Back to PHI 350 Home Page


Kelly Forsyth, Amy Brooks, Liz Hodges, Jeff Carrico, Jared Hilton

PHI 350 Presentation

Causes of Death

Today, we would like to discuss how medicine and healthcare have prolonged our life spans. Included, will be a comparison of present day healthcare in the U.S. with healthcare in the past, as well as with healthcare of other nations, both developed and developing.

Over time the U.S. has witnessed a dramatic change in the causes of death. The same trend has been seen with developing nations. This trend is simply a shift from the majority of the causes of death being due to infectious disease to being due to chronic disease. Leading this shift is advances in treatment and technology. Paradoxically, it is due to these technological advances that we have begun to witness a reemergence 6 the incidence of non communicable diseases. Natalie Angier, a journalist of the New York Times stated this point well, "After a brief, charming fantasy that the age of infectious disease was behind us, the entire medieval bestiary of causes of widespread affliction has returned with teeth bared and claws extended."

So we ask ourselves, in terms of causes of death, what does the future behold in lengthening our life spans, and what can we learn from the trends of the past, the present, and of other nations to better and to lengthen our visit here on earth?"

In order to shed some light on these questions, we must first address the issues. The issues include:

-- causes of death: today and the past -- death rate: today and the past -- life expectancy: today and the past -- how healthcare evolves as its environment changes -- changes in infant mortality -- healthcare in the U.S. vs. healthcare in other countries

--the future of our healthcare and the obstacles we'll endure

In the 14th century, the Bubonic plague occurred in Europe. This disease is transmitted by the fleas from rodents. Approximately one-third of the population died from this disease. This epidemic continued until the 1660's when a London fire killed most of the rodent population.

In the 1700's, James Lind was interested in studying the causes of scurvy and developing treatments to prevent the death of many men. Initially, he thought that it was something in the air. After finding little evidence to support this theory, he began to think that it could be something in the diet. He placed men into groups and fed them specific foods. He found that the men that were fed lemons and oranges got better. From this point on, the British navy began including citrus fruits in the diets of men at sea. This saved the lives of many men.

Childbed fever occurred in the 1840's in Europe. Many women and children died of this disease. After comparing two different clinics, doctors noticed that one clinic had a mortality rate that was five times higher than the other. It was discovered that medical students would perform autopsies at a house next door to the clinic with the high number of cases, and then perform pelvic exams. This is when the disease was transmitted to the women. As a result, doctors were required to wash their hands with chlorinated water. The death rate fell from 12% to approximately 1%.

These problems caused many deaths in the past, but are no longer among the leading causes of death. There are many reasons to explain why these conditions are no longer inflicting us today. Prior to the 1900's there was a large problem with contaminated food and water, and inadequate housing and sewage disposal. This type of situation harbored bacteria and inflicted different types of disease on many people. In the 1940's, penicillin had been accidentally discovered and the first patients were being treated. Doctor's were able to cure a lot of health problems that often had claimed the lives of many. The development of antibiotics shifted the causes of death from infectious diseases to chronic conditions. Today, chronic diseases account for two-thirds of all deaths in the United States.

The infant mortality rate in the United States has dramatically decreased from a level of 47 per 1000 live births in 1940 to 7.7 deaths per 1000 liver births in 1996. This reduction is due to advances in prenatal care, care during delivery, and management of complications existing after delivery. Also, many infectious diseases that used to claim the lives of many infants have been eradicated or controlled. The education of women of childbearing age concerning pregnancy and the widening availability of health care in this country have also played a role in this statistic.

The U.S. and other developed nations have low infant mortality rates in comparison with the rest of the world. This tells us that much of the infant mortality in these underdeveloped countries is preventable. The leading causes of death among infants are:
 

This section of the presentation was done in order to compare the United States to the test of the world The first comparison done was that of the leading causes of death in the U.S as compared to other developed nations and as compared to the developing nations of the world. It is important to note that in comparison to the other developed nations of the world the of death are very similar, being cardiac disease, cancer and stroke. However, in comparison to the developing nations of the world, we see that many infectious diseases play a strong role in the leading causes of death with lower respiratory infections leading the list. One trend we see, however, is that in many of the developing regions, chronic diseases are becoming more of a problem than infectious diseases. This strongly mimics the pattern that we have seen in the development of health care in the U.S. Only in India and Sub-Saharan Africa do infectious diseases still dominate. The next comparison made was that of the life expectancy at birth in the U.S. as compared to the rest of the world. The U.S. falls a tittle down the list. The explanation for this is a combination of lifestyle factors as well as genetics. For example, Japan leads the list. Japan has a very homogenous population while the U.S. is seen as having a very heterogeneous population. Therefore, the life expectancy in the U. S. may be seen as an average of the life expectancies of a group of people from very different genetic backgrounds, while in a country such as Japan, the disparity of genetic backgrounds is much smaller. Only one statement was made about the infant mortality rate as compared to the rest of the world because it was covered in an earlier section. About five million babies born in developing countries in 1995 died in the first month of life. Perhaps as developing countries continue to improve their health care systems this incredibly large figure can be significantly reduced.

A worldwide rise in chronic disease as well as an increased risk of antibiotic resistance are two problems facing the health care community in the future. With the increase in the lifespan of the world's population, chronic disease has more time to reach a deathly or disabling stage. Cancer cases are expected to at least double in most countries during the next 25 years. By 2005, lung cancer cases may rise by 33% in women. Heart disease and stroke will become much more common in poorer countries In the near future. And globally, diabetes will more than double by the year 2005.

This predicted rise in chronic disease has made the World Health Organization move into action to prevent an epidemic of suffering. The WHO is initiation a global campaign to encourage healthy lifestyles and attack the main risk factors of chronic disease. The WHO is also taking steps to prevent the spread of antibiotic resistance. The threat of antibiotic resistance poses to kill millions of people and stretch the limited resources of many poor countries if nothing is done to slow its progression or prevent it altogether.

We as well as other healthcare professionals have the duty to educate the public here in the U.S. and other countries about the risks of chronic disease and antibiotic resistance in order to continue bettering and lengthening the world's lifespan.


Chronic Disease

_ Long-term illness

_ Treatment: symptoms and pain

_ Usually not reversible

_ Goal: retard advancement of disease, maintain health, rehabilitate

_ Long-term care
 

Acute Disease

_ Short-term illness

_ Treatment: antibiotics directed at pathogen

_ Usually reversible

_ Goal: total cure

_ Short-term care
 
 
 

Leading Causes of Death - USA 1996 
Heart Disease  733,834 
Cancer   544,278  
Stroke 160,431 
Chronic Obstructive Pulmonary Disease  106,146  
Accidents    93,874  
Pneumonia/Influenza    82,579  
Diabetes  61,559  
HIV/AIDS    32,655  
Suicide    30,862  
Chronic Liver Disease and Cirrhosis   25,135   

Outline
 

-Of over 52 million deaths in 1996, over 17 million were due to infectious or parasitic diseases- more than 15 million to circulatory diseases; 6 million to cancers- and about 3 million to respiratory disease.

-Infectious and parasitic diseases accounted for 43% of the 40 million deaths in developing countries; almost 40% were due to chronic diseases such as circulatory diseases, cancers and respiratory diseases.

-For several major developing regions, more people already die of noncommunicable diseases than communicable diseases.

-In Latin America and the Caribbean there are almost twice as many deaths from noncommunicable diseases as from communicable diseases.

-In China there are 4.5 times as many deaths from noncommunicable diseases than communicable diseases.

-The balance is tipped toward noncommunicable diseases in Middle eastern crescent and the region comprising Asia beyond India and China and the Pacific Islands.

-Only in India and Sub- Saharan Africa do communicable diseases still dominate accounting for 51% of deaths.

About 5 million babies born in developing countries in 1995 died in the first month of life.


TEN LEADING CAUSES OF DEATH 
United States (1994)   Developed Regions (1990)   Developing Regions (1990) 
1 Heart Disease  Heart Disease  Lower Respiratory Infections  
2 Cancer   Cerebrovascular  Heart Disease 
3 Cerebrovascular  Trachea, Bronchus  Cerebrovascular & Lung Cancer 
4 COPD    Lower Respiratory Infections  Diarrheal Diseases 
5 Accidents  COPD Conditions During Perinatal Period  
6  Pneumnia & Flu   Colon & Rectum Cancer  Tuberculosis 
7 Diabetes  Stomach Cancer  COPD
8 AIDS  Traffic Accidents  Measles
9 Suicide  Self-inflicted  Malaria
10 Liver, Cirrhosis  Diabetes  Traffic Accidents 
 
 
 
LIFE EXPECTANCY AT BIRTH (1989) 
COUNTRY  MALE  FEMALE 
Japan  76.2  82.5 
Sweden  74.2  80.1 
Israel  73.9  77.6 
Canada  73.7  80.6 
Spain  73.6  80.3 
Italy  73.3  79.9 
Australia  73.3  79.6 
France  73.1  81.5 
England, Wales  72.9  78.4 
United States  71.8  78.6 
New Zealand  71.4  77.3 
Portugal  71.1  78.2 
Finland  70.9  79.0 
Puerto Rico  69.1  77.2 
Poland  66.7  78.2 
Former USSR  64.2  73.9 

Of over 52 million deaths in 1996, over 17 million were due to infectious or parasitic diseases; more than 15 million to circulatory diseases; 6 million to cancers; and about 3 million to respiratory disease.

Infectious and parasitic diseases accounted for 43% of the 40 million deaths in developing countries; almost 40% were due to chronic diseases such as circulatory diseases, cancers and respiratory diseases.

For several major developing regions, more people already die of noncommunicable diseases than communicable diseases.

In Latin America and the Caribbean there are almost twice as many deaths from noncommunicable diseases as from communicable diseases.

In China there are 4.5 times as many deaths from noncommunicable diseases than communicable diseases.

The balance is tipped toward noncommunicable diseases in the Middle Eastern crescent and the region comprising Asia beyond India and China and the Pacific Islands.

Only in India and Sub-Saharan Africa do communicable diseases still dominate, accounting for 51% of deaths.
 

Leading Causes of Death For Infants

1. congenital anomalies
2. sudden infant death syndrome (SIDS)
3. respiratory distress syndrome
4. disorders relating to short gestation
 

National Center for Health Statistics
"Births and Deaths: United States, 1996"
 

Infant mortality rates

1995 7.6 deaths/1000 live births

1996 7.2 deaths/1000 live births
 

TABLE 4-2
 
 
Infant Mortality Rate, United States, 1940-1994 
Year  Death Rate per 1,000 
1940  47.0 
1950  29.2 
1960  26.0 
1970  20.0 
1980  12.6 
1990  8.5 
1994  8.0 
Sources: National Center for Health Statistics; U.S. Bureau of the Census


PROBLEMS FACING HEALTH CARE IN THE FUTURE

A recent report released by the World Health Organization (W.H.O.) entitled "Conquering Suffering, Enriching Humanity wams us that Health Care will be put to the test in the coming years to treat the world wide increase in Chronic Diseases as well as keeping infectious disease under control.
 

Problems caused by an Aging World Population

1.Steadily aging global population means more opportunities over time for diseases to progress to deadly disabling stage in larger number of people. 50

2.50 years ago, majority of global population died before age 50

3.1996 - average global life expectancy reached 65.

4.In many industrialized countries, average life expectancy approaching 80.

5.Today - 380 million people age 65+

6.By 2020 - 690 million people age 65+

7.With this large increase in aging population, increases will be seen in:
 

8.These problems will only be made worse with increase in poor diet, inadequate physical exercise, and smoking seen in world's population
 
 

The Ten Leading Killer Diseases 
Coronary Heart Disease  7.2 Million Deaths 
Cancer [all sites]  6.3 Million Deaths 
Cerebrovascular Disease  4.6 Million Deaths 
Acute Lower Respiratory Infections  3.9 Million Deaths 
Tuberculosis  3.0 Million Deaths 
Chronic Obstructive Pulmonary Disease  2.9 Million Deaths 
Diarrhea/Dysentery  2.5 Million Deaths 
Malaria  2.1 Million Deaths 
HIV/AIDS  1.5 Million Deaths 
Hepatitis B  1.2 Million Deaths 

--Majority are preventable, but cannot as of yet be cured

--Emphasis must therefore be on:
 


Cancer

1. Cancer case expected to more than double in most contries in next 25 years

2. Lung cancer expected to increase by 33% in women by year 2005

3. 40% increase in prostate cncer expected in ment by year 2005

4. These increases will put strain on current health care resources

 

Circulatory Disease

1. heart attacks, stroke, and others kill over 15 million people per year

2. account for about 1/2 of all deaths in developed countries

3. account for about 1/4 of the deaths in non-developed countries

4. as countries modernize, they adopt lifestyles similar to industrialized countries including

5. as circulatory disease becomes more common n underdeveloped countries:

more lives will be lost until message of prevention through health lifestyle takes hold
 

Diabetes

1. 135 million people suffer currently

2. this number is expected to rise to 300 million by 2005

3. will cause rise indiabetes complications such as:

Mental Disorders

1. Alzheimer's Disease and other forms of dementia are likely to become leading cause of disability in elderly worldwide

2. Currently, there are 29 million sufferers from dementia worldwide

3. by 2020 Africa, Asia, and Latin America alone should have more than 80 million sufferers


Priorities of Action

1. To be better prepared for future medical problems, the

WHO is initiation an intensified and sustained global campaign to

--encourage healthy lifestyles and attack main risk factors of disease:
 

2. Requirements of campaign to include top level international collaboration between:

3. WHO also attempting to combat antibiotic resistance
 

4. WHO in conjunction with International Federation of Pharmaceutical Manufacturers Associations have implemented a plan which includes:

In conclusion, the WHO Director General, Dr. Hiroshi Nakajima, states, "We must recognize that increased longevity without quality of life in an empty prize, health expectancy is more important than life expectancy. Inevitably, each human life reaches its end, ensuring it does so in the most dignified, caring ,and least painful way deserves as much priority as any other."



 

IN SUMMARY, FIVE CRUCIAL FACTS:

1. Over the last century, the causes of death in the United States have shifted from infectious diseases to chronic diseases such as heart disease, cancer and stroke.

2. The life expectancy in the United States has increased over the last century in response to improved health care and healthier lifestyles.

3. The infant mortality rate in the United States has dramatically decreased from a level of 47 per 1000 live births in 1940 to a level of 7.2 in 1996.

4. The causes of death in the United States are very similar to other developed nations because of similar access to health care. However, the causes of death in developing nations tend to mimic those seen in the U.S. in the past.

5. A world wide rise in chronic disease as well as an increased risk of antibiotic resistance are two problems facing the health care community in the future.