Global Burden of Disease Study 2015 provides GPS for global health 2030

The latest estimates and analyses from the Global Burden of Disease Study 2015 (GBD 2015) provide a vital link between the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs) for 2016–30. The GBD 2015 investigators report global and national trends in various health metrics, from 1990 to 2015, and their association with levels of national development measured through a Sociodemographic Index (SDI), and profi le epidemiological and health transitions across the world. GBD 2015 also measures progress on specifi c MDG-related indicators and non-MDG-related indicators that are included in the SDGs. We can celebrate the 10-year rise in global life expectancy from birth, which occurred between 1980 and 2015, especially the upswing since 2005 in subSaharan Africa which was devastated by HIV/AIDS in earlier decades. There is, however, a grim pointer that regions aff ected by confl ict are showing a decline in life expectancy—for example, in Syria male life expectancy dropped by 11·3 years in the past decade. It will be tragic if the life expectancy gains accruing from socioeconomic development and scientifi c advance are undermined by confl icts which feed sectarian violence and fuel social disruption. The rise in disability-adjusted life-years (DALYs) lost due to war and interpersonal violence in some regions demands that political processes place a premium on peace, social stability, prevention of crime, and arms control. Epidemiological transition, noted in earlier GBD studies, had gathered momentum by 2015. Deaths due to infectious and nutritional causes as well as maternal and child deaths have declined, whereas deaths from non-communicable diseases (NCDs) have risen. However, age-standardised mortality rates of NCDs have fallen, indicating that the SDG goal of reducing premature mortality from NCDs is achievable. Globally, trends suggest that NCDs will pose the challenge of longer survival accompanied by an expansion of morbidity that health systems have to deal with. Even as primary prevention has to be vigorously promoted, the demands of secondary prevention for people who live with NCDs will increase. Countries at a higher level of SDI have shown that a relative compression of morbidity is possible, even with increasing life expectancy, signalling that socioeconomic development and investment in health-system strengthening can yield the dividend of increased healthy life expectancy (HALE). Infectious diseases still demand action for improving environmental hygiene and delivery of health services, with dengue rising in prominence and vaccine-preventable rotavirus and pneumococcus still contributing to a substantial number of child deaths. In responding to these challenges the role of health systems is especially important, since both the unfinished MDG agenda and the SDGs call for efficient and equitable health services. Although maternal and child deaths have declined globally, there are still several countries where mortality rates are appallingly high, which highlights the need for improved antenatal and obstetric care. Risk factors of NCDs dominate the top ten list of global risk factors. Control of high systolic blood pressure, hyperglycaemia, and high cholesterol will require a strong health-system commitment to early risk detection, stratification, and reduction, especially through reconfigured primary health care. Tobacco control, reducing ambient and household air pollution, curtailing alcohol-related harm, and Sv n To rfi nn /P an os See Editorial page 1447