Looking Ahead 161

Notes: (1) Poor eating behavior covers underweight and overweight outcomes (2) Top 24 risk factors based on WHO analysis presented in the 2009 “Global Health Risks Report” and data available in WHO database (3) Deaths and percentages of total deaths attributed to individual risk factors are higher than aggregate percentages due to joint effects Sources: WHO Database of Risk Factor Estimates for 2004; “Global Health Risks Report”, WHO, 2009

Global Deaths Attributable to Top 24 Risk Factors(2)

(In Thousands of Deaths and In % of Total Deaths Attributed Risk Factors, Latest Available Data)

“Risk factors” are human habits or attributes that increase the likelihood of developing a disease or suffering a life-threatening injury. These risk factors include smoking, alcohol abuse, inactivity, obesity and poor eating behaviors(1) which have contributed heavily to the increase in non-communicable diseases globally

MAJOR HEALTH RISK FACTORS ARE CORRELATED WITH BAD LIFESTYLE CHOICES and contribute to 44% of deaths every year

EVOLVING LIFESTYLES, CREATING NEW HEALTH RISK FACTORS

25

Deaths from Top 10 Risk Factors: 33% of Total Deaths(3)

High Blood Pressure12.8%7,512

Tobacco Use8.7%5,120

High BloodGlucose

5.8%3,387

PhysicalInactivity

5.5%3,219

Overweight &Obesity4.8%2,285

HighCholesterol

4.5%2,625

Unsafe Sex4.0%2,354

Alcohol Use3.8%2,252

ChildhoodUnderweight

3.8%2,225

Indoor Smokefrom Solid Fuels

3.3%1,965

Deaths from Top 24 Risk Factors: 44% of Total Deaths

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Africa Americas Southeast Asia Europe EasternMediterranean

Western Pacific

200

100

400

1,000

900

800

700

600

500

300

186

441

255

85

625

151

70

904

350

153

558

168

91

459

272

129

525

212

48

49

50

52

59

41

51

70

0102030405060708090100

65Lao PDR48

48Bulgaria

47Bangladesh48

Albania4864

Ukraine64

Belarus

Tunisia57

Georgia55

Russian Federation66

Indonesia67

31

2930

31

32

3240

40

0 10 20 30 40 50 60 70 80 90 100

Denmark 2735

Bosnia and Herzegovina 27

Croatia28

Bulgaria27

France25

Czech Republic

Greece 3434

Chile 38

Austria 47

Male(1) Female

2011

2008

2011

2008

Respiratory DiseasesCardiovascular DiseasesMalignant Neoplasms Tobacco Attributed Deaths of Each Respective Disease

Source- Upper and Lower Charts: WHO Global Health Observatory Data Repository

Global Economic Burden of Top 10 Risk Factors(In Millions of DALYs, Latest Available Data)

HEALTH RISK FACTORS’ ECONOMIC BURDEN VARIES BY INCOME LEVEL, with substance abuse being the highest risk in higher income countries and childhood underweight being the highest risk in lower income countries

Different disease patterns exist between countries across different income levels. For high and middle-income countries, the most important risk factors are those associated with chronic diseases, while in low income countries childhood underweight is the main risk factor. Weight is a growing risk factor in middle and higher income economies too, but in those countries the issue is having too much weight, not too little

Overweight & Obesity

Indoor Smoke from Solid Fuels

The Burden of Top 10 Risk Factors is 72% ofTotal Risk Factor Burden, Latest Available Data

5 8045 5540 95600 5020 653510 7015 3025 8575 90

High Blood Glucose

Sub-optimal breastfeeding

Tobacco Use

High Blood Pressure

Unsafe Water & Sanitation

Alcohol Use

Unsafe Sex

Childhood Underweight1

2

3

4

5

6

7

8

9

10

Hig

her I

ncid

ence

Indoor Smoke

Breastfeeding

Unsafe Sex

Sanitation & Hygiene

Childhood Underweight1

2

3

4

5 Overweight & Obesity

High Blood Glucose

Tobacco Use

High Blood Pressure

Alcohol Use

0 10 20 30 40 50 60 70 80 90

1

2

3

4

5

0 10 20 30 40 50 60 70 80 90

Low Income Lower Middle Income

Overweight & Obesity

High Blood Pressure

Tobacco Use

Unsafe Sex

Alcohol Use

High Blood Glucose

High Blood Pressure

Overweight & Obesity

Alcohol Use

Tobacco Use1

2

3

4

5

0 10 20 30 40 50 60 70 80 90

1

2

3

4

5

0 10 20 30 40 50 60 70 80 90

Upper Middle Income High Income

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Africa Americas Southeast Asia Europe EasternMediterranean

Western Pacific

200

100

400

1,000

900

800

700

600

500

300

186

441

255

85

625

151

70

904

350

153

558

168

91

459

272

129

525

212

48

49

50

52

59

41

51

70

0102030405060708090100

65Lao PDR48

48Bulgaria

47Bangladesh48

Albania4864

Ukraine64

Belarus

Tunisia57

Georgia55

Russian Federation66

Indonesia67

31

2930

31

32

3240

40

0 10 20 30 40 50 60 70 80 90 100

Denmark 2735

Bosnia and Herzegovina 27

Croatia28

Bulgaria27

France25

Czech Republic

Greece 3434

Chile 38

Austria 47

Male(1) Female

2011

2008

2011

2008

Respiratory DiseasesCardiovascular DiseasesMalignant Neoplasms Tobacco Attributed Deaths of Each Respective Disease

Nearly 20% of the world’s population smokes cigarettes, including more than 200 million women and 800 million men. While worldwide smoking prevalence declined between 1980 and 2012 by an estimated 25% for men and 42% for women, the number of daily smokers remains on the rise due to population growth. Rates have persisted at their old levels or increased in many countries where prevalence is highest. Tobacco is the leading cause of preventable death worldwide and plays a part in 12% of deaths among adults over 30

SMOKING PREVALENCE – HIGHER AMONG MEN – IS ON THE DECLINE, but remains a major cause of respiratory disease especially in the Americas, Europe and Western Pacific

Top Ten Countries by Prevalence of Smokers by Gender and over Time(In % of Total Adult Population, 2008 and 2011)

Tobacco Attributed Deaths from Non-Communicable Diseases(In Number of Deaths per One Hundred Thousand People, Latest Available Data)

Note: (1) Excludes Kiribati and Papau New Guinea due to lack of 2008 dataSources- Upper Charts: WHO Global Health Observatory Data Repository; WHO Global Report on the Tobacco Epidemic 2008 and 2011Source- Lower Chart: WHO Global Health Observatory Data Repository

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37%

2015

4.8

Obese

Other

2020

Overweight

5.1

40%

15%

45%

14%

49%

2010

4.4

35%

12%

53%

2005

4.1

33%

11%

56%

6.6

10.9

CAGR (In %, 2005-2020)

AverageCountryBMI for

BothGenders(2009)

High IncomeUpper Middle IncomeLower Middle IncomeLow Income

Top Five Obese Countries(2)

Bottom Five Obese Countries

30 = WHOstandard for

Obesity

-90°+90° 0° +150°

Russia26.0

South Africa26.8

Brazil25.8 Zambia

20.7

Mexico27.4

SouthKorea23.9

India20.9

Kuwait29.2

Qatar28.1

Saudi Arabia27.9

UK27.4 Germany

27.2

UAE28.1

Japan23.5China

22.9

Nepal20.8

Afghanistan20.6

Bangladesh20.4

Ethiopia20.3

Dem. Rep.Congo19.9

+90°

Chile27.0

US28.5

+60°

+30°

0°

-30°

12.612.912.914.5

16.217.117.4

0

5

10

15

20

AustraliaRomaniaSerbiaCzech Republic

14.1

Russian Federation

LithuaniaBelarusRepublic of Moldova

0

2

4

6

8

10

12

14

Unreported Consumption

Reported Consumption

World

6.2

24%

76%

Eastern Mediterannean

0.7

57% 43%

Southeast Asia Region

3.4

47%

53%

Africa

6

30%

70%

WesternPacific

6.8

25%

75%

Americas

8.4

14%

86%

Europe

10.9

17%

83%

AlcoholAttributed

Fractions(1),Cirrhosis of

the Liver andAll Causes(In%, byGender,2012)

Liters of PureAlcohol

Consumedper Capita(In Liters,

2015Projection)

73787778

48515148

706160

7274747372

514

810

25262825

1412

37364242

All Causes-FemaleCirrhosis of the Liver-Female All Causes-MaleCirrhosis of the Liver-Male

Notes: (1) The Body Mass Index (BMI) is an index of weight to height (weight in kilograms divided by the square of the height in meters) that is commonly used to classify underweight, overweight and obesity in adults

(2) Excludes Pacific countries and other small islandsSources – Upper Chart: WHO Statistics DatabaseSources – Lower Chart: WHO Statistics Database; Imperial College Data

Share of Overweight and Obese People among Adults over Time(In Billion and In % of World Adult Population, 2005-2020)

BMI(1) Rates for Select Countries(In Mean Age-Standardized BMI kg/m2, 2008)

More than 1.9 billion adults were overweight in 2014, including more than 600 million obese. The consumption of energy-dense foods and physical inactivity are the main causes of this problem, which affects more than 50% of the population in high income countries, according to the World Health Organization. While obesity is most prevalent in developed economies, the rate of increase of childhood overweight and obesity has been more than 30% higher in lower and middle-income countries than in developed countries

ALMOST HALF OF THE GLOBAL ADULT POPULATION IS OVERWEIGHT, with global obesity on the rise and projected to affect 15% of the world’s adult population by 2020

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12.612.912.914.5

16.217.117.4

0

5

10

15

20

AustraliaRomaniaSerbiaCzech Republic

14.1

Russian Federation

LithuaniaBelarusRepublic of Moldova

0

2

4

6

8

10

12

14

Unreported Consumption

Reported Consumption

World

6.2

24%

76%

Eastern Mediterannean

0.7

57% 43%

Southeast Asia Region

3.4

47%

53%

Africa

6

30%

70%

WesternPacific

6.8

25%

75%

Americas

8.4

14%

86%

Europe

10.9

17%

83%

AlcoholAttributed

Fractions(1),Cirrhosis of

the Liver andAll Causes(In%, byGender,2012)

Liters of PureAlcohol

Consumedper Capita(In Liters,

2015Projection)

73787778

48515148

706160

7274747372

514

810

25262825

1412

37364242

All Causes-FemaleCirrhosis of the Liver-Female All Causes-MaleCirrhosis of the Liver-Male

In 2012, 5.9% of the world’s total deaths (3.3 million) were attributable to alcohol consumption, with more than half of the deaths involving NCDs. High income countries remain the world’s highest consumers, with average per capita consumption of 9.6 liters a year, three times the 3.1 liter average in low income countries. Declining European consumption and rising consumption in the Western Pacific region are expected to keep global rates constant over the next decade

ALCOHOL CONSUMPTION IS HIGHEST IN EUROPE AND THE AMERICAS with alcohol-attributed death due to liver diseases highest in Eastern Europe

Average Total Alcohol Consumed by Region(In liters of alcohol consumed per capita, Latest Available Data)

Top Countries by Alcohol Consumption and National Alcohol Attributed Death Rates(In projected liters of pure alcohol consumed per capita, 2015 Estimates)

Note: (1) The alcohol-attributable fraction (AAF) denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed)

Source- Upper Chart: “Global Status Report on Alcohol and Health 2014”, WHO, 2014Sources- Lower Charts: WHO Global Health Observatory Data Repository; “Global Status Report on Alcohol and Health 2014”, WHO, 2014

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4.0

2.5

3.43.6

3.94.0

4.4

0

1

2

3

4

5

World

1.5

Latin America& the

Caribbean

Sub-SaharanAfrica

Middle East &North Africa

2.0

Europe &Central Asia

NorthAmerica

South AsiaEast Asia &the Pacific

3.8

WHO Recommendation

American HeartAssociationRecommendation

0 5 10 15 20 25 30 35+

Proportion of Cardiovascular Disease Mortality Attributed to Sodium Intake (In Percent of Total Cardiovascular Disease Mortalities, Latest Available Data)

Note: (1) Regional averages calculated as an average of sub-regional sodium intake; not weighted based on populationSource- Upper Chart: “Global, regional and national sodium intakes in 1990 and 2010”, BMJ, 2013Source- Lower Chart: “Global Sodium Consumption and Death from Cardiovascular Causes”, New England Journal of Medicine, 2014

Average Daily Sodium Consumption Rates by Region(1)

(In grams of sodium/day, Latest Available Data)

Sodium intake around the world is far beyond physiological need and is closely linked with high cholesterol rates, elevated blood pressure, and cardiovascular disease. Since 1980, average daily sodium consumption globally has remained 4 grams/day, double the level recommended by WHO. While Central and Southeast Asia have the highest sodium intake, countries in West Africa are disproportionately affected by deaths from cardiovascular diseases attributed to sodium

GLOBAL SODIUM INTAKE IS TWICE THE LEVEL RECOMMENDED BY THE WORLD HEALTH ORGANIZATION posing a higher risk of cardiovascular disease albeit new studies are questioning sodium risks

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