A newborn Nepali may expect to live over 7 decades, says a study published today on 18 December 2014 in The Lancet, a renowned global medical journal.
According to this study, which analyzed data from 188 countries and regions published by a consortium of global health experts, life expectancy in Nepal reached 72 years for women and 69 years for men in 2013. This is an increase of 12 years over the last two decades — a rate, double the global average. Nepal was ranked among the top 10 best performers. Indeed this is good news. However, the good news comes at a cost of tricky challenges awaiting the people’s health.
With life expectancy at par with the global rates, non-communicable diseases have clearly taken the lead. In 1990, the three leading killers in Nepal were diarrheal diseases, pneumonia and tuberculosis. In 2013, the three diseases that took most lives included ischemic heart disease, stroke and chronic obstructive pulmonary disease. The death toll claimed by these diseases more than doubled since 1990.
Similar trends were seen for diabetes. This shows clearly that mortality due to life-style related conditions are rapidly increasing in recent times. On the other hand, Nepal saw marked declines in mortality from a number of infectious diseases that used to take a large toll on the country. For instance, by 2013, mortality from diarrheal diseases decreased 75% and pneumonia caused 61% fewer deaths. In 1990, these diseases killed 51,077 people. Twenty-three years later, they claimed 35,501 fewer lives. The top cause of child mortality was pneumonia in 2013, killing 4,384 children under the age of 5.
The mortality figures do not depict the whole spectrum of health challenges in a society. A large burden of disease is contributed by mental illness, with depressive disorders in the lead. Depression and other mental disorders are largely disabling conditions, which if left untreated, kill slowly. One trivial fatal outcome of several mental disorders is suicide. Remarkably, suicide claimed 6,512 lives in 2013 alone. It is no good news that suicide was number 1 killer of the most productive age group of men and women (15-49 years) in Nepal during the last year. In fact, there were as many suicidal deaths as HIV/AIDS and tuberculosis combined.
Improvements in health, reduced fertility, and demographic shift towards ageing populations are global patterns driving global gains in life expectancy. Nepal has gained considerable progress in preventing child and maternal mortality and the toll claimed by infectious diseases are falling. Improved living conditions, socio-economic development, and targeted health interventions seem to have brought these changes.
These latest developments confirm that Nepal has already entered the stage of health transition wherein non-communicable diseases are the main causes of mortality. While embracing the health similar to middle-income countries, Nepal faces unprecedented challenges of quickly gaining momentum to the preventative aspects of life-style related conditions such as cardiovascular diseases and diabetes. Risk factors that require targeted interventions include sedentary lifestyle, tobacco smoking, alcohol drinking and fat-rich diet. At the same time, injuries – both unintended and intentional ones, are great public health challenges. Improved rehabilitation, geriatric care and mental health care are areas that should be addressed without delay.
While all these recent changes may sound overwhelming and calling for priority-shift, it should not be forgotten that the inequalities in health are very wide across regions and social strata. The best barometer for a nation’s health undoubtedly is an equitable health among its people, but not an equitable ailment. While constitution writing may be drawing all attentions in recent times, it is crucial that Nepal work promptly on health policy required to deal with the emerging challenges.
Leading causes of death in Nepal, with the number of lives lost
|1990 (Deaths)||2013 (Deaths)|
|1. Diarrheal diseases (30,300)||1. Ischemic heart disease (20,347)|
|2. Pneumonia (20,777)||2. Stroke (16,097)|
|3. Tuberculosis (14,278)||3. Chronic obstructive pulmonary disease (8,604)|
|4. Neonatal encephalopathy (12,527)||4. Tuberculosis (8,162)|
|5. Ischemic heart disease (8,180)||5. Pneumonia (8,128)|
|6. Tetanus (8,076)||6. Diarrheal diseases (7,448)|
|7. Preterm birth complications (7,694)||7. Suicide (6,512)|
|8. Stroke (6,102)||8. Diabetes (4,400)|
|9. Measles (5,687)||9. Hypertensive heart disease (4,226)|
|10. Chronic obstructive pulmonary disease (5,634)||10. Neonatal encephalopathy (4,123)|
Dr. Sudan Prasad Neupane ( firstname.lastname@example.org) co-authored The Lancet publication cited in this article. Title of the study was ‘Global, regional, and national age-sex-specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.’