Researchers Call For Setting Quantitative Health Target Of
Preventing 40% Of Under Age- 70 (Premature) Deaths By 2030
Desire Is To
Have Simple, Understandable, Measurable Targets
What is life
expectancy worldwide now? How many millions of deaths occur in the
world each year? Are they increasing or decreasing? How many of
these deaths are preventable? These are some of the topics which
have engaged the authors of a recent paper in The Lancet.
Driven by the value of setting plausible goals and the fact that
death in old age in inevitable but death before old age is not,
researchers writing in The Lancet in September provide analyses of
decreasing national mortality trends which they hope will influence
the United Nations in setting disease and death reduction targets
for the next round of international development goals. The current
set of goals, called the Millenium Development Goals is set to
expire in 2015 and will be replaced by a new set of Sustainable
Development Goals. (see related article for a list of these proposed
goals).
Past Achievements
2000-2010
Lead author Ole
Norheim of Norway and epidemiology and public health colleagues
from around the world reported that between 2000 and 2010,
proportional decreases in death rates fell by 13-34% depending on
the age group. The largest decrease took place in the 0-4 year age
group.
Comparing causes of death, rates fell by 30% for communicable,
perinatal, maternal, or nutritional causes, by 14% for
non-communicable diseases, and by 13% for injuries.
According to
Richard Peto, one of the co-authors, “In all major countries,
except where the effects of HIV or political disturbances
predominated, the risk of premature death has been decreasing in
recent decades, and it will fall even faster over the next few
decades if the new Sustainable Development Goals get the big causes
of death taken even more seriously.” The authors of the Lancet paper
make the important points that if targets are to be pursued
seriously, progress towards them needs to be measured. Also, the
measures need to be robust and easy or simple to communicate.
In the paper in The Lancet, the authors propose giving greater
definition to the current health goal which is currently formulated
as “Ensure healthy lives and promote well-being for all at all
ages.” The Lancet authors call for the broad health goal to be
accompanied by a specific target to avoid 40% of all premature
deaths in each country (that is 40% of the deaths that would occur
in the 2030 population of that country, if its 2010 death rates
continued). The 40% target is considered feasible, according to Peto
writing also in Science in September, because it would “…reinforce
current successful efforts to reduce maternal and child mortality
and death from HIV, tuberculosis, malaria, and other communicable
diseases, but would also require serious and successful efforts to
substantially reduce accidents and NCD mortality.”
Serious Extra Effort
Required
Nordheim said “we
are going to need improved health care, intensified international
efforts to control communicable diseases, and more effective
prevention and treatment of non-communicable diseases and injuries.
He called these efforts “realistically moderate improvements in
current trends” and said the target is realistic where deaths are
not dominated by new epidemics, political disturbances, or
disasters.
Making these points
at this time is important because the United Nations is in the
process of setting new ambitious Sustainable Development Goals for
the period 2016-2030 which will replace the Millenium Development
Goals expiring in 2015. The Lancet authors consider some of the
draft goals to be implausible and they wish to add an overarching
numerical target that could with serious extra effort be feasible by
2030 or the 2030s. Commentators on the Lancet article urged the
medical community to develop a common position that can help the
international community arrive at a single health goal with a
limited number of simple, understandable, and measurable targets.
In their Lancet
conclusion, the authors provide the estimated numbers of lives saved
if the goal could be achieved. They state, “if achieved, these
reductions avoid about 10 million of the 20 million deaths at ages 0-49 years that
would be seen in 2030 at 2010 rates, and about 17 million of the 41
million such deaths at ages 0-69 years…”
The currently
proposed draft of Sustainable Development Goals including the goal
for health and its subgoals are listed in abridged form in the following article and
are available in entirety at:
http://tinyurl.com/nasnrsy
The broad health
target and four global subtargets for health proposed by Nordheim
and colleagues are:
Target:
Avoid in each
country 40% of premature deaths (that is under-70 deaths that would
be seen in the 2030 population at 2010 death rates) AND improve
health care at all ages.
Sub-targets:
1. Avoid two-thirds
of child and maternal deaths.
2. Avoid two-thirds
of TB, HIV, and malaria deaths.
3. Avoid one-third
of premature deaths from non-communicable diseases.
4. Avoid one-third
of deaths from other communicable diseases, undernutrition, and
injuries.
Achieving these
subtargets would translate into halving under 50 deaths and avoid a
third of the deaths at 50-69 years and altogether avoid 40% of
under-70 deaths. ■
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