A huge new accounting for the health of humans on Earth, collecting and inferring statistics on hundreds of illnesses and injuries in 204 countries, has mostly good news. People are healthier and they stay that way longer. The bad news: It’s not true if these people are poor, are people of color, live in the United States, and there is a pandemic.

Then they’re screwed.

The ongoing work of thousands of international researchers, the Global burden of disease is based at the University of Washington. This is a large part of the work of the Institute for Health Metrics and Evaluation, which you may remember from its hyper pessimistic but very motivating models from the coronavirus pandemic earlier in the year. With the GBD, this modeling experience fills the gaps for countries that do not all collect the same data, but overall the work lies in all kinds of epidemiological numbers and health outcomes from governments and organizations. health care, and tabulates who gets which disease by age and sex. This represents 286 causes of death, 369 illnesses and injuries, and 87 risk factors in 204 countries and territories, with figures dating back to 1990. The last bolus of data, published in the medical journal The Lancet, takes it back to 2019. (The Bill and Melinda Gates Foundation is the main source of funding.)

In a way, the Global Disease Burden report is a blast from the past, a look at the health of a now-extinct planet – the best of Before Times and the worst of Before Times. Chronic diseases undermine the achievements of modern medicine and public health. But 10 months after the start of a pandemic, the GBD report is a map of the vulnerabilities Covid-19 would exploit. It’s also a laser pointer showing the way to a brighter timeline.

Overall, the things that kill the most people aren’t communicable diseases like Covid-19. High blood pressure is the leading cause of death worldwide; the second is smoking related illness. In fact, everything on the top 10 list is the same population-wide problem that needs systemic change to be fixed. It’s the air pollution; nutritional deficiencies that lead to diabetes, obesity and heart disease; and alcohol abuse. Infant and maternal mortality still creeps into the world’s top 10 as well.

Smoking has actually gone down over the past decade, while the “metabolic risks” – obesity, high blood sugar, high blood pressure, high cholesterol – have moved the other way. Together, these four people were responsible for 26.9 million deaths in 2019 and almost 20% of what the GBD report describes as loss of health worldwide. This is a loss of life, but also a loss of healthy years at the end of life, a statistic captured by Mortality-Adjusted Years of Life, or DALYs. This number has increased by 50% since 1990.

Of course, as the authors of the GBD note, these effects vary geographically. The nutritional and tobacco effects are worse in Asia, Europe and Latin America. Their Pacific group suffers the most from malnutrition and air pollution; in sub-Saharan Africa, the worst things are malnutrition and lack of access to clean water and sanitation. “This shows a global chronic disease crisis,” says Ali Mokdad, professor of health sciences at IHME and one of the authors of GBD, “and quite frankly, a failure of our public health system to cope to these rapidly increasing risk factors that are preventable, that make our population sick, kill many of us and cause many health emergencies. “

But the really interesting breakdown is along the economic lines. Low-income countries actually do a better job of reducing DALYs than middle- and high-income countries like the United States. And the burden of disease in the United States is disproportionately on the poor and on those who are not white. “In the United States, when you compare us to the rest of our peers – countries that are very rich, that look like us, we are doing badly,” Mokdad says. “Very poorly.”

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