The Global Burden of Disease study for 2019 published in The Lancet has found that failure in tackling preventable non-communicable diseases has made the world more vulnerable to COVID-19. The study also highlights worrying data about alcohol’s contribution to the global burden of disease.

The Global Burden of Disease (GBD) study is a resource providing understanding of the changing health challenges facing people across the world in the 21st century. The GBD is led by the Institute for Health Metrics and Evaluation (IHME) and published in The Lancet journal. It is the most comprehensive worldwide observational epidemiological study to date. The information from the study informs clinicians, researchers, and policy makers to promote accountability, and improve lives worldwide.

The 2019 GBD study analyzed 286 causes of death, 369 diseases and injuries, and 87 risk factors in 204 countries and territories. The study shows the preparedness – or lack thereof – of countries’ public health systems in terms of tackling underlying health issues which increase the impact of the COVID-19 pandemic. The failure of countries’ public health systems to tackle preventable risk factors has made the world population highly vulnerable to the ongoing pandemic brewing the perfect storm, fueling COVID-19 deaths.

In the UK the areas where life expectancy was lowest – the north-east, north-west, Yorkshire and Humberside – were the areas hardest hit by Covid. I don’t think it’s a coincidence,” said Dr. Richard Horton, Editor of The Lancet as per The Guardian.

Dr. Richard Horton, Editor, The Lancet

Dr. Horton highlighted that the GBD study found that COVID-19 was not a single pandemic, but a synthesis of a coronavirus and an epidemic of non-communicable diseases on a background of poverty and inequality.

It is the interaction of the virus with people living with other diseases – that is the challenge that we face, especially when you factor in the social gradient issue. So I think governments, if they focus only on trying to reduce the prevalence of a virus, this is a strategy that in the long term will fail,” added Dr. Horton, as per The Guardian.

Dr. Richard Horton, Editor, The Lancet

Failure of public health to stem risk factors for preventable NCDs and disability

While global healthy life expectancy – the number of years a person can expect to have good health – has increased between 1990 and 2019, it has not risen as much as overall life expectancy in 198 of the 204 countries assessed. This indicates that people are living more years in poor health.

Disability, rather than early death, has become an increasingly large share of the global disease burden – rising from around a fifth (21%) of total burden in 1990 to more than a third (34%) in 2019.

While low and middle income countries (LMICs) have made significant gains in improving health systems, they are still not equipped to manage the growing NCD burdens in their countries. While deaths from infectious diseases decrease in LMICs deaths due to NCDs have been on the rise.

Improvements to health systems in high income countries have started to stagnate and reverse in some cases such as the United States.

The rising NCD disease burden is driven by the inability of health systems to tackle preventable risk factors. Over the past decade, large and worrying increases over 0.5% globally have been noted in exposure to several highly preventable risks including alcohol use, other drug use, obesity and high blood sugar. These risks contribute heavily to the growing NCD burden in the world.

Alcohol remains one of the leading risk factors contributing to the global burden of disease. As per the GBD Study:

  • Alcohol is the eight leading preventable risk factor of disease.
  • The contribution of alcohol to the global disease burden has been increasing year by year from 2.6% DALYs in 1990 to 3.7% DALYs in 2019.
  • In high income countries alcohol use is the second fasted growing risk factor and in LMICs it is the fourth fastest rising risk factor.
  • Alcohol is the second largest risk factor for disease burden in the age group 10-24 years (GBD does not count FAS and FASD, so alcohol is not mentioned in the group 0-9 years).
  • Alcohol is the largest risk factor for disease burden in the group 25-49 years.

Alcohol rising contribution to the global burden of disease

In 2010, the WHO member states unanimously adopted the World Health Organization Global Alcohol Strategy. Based on that landmark decision, alcohol was then also included in the 2013 Global Action Plan on NCDs, adopted by the World Health Assembly, in which governments committed to a voluntary goal of reducing per capita alcohol use by 10% until 2025.

Unfortunately, implementation of the WHO Global Alcohol Strategy has been and is inadequate, flawed and – as Movendi International explained in a comprehensive analysis submitted to the WHO.

In addition, recent landmark studies clearly show that global goals of alcohol use reduction remain out of reach. In fact, in several parts of the world, alcohol consumption is even increasing.

We are deeply concerned by the new findings of the Global Burden of Disease Study 2019 and what they reveal about the global alcohol burden,” says Kristina Sperkova, International President of Movendi International.

The data shows that alcohol causes massive harm early in people’s lives and that alcohol-related disability extends across the life-course, adversely affecting health, quality of life and people’s capacity to contribute to their families, communities and the economy.

This could be avoided because best buy policy solutions are proven and available but our governments have largely failed to make alcohol policy the priority it should be.

As a consequence, alcohol’s contribution to the global disease burden is growing, not shrinking. The fact that alcohol has remained over a thirty year period the number one risk factor for disease burden among the 24 to 49-year olds is truly shocking.

It shows that the commitments made so far on international level, especially the WHO Global Alcohol Strategy, are ineffective, inadequate and outdated. The current level of political attention, commitment and resource allocation for alcohol prevention and control is far from where it should be. Better tools and international instruments need to be developed.

It is time to make alcohol the public health priority it clearly needs to be. It is time to accelerate action on developing a modern, comprehensive and effective approach to alcohol harm.”

Kristina Sperkova, International President, Movendi International

The study highlights that urgent action is necessary to address the global syndemic of chronic diseases, social inequalities, and COVID-19 to ensure more robust health systems and healthier people, making countries more resilient to future pandemic threats.

The GBD can act as a roadmap to address problems and improve health systems by pointing to where need is greatest, with country-specific data on risk factors and chronic disease burden.

For further reading

Global Burden of Disease Study 2019: Analysis of 87 Risk Factors in 204 Countries and Territories, 1990 – 2019


The Guardian: “Thirty-year failure to tackle preventable disease fuelling global Covid pandemic

The Lancet: “Global Burden of Disease

IHME: “The Lancet: Latest global disease estimates reveal perfect storm of rising chronic diseases and public health failures fuelling COVID-19 pandemic