The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3•5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

No abstract

Background: This study aimed to examine the longitudinal contributions of four political and socioeconomic factors to the increase in life expectancy in less developed countries (LDCs) between 1970 and 2004.

BackgroundThe impact of global warming on population health is a growing concern and has been widely discussed. The issue of heat stress disorders and consequent productivity reduction among workers has not yet been widely addressed. Taiwan is an island straddling the Tropic of Cancer in the West Pacific and has both subtropical and tropical climates. As of 2008, the economy of Taiwan accounts for 1.1% of the world gross domestic product at purchasing power parity and is listed as 19th in the world and eighth in Asia, according to International Monetary Fund data.ObjectiveThe aim of this paper is to identify occupations at risk and the potential health impacts of heat on workers in Taiwan.DesignHistorical data relating to meteorology, population, the labour force and economy were obtained from publicly available databases from the Taiwanese government.ResultsHot seasons with an average maximum temperature above 30°C and relative humidity above 74%, lasting for four to six months from May to October, pose health threats to construction, farming and fishery workers. In particular, populations of ageing farmers and physically overloaded construction workers are the two most vulnerable worker categories in which high temperature impacts on health and productivity.ConclusionsCurrently, regulations and preventive actions for heat relief are difficult to enforce for several reasons, including lack of equipment for measuring environmental conditions, lack of awareness of potential hazards and strict time constraints imposed on workers. There is an urgent need to systematically and comprehensively assess the impact of a warming climate on workers’ health and productivity to provide effective prevention strategies for a better working and living environment in Taiwan.

BackgroundGovernance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control.MethodsWe obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time.ResultsGovernance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors.ConclusionsIn the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control.

Objective Overwork‐related cardiovascular and cerebrovascular disease (CVD) has a large impact on workers' rights and labor standards across East Asian countries. This article describes the background and impact of policies regarding overwork‐related CVD in the past decades in Taiwan. Methods We reviewed government policies, guidelines, literature, and news addressing the problems and impact of policy changes to prevent and recognize overwork‐related CVD since the 1990s, and collected data on overwork‐related CVD cases in Taiwan from 2006 to 2017. Results In 2017, overwork‐related CVD accounted for 13% of all cases of occupational diseases, but 79% of all deaths due to occupational diseases. Guidelines for recognizing overwork‐related CVD cases were established in 1991; however, under‐recognition exists in Taiwan due to poor exposure data on working hours and psychological factors and because most medical expenses are covered by the national health insurance system. Amendments on the guidelines, and stricter policies on overwork prevention were enforced following calls from labor unions, nongovernmental organizations, and legislators, but health disparities were introduced when certain industries were exempted from restrictions. Conclusions Long working hours and other work characteristics increase the risk of overwork‐related CVD. By reviewing the changes in policy for preventing overwork and recognizing overwork‐related disease, we identified the need for clearly defined guidance on evaluating overwork‐related CVD, with specific criteria for working hours and other risk factors regarding work characteristics. National policies that lead to better working conditions and prevent overwork‐related diseases must be developed.

The crude PRs of symptoms were lower than those reported by European and American studies but closer to those of previous Chinese studies. The risks of respiratory symptoms in this population were increased by smoking, occupational exposures to dust and gas, and combined residence-related exposures such as living close to a main road, factory or chimney, indoor coal use and the presence of irritating smoke during cooking, among other risk factors.

BackgroundExposure to ambient particulate matter generated from coal-fired power plants induces long-term health consequences. However, epidemiologic studies have not yet focused on attributing these health burdens specifically to energy consumption, impeding targeted intervention policies. We hypothesize that the generating capacity of coal-fired power plants may be associated with lung cancer incidence at the national level.MethodsAge- and sex-adjusted lung cancer incidence from every country with electrical plants using coal as primary energy supply were followed from 2000 to 2016. We applied a Poisson regression longitudinal model, fitted using generalized estimating equations, to estimate the association between lung cancer incidence and per capita coal capacity, adjusting for various behavioral and demographic determinants and lag periods.ResultsThe average coal capacity increased by 1.43 times from 16.01 gigawatts (GW) (2000~2004) to 22.82 GW (2010~2016). With 1 kW (KW) increase of coal capacity per person in a country, the relative risk of lung cancer increases by a factor of 59% (95% CI = 7.0%~ 135%) among males and 85% (95% CI = 22%~ 182%) among females. Based on the model, we estimate a total of 1.37 (range = 1.34 ~ 1.40) million standardized incident cases from lung cancer will be associated with coal-fired power plants in 2025.ConclusionsThese analyses suggest an association between lung cancer incidence and increased reliance on coal for energy generation. Such data may be helpful in addressing a key policy question about the externality costs and estimates of the global disease burden from preventable lung cancer attributable to coal-fired power plants at the national level.Electronic supplementary materialThe online version of this article (10.1186/s12940-019-0448-8) contains supplementary material, which is available to authorized users.