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The health of most of the planet's population is rapidly coming to resemble that of the United States, where death in childhood is rare, too much food is a bigger problem than too little, and life is long and often darkened by disability.
High blood pressure is now the leading "risk factor" for disease around the world. Alcohol use is third. Low-back pain now causes more disability than childbirth complications or anemia.
"We are in transition to a world where disability is the dominant concern as opposed to premature death," said Christopher J.L. Murray, who headed the Global Burden of Disease Study, published Thursday. "The pace of change is such that we are ill prepared to deal with what the burden of disease is now in most places."
Produced over five years by 486 researchers at 302 institutions in 50 countries, the study is the most detailed look at health on the population level ever attempted.
It charts 235 causes of death, including AIDS, alcoholism, bladder cancer and animal bites. It examines the effects of 67 "risk factors" — as diverse as not enough fruit in the diet and childhood sexual abuse — that can lead to illness.
The calculations are made for two points in time — 1990 and 2010. As a consequence, the study reveals how the world's health has changed over two decades and provides a trajectory of where it might be headed. The purpose is to give governments, international agencies, donors and researchers an idea of what to plan for.
The study provides both a broad-brush portrait of 7 billion people and a detailed etching of what's happening in 187 individual nations.
Heart disease and stroke were the leading and second-leading causes of death in 1990 and remained so in 2010. But over that two-decade period, malnutrition dropped from the 11th to the 21st cause of death. Diabetes, car accidents and lung cancer rose in the rankings.
Africa remains the one place where afflictions of the poor — AIDS, malaria, childhood infections, malnutrition, childbirth calamities — remain hugely important. They account for three-quarters of all premature deaths.
The study reveals many highly localized variations in health:
• As a consequence of the earthquake in Haiti in 2010, Haitian men that year had the globe's lowest life expectancy: 33 years.
• Egypt has the highest rate of cirrhosis of any country, caused by hepatitis C unwittingly transmitted to millions of people through unclean needles used in public health campaigns against the tropical infection schistosomiasis.
• Ethiopian men gained 13 years of "healthy life expectancy" between 1990 and 2010, the most of any group in the world.
• There's a "homicide belt" in Latin America and a "suicide belt" in Asia.
The package of seven papers totaling 196 pages is being published in the Lancet. It is the first time an entire issue of the journal has been given over to one research study.
Although population aging, declining poverty and smaller family size have been the major forces changing the world's health profile over the two decades, improvements in medicine and public health have also made a huge difference. Measles tells the story.
In 1990, 631,000 people died from that childhood infection, which was the world's 19th-leading cause of death. In 2010, only 125,000 people died from measles, which had fallen to the No. 62 cause.
"There have been very, very big payoffs in all the investments made to improve child survival," said Alan Lopez, the dean of the school of population health at the University of Queensland in Australia, who with Murray led the project.
Those investments include vaccines, vitamin A and zinc supplements, antibiotics for children with pneumonia, insecticide-treated mosquito nets for children to sleep under in malaria zones, and better obstetrical care.
The risk of dying prematurely from many "adult" diseases (such as heart attacks and cancer) has fallen because of better treatment and prevention. As a result, the average age of the world's population is getting older. Soon after 2015, for the first time in history, there will be more people older than 65 than younger than 5. That has had two consequences.
More people are surviving to die of diseases that occur only in old age. These include Alzheimer's disease, deaths from which tripled from 1990 to 2010, and Parkinson's disease, whose deaths doubled. At the same time, people are living with conditions that don't kill them but that affect their health.
People are living longer lives, but the time they are gaining isn't entirely time with good health. For every year of life expectancy added since 1990, about 9 ½ months is time in good health. The rest is time in a diminished state — in pain, immobility, mental incapacity or medical support such as dialysis.
The trend of adding increasing amounts of bad health to life is known as the "expansion of morbidity." It is likely to be the biggest challenge to patients, doctors and people who pay for medical care for the next few centuries.
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