If you’re living with multiple ailments, you’re not alone.
According to an analysis published last month in the British medical journal The Lancet, 2.3 billion people, almost one-third of humanity, suffered from five or more health problems in 2013. More than 80 percent of those people were younger than 65 years old. And between 1990 and 2013, the number of people in developed countries who suffered from 10 or more ailments increased by 52 percent.
These figures, based on some 36,000 sources of health data gathered for an international study called the Global Burden of Disease, are only approximate. But they provide the most complete picture yet of a global population’s need for increasingly complex care. Two or three generations ago, communicable diseases and problems in pregnancy and early childhood were the leading health concerns in all but the wealthiest countries. Now, after decades of economic development, rising aid money for health, and medical advances, these problems predominate only in sub-Saharan Africa, and life expectancy averages 71 years worldwide. But progress carries a price: The longer people live, the more health problems — and simultaneous health problems — they tend to suffer.
The most common ailments worldwide include iron-deficiency anemia, hearing loss, low back pain and diabetes, each affecting more than 400 million people, according to the study. How many health clinics, charities, governments or global public health agencies are prepared to diagnose and treat a deaf person suffering from diabetes, anemia and low back pain, for decades?
“The transition in terms of illness patterns has happened very quickly, but the health system transition has not,” said Dr. Rifat Atun, director of the global health systems cluster at the Harvard T.H. Chan School of Public Health. “We have individuals from a very young age living with an illness, disease or disability for 30, 40, or 50 years — and they will have not just one, but multiple conditions, and multiple consequences of these conditions. And health systems are not really set up to manage this.”
In low- and middle-income countries, aid efforts and government programs still concentrate almost exclusively on communicable diseases and problems of pregnancy and early childhood, though close to 75 percent of deaths in these countries are now caused by noncommunicable diseases and injuries. Even in wealthy countries, most funding goes to those diseases and injuries that kill people rather than much more common conditions that cause long-term illness and disability. And maladies are usually addressed one by one, if at all, rather than as a cluster.
India, where life expectancy at birth is now 66 years old, exemplifies all these trends. Deaths from tuberculosis, pneumonia, diarrheal diseases and preterm birth complications have all fallen sharply — in total, these diseases today kill fewer than 2 million Indians annually, according to Global Burden estimates. Meanwhile, in 2013, approximately 239 million Indians were migraine sufferers, 60 million had diabetes, 37 million had anxiety disorders and 26 million had osteoarthritis. Yet people with these conditions — and often all of them at once — have gotten little aid or attention.
“There’s a crushing reality in our field that we’re funded by big global institutions like USAID to achieve health outcomes in the developing world,” said Karl Hofmann, who leads a global health nonprofit, referring to the United States Agency for International Development. “And there’s a big disconnect between what they want to fund and what really kills and sickens people.”
His nonprofit, PSI, which supports 15,000 health care providers in 65 countries, has expanded its offerings in the last decade to include screenings for hypertension, cervical cancer and gender-based violence along with childhood vaccinations and family planning services. Still, Mr. Hofmann observed, someone entering even the best health clinic or hospital with multiple chronic sources of disability is unlikely to have all of his or her conditions addressed comprehensively — in India or in the United States.
“You have to look at the patient or consumer as a whole person and you have to look at the whole health system with all its component parts: public sector, private sector, public payment, third-party payment, what the patient pays, what the government pays,” he said. “That’s the transcendent challenge in the coming decades — trying to deal with the human reality of the health consumer, or patient, rather than the vertical, disease-specific issues.”
The longer the status quo continues, the greater the cost — both human and financial. “This is a major societal challenge,” said Dr. Atun of Harvard. “It puts pressure on not just the health systems, but also the entire economy.” Given how many people are suffering from simultaneous health problems, and the resultant loss of productivity to society, “the issue is not whether or not, but how rapidly can we transition health systems,” he concluded.
Policy makers, public health professionals and physicians can take inspiration from their remarkable past triumphs. Globally, age-standardized death rates fell 24 percent between 1990 and 2013. If new programs can reduce nonfatal ailments at the same rate over the next two decades, billions of people will benefit for a lifetime.
An earlier version of this article misspelled the name of the head of PSI, a global nonprofit. He is Karl Hofmann, not Hoffman.