The world is getting sicker. According to the latest Global Burden of Disease (GBD) study, a project unprecedented in its scope and funded by the Bill and Melinda Gates Foundation, the continual improvements in human health that we have taken for granted at least since the end of the Second World War have, in global terms, halted.

It is rare to see an inflection point for a major phenomenon in such stark perspective, but the GBD is clear: the figures for 2017 show plateauing death rates, with some disturbing and surprising trends underlying the data. We can’t be surprised, for example, that half of all global deaths arise from four key risk factors, some interrelated – high blood pressure, smoking, high blood glucose and high body mass index (BMI). Still, the scale of the obesity epidemic – most obvious in the advanced western economies but extending towards middle-income and developing states too – is alarming. Indeed, obesity rates have risen in virtually every nation, leading to more than a million deaths for type 2 diabetes, and half a million from diabetes-related kidney failures.

In most tropical and subtropical countries the burden of dengue fever has increased over time, seemingly linked to the wider spread of the mosquito that carries it. That, in turn, could be linked to climate change, a phenomenon that will continue to affect health outcomes in unpredictable ways.

The GBD also suggests that the opioid dependency rate is becoming a serious cause of premature death around the world, with more than 4 million new cases and around 110,000 deaths in 2017. The “war on drugs”, whatever else, is claiming more casualties.

And, though life expectancies have begun to stabilise, there is also evidence that more of the world’s old folks are passing more of their sunset years in poor health. Low back pain, headache disorders and depressive disorders were the three leading causes of disability globally in 2017, and have prevailed as leading causes for nearly three decades.

Terrorism and war have also emerged since the 9/11 attacks on the United States and the series of upheavals in the Middle East as a new major cause of death – a poignant thought as we commemorate the end of the Great War a century ago (where the number of fatalities was far outstripped by the influenza pandemic that followed the peace).

No one knows for sure how many have died in Syria, Iraq, Yemen, Libya and Afghanistan, for example, because none of the international agencies or national governments (where functioning) have managed to collate them. We know, however, that they run into many millions.

So much for the state of the world’s heath; who, though, is going to look after an ageing population demanding more and better healthcare – a situation extremely familiar to the British. Whatever the strains may be on the National Health Service, they have to some extent been ameliorated by migration of skilled nurses, doctors and carers from much poorer nations – which has exacerbated the health challenges in those countries. If the UK is attracting migration from, say, the Philippines and South Africa to help fill vacancies in British GP surgeries, hospitals and care homes, having been trained in those nations, then that is at least a questionable state of affairs.

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More broadly, falling fertility rates in the west are creating a “baby bust”, in contrast to the “baby boom” that marked the 1950s and 1960s. In some countries, such as Japan, Italy and Spain, the lack of babies to become the workforce of the future is provoking a crisis: voters generally dislike immigration, but they are also unwilling to face up to the consequences for health and social care, and economic growth generally, when their demographics become so distorted. In Italy and Russia they are talking about incentives to encourage people to plan for larger families; in Japan they are taking the unthinkable (for them) step of allowing immigration, long a taboo in that ethnically homogenous society; in China the one child policy, recently relaxed, will lead to a dramatic reduction in its vast population in the middle decades of this century.

In such tables of demographics Britain usually occupies a middling place, but has been slipping recently as the fertility rate continues to slip. Such has been the scale of migration in recent decades, and especially in the past 15 years or so, that the UK population is at an all-time high, and will continue to increase for many years to come. However, Brexit will almost certainly reduce inward migration, and start to contribute to a demographic crisis as today’s young people head towards retirement. It will also, in all likelihood, reduce economic growth and the economy’s overall ability to support good public services and pay out a state pension worth as much as it is even now.

The British people may not like immigration much, but there is some evidence that the post-Brexit debate and the Windrush scandal has led to a more enlightened outlook on what has been happening, and why, and what contribution people from other countries can make to British society – not least the health services where generations of Caribbean, Irish, Philippine, east European and African medical staff have done so much for so many of their follow citizens. A growing crisis in social care will concentrate minds still further. Britain’s demographic problems, though less severe than in other nations, will not disappear after Brexit.



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