The latest estimates and analyses from the Global Burden of Disease Study 2015 (GBD 2015)1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar, 2GBD 2015 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1545-1602Summary Full Text Full Text PDF PubMed Scopus (4492) Google Scholar, 3GBD 2015 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1603-1658Summary Full Text Full Text PDF PubMed Scopus (1417) Google Scholar, 4GBD 2015 Risk Factors CollaboratorsGlobal, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1659-1724Summary Full Text Full Text PDF PubMed Scopus (2841) Google Scholar, 5GBD 2015 Child Mortality CollaboratorsGlobal, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1725-1774Summary Full Text Full Text PDF PubMed Scopus (461) Google Scholar, 6GBD 2015 Maternal Mortality CollaboratorsGlobal, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1775-1812Summary Full Text Full Text PDF PubMed Scopus (610) Google Scholar, 7GBD 2015 SDG CollaboratorsMeasuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1813-1850Summary Full Text Full Text PDF PubMed Scopus (330) Google Scholar provide a vital link between the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs) for 2016–30. The GBD 2015 investigators report global and national trends in various health metrics, from 1990 to 2015, and their association with levels of national development measured through a Socio-demographic Index (SDI), and profile epidemiological and health transitions across the world. GBD 2015 also measures progress on specific MDG-related indicators and non-MDG-related indicators that are included in the SDGs.1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar, 2GBD 2015 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1545-1602Summary Full Text Full Text PDF PubMed Scopus (4492) Google Scholar, 3GBD 2015 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1603-1658Summary Full Text Full Text PDF PubMed Scopus (1417) Google Scholar, 4GBD 2015 Risk Factors CollaboratorsGlobal, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1659-1724Summary Full Text Full Text PDF PubMed Scopus (2841) Google Scholar, 5GBD 2015 Child Mortality CollaboratorsGlobal, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1725-1774Summary Full Text Full Text PDF PubMed Scopus (461) Google Scholar, 6GBD 2015 Maternal Mortality CollaboratorsGlobal, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1775-1812Summary Full Text Full Text PDF PubMed Scopus (610) Google Scholar, 7GBD 2015 SDG CollaboratorsMeasuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1813-1850Summary Full Text Full Text PDF PubMed Scopus (330) Google Scholar We can celebrate the 10-year rise in global life expectancy from birth, which occurred between 1980 and 2015, especially the upswing since 2005 in sub-Saharan Africa which was devastated by HIV/AIDS in earlier decades.8Ngom P Clark S Adult mortality in the era of HIV/AIDS: sub-Saharan Africa. Population Division, Department of Economic and Social Affairs, United Nations Secretariat, New York2003Google Scholar There is, however, a grim pointer that regions affected by conflict are showing a decline in life expectancy—for example, in Syria male life expectancy dropped by 11·3 years in the past decade.1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar It will be tragic if the life expectancy gains accruing from socioeconomic development and scientific advance are undermined by conflicts which feed sectarian violence and fuel social disruption. The rise in disability-adjusted life-years (DALYs) lost due to war and interpersonal violence in some regions3GBD 2015 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1603-1658Summary Full Text Full Text PDF PubMed Scopus (1417) Google Scholar demands that political processes place a premium on peace, social stability, prevention of crime, and arms control. Epidemiological transition, noted in earlier GBD studies, had gathered momentum by 2015. Deaths due to infectious and nutritional causes as well as maternal and child deaths have declined, whereas deaths from non-communicable diseases (NCDs) have risen.1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar However, age-standardised mortality rates of NCDs have fallen,1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar indicating that the SDG goal of reducing premature mortality from NCDs is achievable. Globally, trends suggest that NCDs will pose the challenge of longer survival accompanied by an expansion of morbidity that health systems have to deal with. Even as primary prevention has to be vigorously promoted, the demands of secondary prevention for people who live with NCDs will increase. Countries at a higher level of SDI have shown that a relative compression of morbidity is possible, even with increasing life expectancy, signalling that socioeconomic development and investment in health-system strengthening can yield the dividend of increased healthy life expectancy (HALE).3GBD 2015 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1603-1658Summary Full Text Full Text PDF PubMed Scopus (1417) Google Scholar Infectious diseases still demand action for improving environmental hygiene and delivery of health services, with dengue rising in prominence1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar and vaccine-preventable rotavirus and pneumococcus still contributing to a substantial number of child deaths.1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar In responding to these challenges the role of health systems is especially important, since both the unfinished MDG agenda and the SDGs call for efficient and equitable health services. Although maternal and child deaths have declined globally, there are still several countries where mortality rates are appallingly high, which highlights the need for improved antenatal and obstetric care.5GBD 2015 Child Mortality CollaboratorsGlobal, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1725-1774Summary Full Text Full Text PDF PubMed Scopus (461) Google Scholar, 6GBD 2015 Maternal Mortality CollaboratorsGlobal, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1775-1812Summary Full Text Full Text PDF PubMed Scopus (610) Google Scholar Risk factors of NCDs dominate the top ten list of global risk factors.4GBD 2015 Risk Factors CollaboratorsGlobal, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1659-1724Summary Full Text Full Text PDF PubMed Scopus (2841) Google Scholar Control of high systolic blood pressure, hyperglycaemia, and high cholesterol will require a strong health-system commitment to early risk detection, stratification, and reduction, especially through reconfigured primary health care. Tobacco control, reducing ambient and household air pollution, curtailing alcohol-related harm, and countering the growing problem of drug use call for coherent multisectoral responses propelled by unwavering political commitment. The many faces of malnutrition continue to feature prominently in GBD 2015, albeit with considerable geographical diversity. With anaemia affecting 2·36 billion people2GBD 2015 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1545-1602Summary Full Text Full Text PDF PubMed Scopus (4492) Google Scholar in 2015 and child undernutrition still a major contributor to DALY loss in sub-Saharan Africa,3GBD 2015 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1603-1658Summary Full Text Full Text PDF PubMed Scopus (1417) Google Scholar nutrition transition is still patchy. Rising risks attributable to high salt diets, high body-mass index, and diet-related metabolic risk factors suggest diet-related NCDs will become the dominant nutrition challenge on the road to 2030. The relation of various health metrics to SDI (a composite index of income per person, educational attainment, and fertility) reveal a broad global pattern of countries with low SDI still having high burdens of maternal and child mortality and infections, whereas countries higher on the SDI scale have higher absolute burdens of NCDs.1GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Summary Full Text Full Text PDF PubMed Scopus (4084) Google Scholar, 2GBD 2015 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1545-1602Summary Full Text Full Text PDF PubMed Scopus (4492) Google Scholar There is, however, substantial variability within geographical regions and SDI categories. The NCD epidemics are still evolving in low-income and middle-income countries and the social gradients are likely to change as the epidemics mature.9Reddy KS Prabhakaran D Jeemon P et al.Educational status and cardiovascular risk profile in Indians.Proc Natl Acad Sci USA. 2007; 104: 16263-16268Crossref PubMed Scopus (146) Google Scholar The causes of health inequities within countries have not been mapped out, although that profiling is far more relevant to national health policy and system response than the positioning of countries across a global gradient. The recommendation that countries should aim to increase income and educational levels, while reducing fertility through improved access to reproductive health services, is a useful steer to national policy makers. Although necessary, that action is not sufficient. At each level of SDI, stronger performance of the health system must avert or attenuate the anticipated health burdens. GBD 2015 also tracks progress on the 33 health-related indicators of the SDGs.7GBD 2015 SDG CollaboratorsMeasuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1813-1850Summary Full Text Full Text PDF PubMed Scopus (330) Google Scholar Understandably, attention to the MDGs since 2000 has resulted in greater progress on MDG-related indicators than on the additional indicators in the SDGs. While accelerating progress on the MDG indicators, health systems must also now address major NCDs, mental health, substance use disorders, and road traffic injuries, as well as the growing burdens of sense organ disorders and musculoskeletal disorders. This composite agenda must be positioned in the framework of universal health coverage. GBD is not a repetitive exercise of cataloguing current and future disease catastrophes with greater and greater precision. Improved mapping of trends and future projections from GBD, as well as climate change predictions,10Watts N Adger WN Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; 386: 1861-1914Summary Full Text Full Text PDF PubMed Scopus (1018) Google Scholar provide a picture of where our world is headed if we do not resolutely act to design a healthier and more secure future for all of humanity. Never before have we been so forewarned of the dangers that await us if we do not act now. We have the knowledge and tools to avert those dangers. It is a challenge to human intellect and enterprise, as well as the shared values of social solidarity and equity, as to how best we use this knowledge to create our common future. I declare no competing interests. GBD 2015: from big data to meaningful changeThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 ( GBD 2015 ) brings together the most recent epidemiological data according to year, age, and sex from 195 countries and territories. In a continuation of the partnership between The Lancet and the Institute for Health Metrics and Evaluation ( IHME ), this year marks the first of an annual commitment to publish the four capstone GBD papers—on global mortality, years lived with disability, disability-adjusted life-years, and risk factors—in a single issue. Full-Text PDF Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Full-Text PDF Open AccessGlobal, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Full-Text PDF Open AccessGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Full-Text PDF Open AccessGlobal, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Full-Text PDF Open AccessGlobal, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Full-Text PDF Open AccessGlobal, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Full-Text PDF Open AccessMeasuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.
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