World Health Summit – GBD 2023 panel discussion: Emerging risks

IHME announced the release of GBD 2023 study at the World Health Summit on October 12. A panel of global health leaders and IHME experts discussed the latest research from GBD 2023 — progress on life expectancy and child health, the increasing burden of mental health and non-communicable diseases, and the power of data to improve health systems.

Video Source: World Health Summit

Video transcript

This transcript has been lightly edited for clarity

This video explores insights from the Global Burden of Disease (GBD) 2023 on the state of global health today. A panel of experts from the World Health Summit discussed changes in life expectancy, disease patterns, and key risk factors around the world.

Jane Halton (JH): So the results on mental health disorders – and I think it’s probably something that all of us are very familiar with. It is a subject of some comment in the general press as well as in the academic context. And I think all of us are particularly conscious of that in the issues both before and after the pandemic. So anxiety, depressive disorders, and particularly the impact on young people and adolescents, again, I think is something that we’re all very familiar with.

Can you talk to us a little bit about those trends and patterns for adolescents? What do we think is the scale of this issue? What do we think are the drivers? The growing burden question?

Damian Santomauro: I think what we’re seeing at the moment is an unprecedented level of prevalence and burden of mental disorders among adolescents and young people. This has actually gotten to the point now where the peak of the burden of mental disorders is now in the 15–19-year-old age group. Previously we estimated this to be in the middle age but now it’s within youth. This is primarily driven by increases in depressive and anxiety disorders. Globally, what we estimate in GBD was, compared to 2010, anxiety disorders in this age group increased by almost 70% since 2010, and for depressive disorders it was increased by almost 30%, so these are very large increases that we’re estimating here.

Now a large part of this was what we estimated as an impact, or a bump, during the COVID-19 pandemic. So for this work, we compiled data collected during the pandemic with comparative pre-pandemic baseline data, and we use this in our modeling to quantify what the impact of the pandemic would be on the population. And that’s where we see the spike particularly in youth. But at the same time, we’ve also seen in some regions around the world an increase that is evident before the before the pandemic. So particularly Australasia and Western Europe really show this trend, but we see it in other places around the world as well. For depression and anxiety disorders in particular, we’ve got bullying, intimate partner violence, and sexual violence against children. But when we look at the temporal trends for those risk factors, they don’t align with the temporal trends we’re seeing with the mental disorder prevalence and burden. And then when we look at how much burden they explain, it’s not even a quarter of that burden, which makes me think something else is going on here. I then reflect, okay, well, what is it about this population? What is it about youth and their experience today that is different to, say, 15 years ago? And I think everyone in the room knows what the answer to that question is. And I do believe that social media and I believe that cell phones are having a detrimental impact to the mental health of youth. The problem is the data that we have to inform this does not really pass muster for inclusion in GBD as a risk factor. For inclusion of a risk factor in GBD, we really need strong evidence of a causal direction, but all the evidence on social media is associations.

JH: I think I might turn, Emm, to you if I could please. And because the GBD actually does have obesity and sexual violence against children as both major and probably often unrecognized factors, and I think many people in our community would be surprised to hear how much of a risk factor that they are. And it’s not only in high-income countries, it’s in other countries as well. So if we do think this sexual violence against children drives significant mental and physical health challenges, what should leaders do, what should people running health systems and other relevant systems do to act on that challenge?

Emmanuela Gakidou (EG): So being a data person myself, one of the things that I would say we have to do is improve the evidence base. It’s a really difficult field to measure. I have dabbled in many different fields throughout my career, and this one has been the most challenging to measure accurately and do justice to the magnitude of the problem and its consequences. I would say definitely invest in better measurement and quantification of the size of the problem. But we don’t need to wait for that. If we look at women of reproductive age – so one of the views you can look at on GBD Compare is the age group 15 to 49. You look across the globe, sub-Saharan Africa, high-income region, any region you want, intimate partner violence and sexual violence against children are among the top five risk factors for women. So if you want to do something about maternal health, reproductive health, health of women, you can no longer ignore it. We have now quantified it among the top five risk factors. It’s not in one country. It’s not in one region. It’s global. And part of the reason behind it is also its exceedingly high prevalence. So we’re talking about one in five girls, one in seven boys who are now adults were exposed to sexual violence as children.

For intimate partner violence, the estimates are in the magnitude of one in three, one in four adult women. So these are very big, important drivers of health, and I think in global health and ministries of health they have not traditionally considered them as health challenges. Damian also spoke about the lack of availability of provision of mental health services in many parts of the world, and we saw that the burden from violence – exposure to sexual violence, intimate partner violence – also is concentrated in a lot of mental health disorders, but we’re now also seeing it come up in conditions like asthma and conditions like diabetes. So when physicians are treating a woman of reproductive age with a condition, I think it’s important to raise awareness that one of the drivers might be exposure to violence, because the mechanism to improve the health and well-being of those survivors might be different than somebody with that condition who has not been exposed to violence.

JH: So this is my point. There’s so much material in the GBD. Obesity is the leading cause now of DALYs in a number of regions. I struggle with this as a policymaker, and I can’t see any country that’s had really any success here. Do we just give up? We cannot give up. We cannot give up, so what are we going to do? What are the priorities?

EG: We need to recognize it for the disease that it is and all its health consequences and seriously put all of our resources to tackling it. We have exciting developments in the pharmacological treatment, but that’s not sufficient and that’s not going to reverse the epidemic. And I think Zulfi mentioned that we have been neglecting the age group 5 to 14. That’s the part that worries me the most. If you see the increasing trends in overweight and obesity among children, we as adults have failed those children. And it’s definitely reversible before those children become obese, so we have a window of opportunity, particularly for young individuals who are overweight to prevent obesity. But I really think we just need to fundamentally change how we have been approaching obesity because it’s not working – we have irrefutable evidence that it’s not working. So, it’s time for a fundamental change. Maybe it’s cultural, social acceptability, in combination with pharmacological treatments, and an approach that spans everybody because it’s also rising everywhere. The levels may not be the same in every country, but there’s no country where obesity is not either a current or an upcoming problem.

JH: The other big one, of course, is the environment, ambient air pollution. Chris called out the lead information, something which I think took a number of us by surprise. It certainly did me. And extreme heat. I think we are conscious of that, but they’re all contributing factors in the results that we’re seeing. And then other things that we don’t always connect into the environmental issues, like dementia. So there were a number of things I found surprising.

What were the things you found surprising?

Michael Brauer: I think there are three aspects to this that surprise me, even though I’ve been studying this for decades. First is just the sheer magnitude of the impact of these environmental risks on disease burden: seven and a half million deaths in 2023 from air pollution, three and a half million deaths from lead exposure. And these are also risks that I would say we’ve known about for a long time. Lead has been known as a harmful substance since Roman times, if not before. But it’s still underappreciated in the sense that we know how to solve these problems and just have not done the implementation that’s been necessary.

Secondly, I think I continue to be surprised by their impact on NCD progression. I think we tend to think about environmental risks, we tend to get a concerned about them when we see them, when there’s an episode, an extreme heat event, a severe air pollution episode, uncovering of massive lead exposure in a municipal water supply, something like that. But these are really affecting each and every one of us every day of our lives. We think about something like extreme heat. Now we have children that are having multiple episodes every year of their life, and we just don’t know what the impact of that is going to be. We’re in a new era with that.

And then the third surprising aspect, and this really continues to astound me, is the breadth of diseases that are affected by these environmental risks. So air pollution is linked now to I think the eight leading causes of death that we assess in the GBD. You mentioned dementia. I guess when we started that work, I was quite skeptical that we would see a solid relationship, and yet again there it is and it really holds up. So the same thing from the slide that that Chris showed on temperature and the magnitude of diseases that it’s affecting. So everything from infectious diseases, respiratory infections, injuries, self-harm, homicides, to then the chronic diseases, cardiovascular disease, for example. So there are these three sort of aspects. It’s large. It’s affecting multiple diseases, and these are the diseases that are the main killers today.