No health system is perfect, and all countries have people who are left behind. It is therefore important to accurately document the state of global health and how it is changing,” said Dr Tedros Adhanom Ghebreyesus (WHO Director-General) after the publication of the 2019 World Health Statistics.
“In order to track our progress reaching health-related Sustainable Development Goals (SDGs) and associated targets we need accurate statistics. “Although the World Health Statistics 2019 tells its story with numbers the consequences are human,” said Tedros, as he is widely known. “Behind every number in [the report] is a person, a family, a community and a nation.”
Unsurprisingly, the new WHO statistics highlight the need to improve access to primary health care worldwide and to increase uptake. “The report reveals that in low-income countries, health is frequently compromised by diseases and conditions that are preventable or treatable. Not only are the risks of maternal deaths elevated by poverty, but their occurrence perpetuates the cycle of poverty in poor communities from one generation to the next.”
For the first time the WHO’s Global Health Statistics were disaggregated by sex. Although many countries still struggle to provide gender disaggregated information, this new analysis has provided insights into the health and needs of people around the world. “Closing data gaps will accelerate and is important to closing the gender gap,” said Dr Richard Cibulskis, the report’s main author. “Collecting, analysing, and using good quality, disaggregated data is central to improving people’s health and wellbeing. Health policy and practice must be underpinned by robust and reliable data, generated in countries.”
“Breaking down data by age, sex and income group is vital for understanding who is being left behind and why,” said Tedros. “Our task is to use these data to make evidence-based policy decisions that move us closer to a healthier, safer, fairer world for everyone,” said Tedros.
MEN vs WOMEN
Attitudes to healthcare differ. According to the report, where men and women face the same disease, men often seek healthcare less than women. In countries with generalised HIV epidemics, for example, men are less likely than women to take an HIV test, less likely to access antiretroviral therapy and more likely to die of AIDS-related illnesses than women. Similarly, male TB patients appear to be less likely to seek care than female TB patients. Of the 40 leading causes of death, 33 causes contribute more to reduced life expectancy in men than in women.
In 2016, the probability of a 30-year-old dying from a noncommunicable disease before 70 years of age was 44% higher in men than women. Global suicide mortality rates were 75% higher in men than in women in 2016. Death rates from road injury are more than twice as high in men as in women from age 15, and mortality rates due to homicide are four times higher in men than in women.
Age-standardised prevalence of tobacco smoking was five times higher in men than in women in 2016, and globally, per capita alcohol consumption was almost four times higher in men than in women. Women live longer than men, but the additional years are not always healthy. The number of equivalent years of full health lost through living in poor health from birth is also greater in women than in men (9.5 vs 7.8 years).
Globally, the sex ratio at birth has been in the range of 105-110 males to every 100 females; however, mortality rates are higher in males, so the ratio changes as the population ages. Because the incidence of different diseases varies with age, and women live longer than men, some diseases can be more common in women; for example, the lifetime risk for Alzheimer disease is greater in women than in men, partly because more women survive to ages at which the disease most commonly occurs, although in some locations women also appear to be more susceptible to Alzheimer disease.
In low-income countries, differences in life expectancy between males and females are due to causes that are frequently preventable, or treatable through access to basic health services. The gap between men’s and women’s life expectancy is narrowest where women lack access to health services. In low-income countries, where services are scarcer, one in 41 women dies from a maternal cause, compared with one in 3 300 in high-income countries. In more than 90% of low-income countries, there are fewer than four nursing and midwifery personnel per 1 000 people.
The report suggested four key actions based on the findings of the 2019 World Health Statistics:
1. Achieve universal health coverage. For many conditions, particularly in low-income countries, premature deaths can be averted by improving access to and use of preventive and curative health services. This may require a strengthened health workforce and increased provision of health facilities, equipment, medicines and vaccines. It will also require removing economic and cultural barriers to accessing services.
2. Promote healthier populations. The health of populations can also be improved by reducing exposure to risk factors such as unsafe water and sanitation, air pollution, violence, unsafe roads, tobacco use and alcohol consumption.
3. Make health systems responsive to sex and gender. Health planning needs to allow for the different needs of men and women, including exposure to risk factors, barriers to access and health outcomes. Gender analysis and health policies should consider women, men and gender-diverse population groups, to ensure equitable health outcomes.
4. Invest in data systems for health, including disaggregated data. Progress in achieving the SDG goals is inhibited by incomplete or outdated information on several health-related indicators. Collecting, analysing and utilising data of good quality is an important step to progressing health care, allowing better allocation of resources and timely interventions, and reducing costs while also improving the health care received.
Routine information systems, health facility or household surveys, and civil registration and vital statistics systems must be designed to provide relevant, timely and accurate data. “These statistics underscore the need to prioritise primary health care urgently to effectively manage noncommunicable diseases, and to curb risk factors.” said Dr Samira Asma, WHO Assistant director general for Data, Analytics and Delivery.