Institute for Health Metrics and Evaluation experts reveal 11 most critical global health issues for 2023

As we enter our first tentative steps into 2023, experts at the Institute for Health Metrics and Evaluation have weighed in on the most critical global health issues to watch out for over the 12 months ahead. The faculty members and research scientists who shared their insights are professor Mohsen Naghavi, assistant professor Hwme Kyu, assistant professor Angela Micah, affiliate professor Michael Brauer, affiliate assistant professor Alize Ferrari, lead research scientist Liane Ong, lead research scientist Sarah Wulf Hanson, postdoctoral scholar Christian Razo, postdoctoral scholar Ewerton Cousin, and researcher Emma Nichols. Here’s what they found and where Australia stands in each category: 1. Long COVID As the world faces a fourth year in the grips of the COVID-19 pandemic, the ongoing health repercussions of those affected by long COVID are becoming more clear. “Long COVID is absolutely a health issue to watch in 2023. The health impact of long COVID often disrupts a person’s ability to engage with school, work, or relationships for months at a time,” Dr Sarah Wulf Hanson said. “People with long COVID need diagnostic and proper rehabilitation support from primary care physicians. “We desperately need more research to find effective treatments as well as preventive measures to reduce the risk of developing long COVID.” According to the Australian Institute of Health and Welfare: “long COVID is a multi-system illness characterised by ongoing persistent symptoms that can last for weeks or months following COVID-19 infection”. While there is limited data on the Australian context available, an AIHW review of the literature on the scale and impact of long COVID found current prevalence estimates of long COVID (defined as >12 weeks) in Australia range from 5 to 10 per cent of COVID-19 cases. Wide variation in estimates has been reported from international data, ranging from 9 to 81 per cent in a global systematic review. Long COVID is a complex illness with the potential for a substantial impact on society, from increased healthcare costs to economic and productivity losses. Symptoms may persist for weeks or months following acute SARS-CoV-2 infection, come and go over time, or manifest as new onset chronic conditions, such as heart disease, diabetes, kidney disease and neurological conditions. 2. Mental health “Mental disorders are a leading cause of disability worldwide, with no evidence of a decrease in this burden since 1990,” Dr Alize Ferrari said. “The impact of the COVID-19 pandemic, war, and violence on mental health remains a priority, specifically understanding how these have impacted the prevalence and burden of mental disorders in 2022 onward and how countries should be adapting their mental health response accordingly. “Currently in the Global Burden of Disease study, we investigate childhood sexual abuse, intimate partner violence, and bullying victimisation as risk factors for mental disorders. “Going forward, we need a better understanding of the other risk factors for mental disorders, how these vary across different populations, and how to offer the best opportunities for prevention at the population level.” According to AIHW: “A mental illness can be defined as ‘a clinically diagnosable disorder that significantly interferes with a person’s cognitive, emotional or social abilities’. The term itself covers a range of illnesses including anxiety disorders, affective disorders, psychotic disorders and substance use disorders.” Mental health is a key component of overall health and wellbeing; however, almost half of Australians have suffered from poor mental health. The National Study of Mental Health and Wellbeing conducted in 2021 found that an estimated 1 in 5 (21 per cent) Australians aged 16–85 experienced a mental disorder in the previous 12 months. More than 2 in 5 (44 per cent) Australians aged 16–85 had experienced a mental disorder during their lifetime. 3. Impact of climate change “Climate change is already affecting the health of millions of people all over the world, and more importantly, climate change will worsen throughout this century,” Dr Michael Brauer said. “People are experiencing both the direct effects of extreme heat that we measure in the GBD and myriad indirect effects. “Flooding can force people from their homes and affect their mental health, droughts and storms can impact food security and water availability, and wildfire smoke episodes can increase air pollution. As we know from the pandemic, preparedness is key, and we are far from prepared for the health impacts of a warmer climate.” Professor Brauer said efforts to reduce emissions to date had been “far too modest” and that with “climate change clearly with us” much more attention needs to be put on minimising the impacts on global health through adaptation or enhancing resilience. “Air pollution is one of the leading global risk factors that we evaluate in the GBD – currently responsible for about 8 per cent of all global mortality – yet it is a problem with known solutions. Increasing the speed at which we address air pollution will save lives today.” Climate change affects environmental determinants of human health through a range of different pathways, from the frequency of extreme weather events to the prevalence of infectious and communicable diseases, to the availability of food and water. This can result in health effects such as thermal stress, injury, vector-borne diseases and other infectious diseases, food insecurity and poor mental health. Climate change affects some population groups more than others, with older people, children, people with chronic conditions and multimorbidity, outdoor workers, people living in rural and remote areas, those living in low-lying, flood- or bushfire-prone areas, and socioeconomically disadvantaged groups at higher risk. According to AIHW, Aboriginal and Torres Strait Islander people suffer greater health impacts from climate change, for example, by “disrupting connection to Country, exacerbating existing risk factors or compounding historical injustices”. 4. Cardiovascular disease “Cardiovascular diseases such as ischemic heart disease and stroke are the leading causes of death globally, accounting for 28 per cent of total deaths in 2021,” Dr Christian Razo said. “Additionally, cardiovascular diseases substantially contribute to health loss and the economic burden on health care systems. Most cardiovascular diseases can be prevented by addressing modifiable cardiovascular risk factors such as high blood pressure, high cholesterol, obesity, dietary risks, smoking, and air pollution.” The AIHW has presented sobering statistics for cardiovascular disease in Australians — 6.2 per cent (1.2 million) Australian adults had one or more conditions related to heart, stroke or vascular disease in 2017-18. There were 38,600 stroke events in 2018 — more than 100 each day. There were also 58,700 acute coronary events (heart attacks or unstable angina) among Australians aged 25 and upwards — about 161 each day. And there were 591,000 hospitalisations with cardiovascular disease at the principal diagnosis in 2018-19, making up 5.2 per cent of all hospitalisations. 5. Lower respiratory infections Lower respiratory infections — especially respiratory syncytial virus and influenza — are health issues to watch in 2023. “We saw a general decline in influenza and RSV infections in 2020 due to COVID-19 mitigation measures such as mask use and social distancing,” Dr Hmwe Kyu said. “With the relaxation of these measures, many young children who haven’t been exposed to RSV in the past couple of years are being infected, resulting in RSV outbreaks. Countries have also experienced a surge in influenza across all ages. “Annual influenza vaccination provides an opportunity to reduce the LRI burden attributable to flu. There is no vaccine yet to prevent RSV, but promising vaccine trials are underway.” Like most of the world, Australia found flu virtually disappeared during 2020 and 2021. Once restrictions were eased, flu cases began to rise, with 1832 people admitted to hospitals between April and October 2022. Of those people, 122 were admitted to intensive care. In 2022, the deaths of 308 people were attributed to flu in 2022. In contrast, more than 10,000 deaths were attributed to COVID in 2022. RSV, however, made a rapid comeback in Australia after plummeting to record lows during the pandemic. After 2441 infections in August 2022, WA chair of the Royal Australian College of General Practitioners Sean Stevens warned the virus was a bigger problem for children than COVID-19 given the surge in cases. 6. Poverty’s role in health Team lead for causes of death, shocks, intermediate causes and estimating the burden of antimicrobial resistance Mohsen Naghavi labelled poverty the “mother of inequality in health”. “The unequal distribution of resources has expanded due to climate change and increasing violence,” Dr Naghavi said. “Low- and middle-income countries experience worse health outcomes than high-income countries: the life expectancy is 34 years lower, the under-5 mortality around 100 times higher, deaths due to interpersonal violence and suicide are 30 times higher, and deaths attributable to AMR are 12 times higher.” While Australia is considered the “lucky country”, Mission Australia data indicates more than 3.24 million Australians are living in poverty, facing significant disadvantages and challenges in their day-to-day lives. 7. Health systems strengthening “Given the immense strain of COVID-19 on primary care and hospital systems the past two-and-a-half years, attention should be paid to building back up the health care system and enabling frontline workers to do their jobs effectively,” Dr Wulf Hanson said. “Public health leaders and policymakers need to reflect on lessons learned from the pandemic to prevent health care system collapse in the next crisis and to ensure that people who need care can access quality health care.” With the relaxing of borders and other restrictions marking 2022, experts have warned 2023 could present a significant strain on Australian health systems already buckling under the pressure of demand. Medical services across Australia — particularly in regional, rural and remote areas — are suffering severe staffing shortages under severe staffing pressures. 8. Diabetes According to AIHW, 1.3 million Australians were living with diabetes in 2020. Between 2020-21, there were 19,100 emergency department presentations of patients with diabetes, and more than 16.5 million prescriptions dispensed for diabetes medicines. Diabetes is a chronic condition marked by high levels of glucose in the blood. The main types of diabetes are type 1, type 2 and gestational. Type 2 diabetes is the most common form, and is largely preventable by maintaining a healthy lifestyle. “Population-based interventions such as taxes and incentives, more informative food labeling, improving the built environment to facilitate exercise, and greater advocacy to inform people of the risk diabetes poses, combined with expanded health education to combat diabetes risk factors, seem the best options,” Dr Ewerton Cousin said. “Policies aimed to help avoid weight gain and improve dietary quality are also paramount. “Another important aspect is improving the response of health systems in terms of access and quality care. These should include universal access to low-cost insulin and oral anti-diabetic medication to decrease avoidable deaths from acute complications. Health systems should also strive to furnish feedback from their administrative data systems to providers to help orient diabetes care.” 9. Road injuries “Road injuries are still an important and preventable injury. For people 15-49 years old, road injuries are the leading cause of death,” Dr Liane Ong said. “Interventions such as helmets, seatbelts, airbags, speed limits, and laws discouraging alcohol-impaired driving do work. But implementation is not the only thing that determines their success — human behavior must adhere to those policies to make them effective.” In Australia, transport injuries resulted in about 68,000 hospitalisations in 2020-21 and 1300 deaths in 2019-20. In WA, deaths on the road during 2022 Western Australia’s hit a six-year high with 175 killed in total — 112 in the regions and 62 in the metropolitan area. 10. Dementia “Anticipated trends in population growth and population aging are expected to lead to large increases in the number of people affected by dementia globally, underscoring the public health importance of dementia,” Dr Emma Nichols said. “To adequately care for those with dementia, appropriate planning for the necessary supports and services required is needed. “Interventions targeting modifiable risk factors, such as low education, smoking, and high blood sugar, have the potential to reduce the overall societal burden and should be prioritised.” Dementia describes a collection of symptoms that are caused by disorders affecting the brain — affecting thinking, behaviour and the ability to perform everyday tasks. It is the second leading cause of death in Australians and the leading cause of death for women. According to Dementia Australia, there were up to 487,500 Australians living with dementia in 2022 — a number tipped to hit 1.1 million by 2058 unless a “medical breakthrough” is made. 11. Population ageing “Adapting health systems to support older populations’ needs should be front of mind in 2023,” Dr Angela Micah said. “Globally, the proportion of the population that is above 65 is expected to increase in the coming years. “While a lot of attention (and rightfully so) has historically focused on diseases that affect children, it will be prudent to begin thinking through and systematically planning for some of these upcoming changes in demography as well, especially in low- and middle-income countries.” An ageing population will present a demographic challenge for Australia in the future with declining fertility rates and more people living for longer, a report will reveal. New data from the Australian Government’s Centre for Population 2022 Population Statement will be released in full on Friday but an excerpt of the report released on Sunday showed the nation’s average age is projected to rise to 42.8 years by 2060-2061 — up from 38.2 years in 2020-2021 — growing the population to almost 40 million people.