As the UK emerges from the COVID-19 pandemic ‘Build Back Better’ has become the mantra. Important, but we need to Build Back Fairer. The levels of social, environmental and economic inequality in society are damaging health and wellbeing
It was the principles of fairness and the need to do things differently that animated the concrete recommendations we set out in our February 10 Years On Review, just before the pandemic hit with such devastating intensity. Inequalities in mortality from COVID-19 and rising health inequalities as a result of social and economic impacts, have made such action even more important
The aim of this report is three-fold:
To examine inequalities in COVID-19 mortality. Focus is on inequalities in mortality among members of BAME groups and among certain occupations, alongside continued attention to the socioeconomic gradient in health – the more deprived the area, the worse COVID-19 mortality tends to be
To show the effects that the pandemic, and the societal response to contain the pandemic, have had on social and economic inequalities, their effects on mental and physical health, and their likely effects on health inequalities in the future
To make recommendations on what needs to be done
We urge that the Government learns the lessons of the pandemic, prioritises greater equity and health, and works urgently to reduce the severity of the health crisis caused by the economic and social impacts of the pandemic and the societal response.
#BuildBackFairer builds on recommendations in the 10 Years On and Marmot 2010 reports, which were to:
Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure a healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention
NCDs now make up 7 of the world’s top 10 causes of death, according to WHO’s 2019 Global Health Estimates, published today. This is an increase from 4 of the 10 leading causes in 2000. The new data cover the period from 2000 to 2019 inclusive .
The estimates reveal trends over the last 2 decades in mortality and morbidity caused by diseases and injuries. They clearly highlight the need for an intensified global focus on preventing and treating cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, as well as tackling injuries, in all regions of the world, as set out in the agenda for the UN Sustainable Development Goals.
“These new estimates are another reminder that we need to rapidly step up prevention, diagnosis and treatment of NCDs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “They highlight the urgency of drastically improving primary health care equitably and holistically. Strong primary health care is clearly the foundation on which everything rests, from combatting NCDs to managing a global pandemic.”
Heart disease remains the number 1 killer; diabetes and dementia enter the top 10
Heart disease has remained the leading cause of death at the global level for the last 20 years. However, it is now killing more people than ever before. The number of deaths from heart disease increased by more than 2 million since 2000, to nearly 9 million in 2019. Heart disease now represents 16% of total deaths from all causes. More than half of the 2 million additional deaths were in the WHO Western Pacific region. Conversely, the European region has seen a relative decline in heart disease, with deaths falling by 15%.
Alzheimer’s disease and other forms of dementia are now among the top 10 causes of death worldwide, ranking 3rd in both the Americas and Europe in 2019. Women are disproportionally affected: globally, 65% of deaths from Alzheimer’s and other forms of dementia are women.
Deaths from diabetes increased by 70% globally between 2000 and 2019, with an 80% rise in deaths among males. In the Eastern Mediterranean, deaths from diabetes have more than doubled and represent the greatest percentage increase of all WHO regions.
People are living longer – but with more disability
The estimates further confirm the growing trend for longevity: in 2019, people were living more than 6 years longer than in 2000, with a global average of more than 73 years in 2019 compared to nearly 67 in 2000. But on average, only 5 of those additional years were lived in good health.
Indeed, disability is on the rise. To a large extent, the diseases and health conditions that are causing the most deaths are those that are responsible for the greatest number of healthy life-years lost. Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease were collectively responsible for nearly 100 million additional healthy life-years lost in 2019 compared to 2000.
Injuries are another major cause of disability and death: there has been a significant rise in road traffic injuries in the African region since 2000, with an almost 50% increase in both death and healthy life-years lost. Similar but slightly smaller increases (at around 40%) were also observed for the Eastern Mediterranean region. Globally, deaths from road traffic injuries are 75% male. In the Americas, drug use has emerged as a significant contributor to both disability and death.
In the Americas, drug use has emerged as a significant contributor to both disability and death. There was a nearly threefold increase in deaths from drug use disorders in the Americas between 2000 and 2019. This region is also the only one for which drug use disorder is a top 10 contributor to healthy life-years lost due to premature deaths and disability, while in all other regions, drug use does not make the top 25.
Global decline in deaths from communicable diseases, but still a major challenge in low- and middle-income countries
In 2019, pneumonia and other lower respiratory infections were the deadliest group of communicable diseases and together ranked as the fourth leading cause of death. However, compared to 2000, lower respiratory infections were claiming fewer lives than in the past, with the global number of deaths decreasing by nearly half a million
This reduction is in line with a general global decline in the percentage of deaths caused by communicable diseases. For example, HIV/AIDS dropped from the 8th leading cause of death in 2000 to the 19th in 2019, reflecting the success of efforts to prevent infection, test for the virus and treat the disease over the last two decades. While it remains the fourth leading cause of death in Africa, the number of deaths has dropped by more than half, falling from over 1 million in 2000 to 435 000 in 2019 in Africa.
TB is also no longer in the global top 10, falling from 7th place in 2000 to thirteenth in 2019, with a 30% reduction in global deaths. Yet, it remains among the top 10 causes of deaths in the African and South-East Asian regions, where it is the 8th and 5th leading cause respectively. Africa saw an increase in tuberculosis mortality after 2000, though this has started to decline in the last few years. The new estimates also emphasize the toll that communicable diseases still take in low-income countries: 6 of the top 10 causes of death in low-income countries are still communicable diseases, including malaria (6th), TB (8th) and HIV/AIDS (9th). Meanwhile, in recent years, WHO reports highlight an overall concerning slow-down or plateauing of progress against infectious diseases like HIV, TB and malaria.
Data sources and methodology
WHO’s Global Health Estimates present comprehensive, comparable and transparent time-series data for population health, including life expectancy, healthy life expectancy, mortality and morbidity, and burden of disease at global, regional and country levels disaggregated by age, sex and cause, from 2000 onwards.
“These estimates are produced using data from the best available sources from countries and the international community,” said Dr Bochen Cao, the technical lead for WHO’s Global Health Estimates. “They are based on robust scientific methods for the processing, synthesis and analysis of data. These updated estimates also benefited from the valuable contributions of WHO’s Member States through active country consultation and dialogue.”
The availability of services to prevent, diagnose and treat disease is key to reducing death and disability, influencing where different conditions are ranked. These new estimates clearly indicate where additional investments in services are most urgently needed.
“Robust health data are critical to address inequalities, prioritize policies and allocate resources to prevent disability and save lives,” adds Dr Samira Asma, Assistant Director-General for the Division of Data, Analytics and Delivery for Impact at WHO. “The WHO Global Health Estimates are a powerful tool to maximize health and economic impact. We call upon governments and stakeholders to urgently invest in data and health information systems to support timely and effective decision-making.”
As of today, COVID-19 has tragically claimed more than 1.5 million lives. People living with pre-existing health conditions (such as heart disease, diabetes and respiratory conditions) are at higher risk of complications and death due to COVID-19.
Health authorities worldwide depend on timely, reliable and actionable data to make informed decisions – this is especially true during a global pandemic. The next update to these estimates will include an assessment of the direct and indirect impact of the COVID-19 pandemic on mortality and morbidity.
“We cannot rest if even a single one of our citizens is a victim of discrimination and prejudice on account of having a disability.” This is the message from President Cyril Ramaphosa on International Day of Persons with Disabilities.
Delivering his message on Thursday, President Ramaphosa warned that there can be no sustainable growth and development in any society if there are members who are excluded from being active citizens on account of disability.
The President said the COVID-19 pandemic has exposed the difficulties people with disabilities face in a number of sectors – from accessing healthcare to using public transportation and seeking employment.
“In line with our commitment to building towards an inclusive, accessible and sustainable post COVID-19 world, we must ensure that persons with disabilities are not left behind.
“The social, economic and political inclusion of persons with disabilities is included in the UN Agenda 2030 and Sustainable Development Goals (SDGs), as well as our own National Development Plan (NDP). Now that we are in the final decade of implementation of both the NDP and Agenda 2030, we must increase the pace of change,” President Ramaphosa said.
Presidential Working Group on Disability
The President said through the work of the Presidential Working Group on Disability, government is making sure disability is mainstreamed in all government plans and programmes, along with the necessary budgets.
“Disability has been included in the work streams of the National Coronavirus Command Council. We are striving to ensure that the legal, social, economic, health care and containment work streams include disability in their work.
“A process is underway to finalise a report on the impact of the Coronavirus pandemic on persons with disabilities, which will guide not only our approach to disability in the economic recovery plan, but also our preparation for future crises of this nature,” he said.
As government works to implement the Economic Reconstruction and Recovery Plan, it is making sure that people with disabilities are prioritised when it comes to job opportunities under the Presidential Employment Stimulus, and that businesses owned and managed by people with disabilities have access to opportunities in the key growth sectors.
End gender-based violence against disabled people
As South Africa marks 16 Days of Activism for No Violence against Women and Children, President Ramaphosa challenged every citizen to work to end gender-based violence (GBV) against persons with disabilities, and ensure that survivors get the necessary support.
“According to numerous studies, women with disabilities are more likely to suffer abuse at the hands of partners. Women and children with cognitive disabilities may be taken advantage of due to their perceived inability to report the crime,” the President said.
Disability Rights Awareness Month 2020
The International Day for Persons with Disabilities is observed annually on 3 December to promote the full and equal participation of persons with disabilities in society and the economy, and to take action for the inclusion of persons with disabilities in all aspects of society and development.
The United Nations has themed this year’s commemoration ‘Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World”.
The International Day for Persons with Disabilities also brings to a close government’s Disability Rights Awareness Month 2020 (DRAM 2020).
The DRAM, which run from 3 November to3 December 2020, aims to raise awareness to the harmful effects stigmatisation, prejudice and stereotypes have on the disability sector. The campaign also aims to celebrate individuals who have overcome prejudice, societal barriers, and hardship to excel in their chosen fields.
“We cannot rest if even a single one of our citizens is a victim of discrimination and prejudice on account of having a disability.” This is the message from President Cyril Ramaphosa on International Day of Persons with Disabilities.
Delivering his message on Thursday, President Ramaphosa warned that there can be no sustainable growth and development in any society if there are members who are excluded from being active citizens on account of disability.
The President said the COVID-19 pandemic has exposed the difficulties people with disabilities face in a number of sectors – from accessing healthcare to using public transportation and seeking employment.
“In line with our commitment to building towards an inclusive, accessible and sustainable post COVID-19 world, we must ensure that persons with disabilities are not left behind.
“The social, economic and political inclusion of persons with disabilities is included in the UN Agenda 2030 and Sustainable Development Goals (SDGs), as well as our own National Development Plan (NDP). Now that we are in the final decade of implementation of both the NDP and Agenda 2030, we must increase the pace of change,” President Ramaphosa said.
Presidential Working Group on Disability
The President said through the work of the Presidential Working Group on Disability, government is making sure disability is mainstreamed in all government plans and programmes, along with the necessary budgets.
“Disability has been included in the work streams of the National Coronavirus Command Council. We are striving to ensure that the legal, social, economic, health care and containment work streams include disability in their work.
“A process is underway to finalise a report on the impact of the Coronavirus pandemic on persons with disabilities, which will guide not only our approach to disability in the economic recovery plan, but also our preparation for future crises of this nature,” he said.
As government works to implement the Economic Reconstruction and Recovery Plan, it is making sure that people with disabilities are prioritised when it comes to job opportunities under the Presidential Employment Stimulus, and that businesses owned and managed by people with disabilities have access to opportunities in the key growth sectors.
End gender-based violence against disabled people
As South Africa marks 16 Days of Activism for No Violence against Women and Children, President Ramaphosa challenged every citizen to work to end gender-based violence (GBV) against persons with disabilities, and ensure that survivors get the necessary support.
“According to numerous studies, women with disabilities are more likely to suffer abuse at the hands of partners. Women and children with cognitive disabilities may be taken advantage of due to their perceived inability to report the crime,” the President said.
Disability Rights Awareness Month 2020
The International Day for Persons with Disabilities is observed annually on 3 December to promote the full and equal participation of persons with disabilities in society and the economy, and to take action for the inclusion of persons with disabilities in all aspects of society and development.
The United Nations has themed this year’s commemoration ‘Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World”.
The International Day for Persons with Disabilities also brings to a close government’s Disability Rights Awareness Month 2020 (DRAM 2020).
The DRAM, which run from 3 November to3 December 2020, aims to raise awareness to the harmful effects stigmatisation, prejudice and stereotypes have on the disability sector. The campaign also aims to celebrate individuals who have overcome prejudice, societal barriers, and hardship to excel in their chosen fields.
The Fix the Patent Laws Coalition (FTPL), a group of over 40 organisations working to reform South Africa’s patent laws, welcomes the progressive proposal by South Africa and India for a waiver of all intellectual property in respect of COVID-19 related diagnostics, therapeutics and vaccines. We have seen how a lack of access to COVID-19 medical tools threatens countries’ ability to respond to the virus, especially developing countries. We believe that this proposal will promote and expedite equitable access to all health technologies in all countries.
We call on all countries to support the proposal to the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council for a temporary waiver of all patents on products needed to test, treat or vaccinate against COVID-19, and to act with urgency. COVID-19 is a global health crisis, and one that affects working-class and poor people disproportionately. The world needs bold steps such as this that prioritise the needs of vulnerable populations above profits and above nationalism.
“While the waiver will not by itself lead to access to COVID-19 health technologies, it is an important step towards equitable access,” says Executive Director at SECTION27 and FTPL member Umunyana Rugege. “In South Africa, we would like to see the draft amendments to the Patents Act published without delay to ensure that the legal environment is readied for the introduction of a range of diagnostics, medicines and vaccines.”
The FTPL coalition has called on the South African government to take the following steps to help fight COVID-19:
Put a temporary moratorium on granting patents on COVID-19 related products as they are proven effective.
Automatic compulsory licensing of COVID-19 related health products with existing or pending patents.
Fix the Patent Laws urgently to ensure use of all legal flexibilities to improve access to health products.
The South African government has shown exemplary leadership on the world stage to ensure that developing and middle-income countries are not left behind while wealthy nations secure deals with pharmaceutical companies, and that monopolies do not stand in the way of widespread African access to COVID-19 vaccines. This is an important opportunity for countries to stand in solidarity and support the call that would ensure all countries stand to benefit from efforts to fight the pandemic.
South Africa’s leadership of the African Union and initiatives like the COVAX facility, and the Access to COVID-19 Tools Accelerator have put solidarity before nationalism, and FTPL is fully behind our government in its quest to protect public health and ensure equitable access to medical products.
FTPL has joined a global community of civil society organisations calling for the urgent adoption of the Waiver. You can read the letter from civil society here.
The NCD Alliance is consulting with people living with a range of NCDs, including care partners on the following:
The experience of living with/managing NCD conditions during the COVID-19 pandemic
Their recommendations to shape stronger health systems and more resilient communities as part of and beyond the COVID-19 response
Their perspectives to inform a Global Charter on the Meaningful Involvement of People Living with NCDs planned for 2021, aiming to promote an NCD response that puts people first
The online consultation survey is available in three languages: English, Spanish or French. The surveywill close on Sunday, 25 October 2020.
#NCDVoices Stronger, Together: We invite you to share the consultation survey with your networks of people living with NCDs!
Read more about the Our Views, Our Voices initiative here. If you have any questions or clarifications, please feel free to contact Manjusha Chatterjee at [email protected]
