Good news on living, dying

Published Dec. 27, 2012

There's good news in a new and certifiable global trend: More elderly people are dying of cancer and heart disease.

That may not sound like good news, and in one obvious sense it isn't. But before you can die in old age of so-called "rich-country" ailments like these, you have to survive many decades. That so many people are doing so represents a huge achievement.

The evidence comes in a new report produced by the Institute for Health Metrics and Evaluation at the University of Washington. It offers a lot of reasons to cheer.

First, infectious diseases kill far fewer people globally today than they did just two decades ago. Diarrhea, tuberculosis, malaria and measles have all dropped in the rankings of top causes of death. Better sanitation, greater availability of medicines and wider inoculations have played crucial roles.

Malnutrition is also subsiding. In 1981, 70 percent of the people in developing nations lived on less than $2 a day. Now, that share of the populace in those countries is down to 43 percent. And while malnutrition in 1990 was the world's top risk factor for deaths and years of life lost, by 2010 it had dropped to eighth.

In the aggregate, then, children in particular are remarkably less vulnerable than they used to be. Since 1990, the death rate of kids younger than age 5 has declined by some 60 percent.

Here is an odd but definite sign of progress in the effort to reduce poverty: More people now die from obesity-related illnesses than from lack of food.

The progress has not been uniform across the globe. Sub-Saharan Africa suffers disproportionately from childhood illnesses and lethal infections, including AIDS. But even there, the average age at death has risen by 10 years since 1970: As more children survive — other effects in a society remaining static — the average age of all its deaths rises. In North Africa, Latin America and Asia, the increase since 1970 in the age of death has been more than 25 years.

As causes of death shift from infectious to non-communicable diseases, AIDS is a global outlier: It may have peaked, but its effect remains steady, claiming some 1.5 million lives worldwide every year.

It's heartening to know that big, positive changes can occur in places that were sometimes seen as hopeless. The measures that have brought about this progress can be reinforced and expanded to make sure it continues.

But there is some bad news. Millions of people still die prematurely from diseases linked to the choices they make — on things like smoking, eating and exercising. Tobacco use alone claims 6 million lives a year. Preventing cancer, heart disease and diabetes often means persuading people to change how they live, and that's not easy to do.

Smoking is a tough habit to break. Rising incomes and cheap, tasty food have helped produce an epidemic of obesity. There is no vaccine for aversion to exercise. The increase in lifestyle-related diseases means that while people are living longer, many of them are also living sicker and requiring more medical treatment, which drives up costs.

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That's the unfortunate price of progress against all sorts of ailments that kill young and old alike. But the progress is real, and it's welcome.

© 2012 Chicago Tribune