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Survive and thrive

Listen to Dr Tanya Marchant describe the theme surviving and thriving throughout the lifecycle and why it is important at every stage.
TANYA MARCHANT: The first life cycle theme, surviving and thriving throughout the life cycle, highlights the moments of greatest risk and the general transition in burden of disease from deaths to disability, from acute infections to chronic non-communicable conditions. Globally, a reduction in mortality has been observed for today’s population, although the largest burden continues to occur in low income settings.
Across the life cycle, we’ve heard that a transition from deaths to disability, from acute infections to chronic non-communicable conditions is occurring. The priority health agenda remains focused on preventing avoidable mortality. But there is sufficient change to ask whether those who survive can live healthily without disability, and contribute more fully to society and the economy as a result. This shift has not occurred equally at each stage of the life cycle. It is notable that at birth, the transition is yet to be fully realised. In the next slide, we look at the life cycle stages individually to highlight key points about surviving and thriving at each stage.
So starting with adolescent health, counting adolescent deaths was not made prominent by the Millennium Development Goals. But we know that mortality rates are low in adolescents relative to other stages. But since adolescents represent 1/6 of the global population, the absolute number of adolescent deaths around the world is high. In addition, since many lifelong habits are formed at this time, there are crucial links between behaviours in adolescents and mortality risks in adulthood. The burden of non-communicable health diseases has been increasing dramatically for this group– that is injuries, mental health disorders, cardiovascular disease, diabetes, and obesity.
And going forward, the major priorities to improve the health of adolescents and young people is to improve nutrition and exercise, to prevent communicable and infectious disease, and to reduce the use of alcohol, tobacco, and psychoactive drugs.
The course has looked at reproductive health as a cross-cutting topic that affects health outcomes across the life cycle. On the course, we’ve heard about the lifesaving potential of making every birth wanted– for newborns, for children, for young people, and for adult women– and that modern methods of contraception are amongst the most cost-effective interventions in the world today. In recent years, there’s been renewed commitment to this end. And the data shows us that access to and use of contraception is increasing around the world. And then there’s even some progress in giving more women access to safe abortions.
Maternal mortality is declining. In the last 15 years, maternal mortality fell by 45% around the world. And today, the largest burden remains in Sub-Saharan Africa. Most maternal deaths occur during labour or within 24 hours of birth. And the women most at risk are adolescents, older women, and the vulnerable– meaning some combination of being unmarried, or poor, or uneducated, and often living in rural areas. The Sustainable Development Goals have defined a new target to reduce the global maternal mortality ratio to fewer than 70 maternal deaths per 100,000 live births by 2030, and importantly, for no individual country to have a maternal mortality ratio of more than 140 deaths per 100,000 live births. We know that such ambitious targets are possible.
We heard the example of Egypt, where increased use of care improved provider a training, introducing new standards of care, upgrading facilities, and running public awareness campaigns all contributed to successes in maternal survival. But Egypt and others like it are increasingly facing the challenge of overmedicalisation.
As maternal survival improves, there’s a need to shift attention to how to reduce the burden of maternal complications, including near misses, some of which lead to long-term disabilities, and impact not only on the woman, but also on household productivity.
Newborn mortality– that’s deaths in the first 28 days of life– continues to be high, and currently represents 45% of all global deaths amongst children under five years of age. Stillbirths are a relatively new focus, and are not well counted. But evidence suggests that they occur in high numbers so that the number of stillbirths and newborn deaths combined totals almost six million deaths each year. As for maternal deaths, the largest number of newborn deaths occur around the time of birth. And 70% of these are preventable without the need for intensive care. The three main causes of neonatal deaths are preterm birth complications, birth complications, and neonatal infections.
And these also result in lost potential for child development due to disability among survivors. In the Every Newborn Action Plan, the target has been set for all nations to reach a stillbirth rate and a neonatal mortality rate of no more than 12 deaths per 1,000 live births by 2030. And finally, looking at child health. Some marked improvements have been made in child survival around the world. Under five mortality reduced from 77 deaths per 1,000 live births in 2000 to 46 per 1,000 in 2014. And we have already seen from the newborn section that 45 percent of these occur in the first month of life.
Half the reduction in child mortality worldwide has been due to better control and treatment of infections, in particular pneumonia, diarrhoea, measles, and malaria. But still, 3.2 million child deaths were estimated to occur in 2014, and work remains to be done to address preventable child deaths. But especially in middle income countries, increasingly there’s a focus on child development, disability, and nutrition. So in summary, we see adolescent health increasingly gaining momentum on the global health agenda, with a strong focus on lifestyle as well as preventing infectious disease. Still births have long been ignored, but are now also receiving attention. But like neonatal mortality, deaths remain high. And relatively little progress has be made in recent years.
But through the Every Newborn Action Plan, attention has sharpened on the problem. And ambitious targets for survival have been agreed. In contrast, improvements in child survival, and also in maternal survival, mean that increasingly we see a shift towards thinking about disability, while also maintaining ambitious targets for improved survival by 2030. Moving forward there’s a need for continued strengthening of data systems to track mortality in countries, including the registration of all births and deaths, and for research that aims to understand the drivers of change.

Over the next few steps Dr Tanya Marchant will pull together the evidence on lifecycle thinking introduced, developed and analysed throughout the course. The first theme we’ll consider is surviving and thriving throughout the lifecycle.

Although there has been a global reduction in mortality for today’s population, the largest burden of mortality continues to occur in low-income settings. We remain focused on preventing avoidable mortality, but we have learned that a transition from deaths to disability is now also happening.

Can those who survive live a healthy life, without disability, and contribute fully to society and the economy as a result?

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