UK’s health performance: an interview with Prof. Murray, University of Washington

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Chris Murray ARTICLE IMAGE

How have the rates of premature mortality in the UK changed over the last two decades?

Rates of premature mortality in the UK have been falling steadily, but the pace of decline is not as fast as in many other high-income countries, such as Australia. In that sense, the UK lags behind.

It’s important to look behind the rates and also examine how the causes of premature death are changing. Some things remain basically the same. In the UK, ischemic heart disease, stroke, and lung cancer were the top three causes of premature mortality in 1990. In 2010, they were still the top three causes, except lung cancer ranked second and stroke had swapped spots.

But some things are changing – rapidly. Cirrhosis, Alzheimer’s, drug disorders, and liver cancer are the fastest growing causes of premature mortality since 1990. Cirrhosis’ contribution to premature mortality has increased 87% increase since 1990, moving up from 14th leading cause of early death in 1990 to the 9th in 2010; liver cancer increased 122%, rising from the 45th to the 29th cause; Alzheimer’s increased 136% from 24th to 10th. Drug use disorders had an astounding increase of 651%, rising in rank from 64 to 21.

How does this compare to other countries in the world?

It’s a mixed picture. The UK compares well to other European countries in terms of some health measures like avoiding premature death due to diabetes, chronic kidney disease, and road injuries.

However, the UK has not done as well at combatting other ailments, and these are, unfortunately, many of the top causes of early death. The UK still has death rates significantly above the average of many comparable countries for ischemic heart disease, chronic obstructive pulmonary disorder, lower respiratory tract infections, breast cancer, other heart and circulatory disorders, esophageal cancer, congenital abnormalities, preterm birth complications, and aortic aneurysm.

The rate of chronic respiratory diseases is much higher in the UK than most comparable countries such as the United States, Australia, Spain, the Netherlands, and Germany.

What are the main causes of premature mortality in the UK?

The top ten causes of premature mortality in the UK are:-

  • ischemic heart disease
  • lung cancer
  • stroke
  • COPD (chronic obstructive pulmonary disease)
  • lower respiratory infections
  • colorectal cancer
  • breast cancer
  • self-harm
  • cirrhosis
  • Alzheimer’s disease

Why do you think the UK ranking in premature mortality rates for adults aged 20-54 years has worsened substantially?

The rate of premature mortality for adults in the prime of their lives – ages 20 to 54 – hasn’t actually worsened in the UK, but it certainly has not improved as much as in other countries.

The situation has improved since 1990, when the UK ranked among the top high-income countries in terms of mortality for adults 20 to 54. While these rates of early death for Britons went down substantially in 20 years, they declined much more dramatically in a number of other high-income countries, including Netherlands, Sweden, Australia, Spain, Italy, Norway and Luxemburg.

While the UK has made progress against forms of cancer – including a ramp up of early screenings for cervical cancer – that affect young people, increases in alcohol and drug use have proven deadly, and these need to be addressed. In addition, the UK needs a national strategy on leading killers such as heart disease, strokes and lung diseases.

What can the UK learn from other countries to reduce the premature mortality rates for adults in the 20-54 age group?

Unfortunately, there is no easy answer. A combination of several diseases are responsible for mortality in the prime of life, and this combination is not the same across countries.

Causes that jump out as being greatest threats to health in the UK are alcohol and drug use disorders, cirrhosis, breast cancer and pneumonia. These are definitely ailments that deserve additional attention from British health experts.

In the case of alcohol and drug consumption, these are dangerous habits that could be at least partially addressed through policies designed to influence lifestyle choices.

Why do you think there has been an increase in the contribution of Alzheimer’s disease and cirrhosis to the leading causes of death in the UK?

For Alzheimer’s, it’s a combination of the population aging and an increase in diagnosis and deaths being attributed to the disease. In the past several decades, more deaths have been certified as resulting from dementia rather than more immediate causes such as pneumonia.

For cirrhosis, the main problem is rising rates of alcohol consumption, as well as Hepatitis B and C – and note that the risk of Hep C is greatly increased by drug use, another major health risk for British adults.

Why do you think tobacco smoking remains the nation’s leading risk factor for ill-health despite tobacco control initiatives?

The UK has taken some impressive measures to curb smoking, and we see that those measures are working. However, there is a considerable time lag between when someone smokes, and when he or she develops diseases such as lung cancer and COPD. Tobacco control measures take time to translate into health improvements.

With continued vigilance against smoking, as well as increased attention to smaller contributors to lung disorders – such as exposure at work to dust, gases, and environmental radon – we will likely see rates of lung cancer and COPD go down, but it will take time. For now, smoking remains a major contributor to disease burden.

What do you think needs to be done to the UK’s health system to improve the UK’s pace of decline in premature mortality?

British health authorities are already working closely with the GBD collaborative to more closely analyze the UK study findings, and figure out how these can be used to inform health policies and investments. Initial analysis and recommendations were published in The Lancet in early March, and further work is needed to identify what could be done to improve the UK’s relative performance.

My initial thoughts are that UK health authorities should pay greater attention to problems like smoking, and alcohol and drug use since these take a tremendous toll on British health. In addition, there needs to be better screening and treatment for high blood pressure, which represents a greater threat to Britons than most other Europeans, leading to a higher incidence of ischaemic heart disease and stroke. The UK also needs to remain vigilant against cancer; the combined health toll of lung, colorectal, and breast cancers remains significant.

It is also important to remember that health is not all about preventing premature death. Like many countries, the UK is grappling with more chronic disability than ever before. The major causes of disability include back and neck pain, mental disorders like depression and anxiety, drug abuse, and injuries from falls. These disabling conditions are causing an increasing amount of health loss.

What plans are currently in place to tackle premature mortality in the UK?

This is a work in progress. Through a unique collaboration with IHME, UK health officials were able to build on the country’s strong measurement systems and benchmark their health outcomes.

The UK has some of the best health data in the world, but country governments typically lack the information to compare themselves against neighbors and peers. 

This collaboration provides insight into where the UK is succeeding in public health and where it will need to make more progress if it wants to catch up to the health improvements that other countries have experienced.

How do you think the future of the UK’s health performance will develop?

That really depends on what type of health policies and investments the UK government adopts.

The great thing about the GBD is that it pinpoints what a country’s health challenges and opportunities are, and how and why that country is lagging behind or leading others. The GBD findings are designed to make the picture of a country’s health as clear as possible, but then it’s up to policy makers and health experts to determine if and how they respond to that picture.

Our goal is to help British health experts and citizens make well-informed decisions about health policies and investments by arming them with information that is up-to-date, comprehensive, and accurate.

Where can readers find more information?

On IHME’s website you can find a range of resources related to the GBD.  In the GBD section, you’ll find links to country-specific data in our country profiles as well as links to our data visualizations.

Bill Gates has called these visualizations one of the best efforts that’s ever been done in terms of allowing people to compare different countries and health issues over time. I hope readers will explore the visualizations to learn more about health in the UK and beyond.

About Prof. Christopher Murray

Chris Murray BIG IMAGEChristopher J.L. Murray, MD, DPhil, is a Professor of Global Health at the University of Washington and Director of the Institute for Health Metrics and Evaluation (IHME).

A physician and health economist, his work has led to the development of a range of new methods and empirical studies to strengthen the basis for population health measurement, measure the performance of health systems, and assess the cost effectiveness of health technologies.

Dr. Murray was one of the founders of the Global Burden of Disease and developed a new metric to compare death and disability from various diseases and the contribution of risk factors to the overall burden of disease in developing and developed countries. This pioneering effort – updated most recently in December 2012 – has been hailed as a major landmark in public health and an important foundation for policy formulation and priority setting.

Dr. Murray worked at the World Health Organization (WHO) from 1998 to 2003 where he served as the Executive Director of the Evidence and Information for Policy Cluster.

From 2003 until 2007, Dr. Murray was the Director of the Harvard University Initiative for Global Health and the Harvard Center for Population and Development Studies.

Dr. Murray has authored or edited 14 books, many book chapters, and more than 200 journal articles in internationally peer-reviewed publications.

He holds Bachelor of Arts and Science degrees from Harvard University, a DPhil in International Health Economics from Oxford University, and a medical degree from Harvard Medical School.

April Cashin-Garbutt

Written by

April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.

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