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Developments and Forecasts on Shifting Health Challenges

Worldwide

Many developing countries must now deal with a “dual burden” of disease: they must continue to prevent and control infectious diseases, while also addressing the health threats from NCDs and environmental health risks.

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  • Ischaemic heart disease and stroke have been the world’s top causes of death for the past 15 years (accounting for a combined 15 million deaths in 2015) and are expected to continue to be so for the foreseeable future.
  • Low- to middle-income countries account for 85% of the world’s population and 92% of the global burden of disease. 
    | Related Megatrends: Inequality; Consumerism; Geopower
  • In developed countries, bacterial infections are rising as resistance to antibiotics is becoming more common. Antimicrobial resistance (AMR) is the cause of premature death of some 25,000 people in the EU and 23,000 people in the USA, yearly. By 2050, global annual death toll due to AMR could grow to 10 million people per year, from today's estimated 700,000 death per year. 
  • Since 2000, the global burden of disease from communicable diseases (e.g. infectious diseases, HIV, tuberculosis, and measles) has been outweighed by noncommunicable diseases, (e.g. cardiovascular diseases, cancers, chronic respiratory diseases, diabetes). The total mortality from infectious diseases fell from 25% in 1998 to less than 16% in 2010. The global disease burden will continue shifting from communicable to noncommunicable diseases (NCD).
  • Global deaths from all communicable diseases — including AIDS, diarrhoea, malaria, and respiratory infections — are projected to continue to decline;
  • HIV continues to be a major global public health issue. Globally, 1 million people died from HIV-related causes in 2016; approximately 36.7 million people were living with HIV and some 1.8 million people became newly infected. Some 54% of adults and 43% of children living with HIV are currently receiving lifelong antiretroviral therapy (ART).

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  • Over 70% – 41 million of total 56 million global deaths are due to noncommunicable diseases (NCDs) with significant differences by countries and regions.
    | Related Megatrends: Inequality; Consumerism; Geopower
  • Noncommunicable conditions are projected to account for 52 million death in 2030, representing some 75% of all deaths — up from 63% (36 million people) in 2013 and 71% (41 million people) in 2016.
    | Related Megatrends: Demography; Inequality; Consumerism;   Geopower
  • Four groups of diseases account for over 80% of all premature NCD deaths: 1. cardiovascular diseases (17.9 million people annually); 2. cancers (9.0 million); respiratory diseases (3.9million); and diabetes (1.6 million) and are expected to remain so given lifestyle paterns and aging population. | Related Megatrends: Consumerism; GeopowerInequality
  • 80% of premature heart disease, stroke and diabetes could be prevented.
  • Cancer is the second leading cause of death globally, caucusing nearly 1 in 6 death. The number of new cases is expected to rise by about 70% over the next 2 decades;
  • Global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014 (some 422 million people) and WHO projects that diabetes might be the 7th leading cause of death in 2030.
  • More than 85% of the ‘premature’ deaths due to NCD occur in low and middle-income countries. | Related Megatrend: Inequality; 
  • In many low-income countries, communicable diseases make up the greatest component of the total disease burden, and the management of communicable diseases signifies an important challenge for health systems.
  • The largest increases in NCD deaths will probably occur in Africa due to the rise of the middle class.
    | Related Megatrends: Inequality; DemographyConsumerism
  • Ageing of populations in low- and middle-income countries will result in significant increase of total deaths due to NCDs.
    | Related Megatrends: DemographyInequality

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  • There is increasing attention to preventive medicine, genetic manipulation to eliminate risks (CRISPR), lifestyle changes, etc.
  • The “new patient” concept implies that patients are not only a clinical concern, but also a reflection of changes in healthcare governance — resulting in both: a health-services consumer and a socio-economically responsible person.

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Focus on Europe

There is increasing attention to preventive medicine, genetic manipulation to eliminate risks, lifestyle changes, etc.

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1. EC, The future of road transport – what we will drive, if we still drive at all
2. EEA, Stronger measures needed to tackle harm from air pollution

 

 

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Technological innovation

Synergies among engineering, physical sciences, computation, and life sciences are revolutionising medicine and health -- advancing techniques to regenerate lost limbs and replace malfunctioning organs, tailored treatments for patients’ needs (using genomics and big data), while therapies to correct disease-causing genetic defects are already in clinical trials.

  • The pharmaceutical industry is increasingly driven by the need to move from treatment to prevention, diagnostics and cure, therefore speeding up innovation and implementation of new technological developments.
  • By 2030, the pharmaceutical industry is expected to be radically different, with a shift in focus towards pharmatech, genetics and immunotherapy.
  • Internet of Life - geomonitoring of pathogens and antibacterial resistance reduces the risk of outbreaks and helps identifying drug development and administration needs. | Related Megatrends: InequalitiesTechnology
  • FoundationOne CDx is a FDA approved “companion diagnostic” that allows to determine which drugs or therapies are best suited to individual cases of cancer patients. | Related Megatrends: Technology
  • Big data can help planning better medical treatments. | Related Megatrends: Technology
  • Artificial intelligence could offer the possibility to timely identify people prone to produce harm (to themselves or others), creating opportunities to intervene long before thoughts turn to action. | Related Megatrends: TechnologySecurity
  • Many leading centres of innovation in disease management will be in the developing world.

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Assistive medical technologies; genetic engineering; highly specific drugs; molecular diagnostics and therapy tools with individualised approach at the cellular level are only some of the trends and promises of future health care.

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Policy Note

Sustainable Development Goal 3: "Ensure healthy lives and promote well-being for all at all ages" of the SDGs includes two targets directly related to noncommunicable diseases.

  • Target 3.4 requests that countries: “By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being”;
  • Target 3.5 requests that countries: “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.”

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