entiredisease and injury burden among male adults age 15 to 44was attributable to injuries, and road traffic accidents,violence, and self-inflicted injuries were all among the top 10leading causes of the burden of disease. Globally, road trafficaccidents were the third leading cause of burden in the sameage and sex group, preceded only by HIV/AIDS and unipolardepression. The burden of road traffic accidents has beenincreasing, especially in the developing countries of sub-Saharan Africa and South and Southeast Asia, andparticularly affects males.Intentional injuries, which include self-inflicted injuries andsuicide, violence, and war, accounted for an increasing shareof the burden, especially among economically productiveyoung adults. In developed countries, suicides accounted forthe largest share of the intentional injury burden, whereas indeveloping regions, violence and war were the major sources.The former Soviet Union and other high-mortality countries ofEastern Europe have rates of death and disability resultingfrom injury among males that are similar to those in sub-Saharan Africa.Regional variations in the burden of diseaseTable 9 summarizes the 10 leading causes of burden for eachof the low- and middle-income regions.In 2001, IHD and stroke dominated the burden of diseasein Europe and Central Asia, and together accounted for moreGlobal Forum Update on Research for Health Volume 4 ✜ 173