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Global Health and Global Inequity UNC Global Health Seminar September 15, 2004 Nils Daulaire, MD, MPH Global Health Council Life Expectancy for Children Born Last Year 74 years Top 1/5 of the 131 million born in that year. Life Expectancy for Children Born Last Year 74 years 64 years Middle 3/5 of all children born. Life Expectancy for Children Born Last Year 74 years 48 years 64 years Bottom 1/5 Life Expectancy for Children Born Last Year 74 years (+2.7) 64 years (+3.9) 48 years (-1.5) How have things changed over the past decade? Global health inequities: • One of every 7 children born into poverty in a developing country will not survive to age 5 – 20 times the risk faced here. Global health inequities: • One of every 7 children born into poverty in a developing country will not survive to age 5 – 20 times the risk faced here. • In many countries, one of every 12 young women will die from pregnancy or childbirth before reaching the end of her reproductive years – 250 times the risk faced here. Global health inequities: • One of every 7 children born into poverty in a developing country will not survive to age 5 – 20 times the risk faced here. • In many countries, one of every 12 young women will die from pregnancy or childbirth before reaching the end of her reproductive years – 250 times the risk faced here. • In some southern African countries, the likelihood that any given adolescent will die from AIDS is greater than that she will live her life HIV-free. Premature Deaths in Developing Countries Injuries 17% Chronic/ Noncommunicable 30% Source: WHO, 2001 Infectious and Reproductive Causes 53% Principal Contributors to Global Burden of Disease 0 * 40 60 80 Pneumonia/ARI * * 20 HIV Perinatal causes * Diarrhea (Unipolar Depression) (Ischemic heart disease) * Vaccine-Preventable (Cerebrovascular) * Malaria *Nutritional deficiencies Source: WHO, 1999 These 10 conditions comprise 46% of all healthy years of life lost worldwide. Disability-Adjusted Life-Years Lost (millions) 100 Children under 5 bear the greatest burden… Proportion of global burden of selected diseases borne by children 0-4 years (estimated, year 2000) Pneumonia Diarrhea Malaria Measles 54% 85% 79% 89% Percentage of deaths occurring among: Source: Adapted from Murray & Lopez, 1996 Children 0 – 4 years All other age groups Laxmi’s Short Life Kg 15 14 13 12 11 M 10 D ARI 9 D D D D ARI D ARI FEVER ARI ARI 8 ARI 7 D ARI D ARI D 6 5 D D D D D ARI ARI D D ARI 4 3 D ARI ARI X D D ARI ARI KEY ARI – Acute Respiratory Infection D – Diarrhea M – Measles FEVER – Fever Unknown Origin ARI 2 0 3 6 9 12 15 18 21 AGE IN MONTHS 24 27 30 33 36