2019: The Ten Greatest Threats to Health Worldwide

How should the planet’s ten biggest health threats affect our approach to health reform in the United States?

The world we live in is facing multiple health challenges. The World Health Organization (WHO) recently released a report detailing the top ten major threats to global health.  From outbreaks of vaccine-preventable diseases like measles, growing rates of obesity, to the health impacts of environmental pollution and climate change, these issues are relevant in our approach to health reform and health policy in the United States.

Here are the planet’s ten biggest health threats according to WHO:

1.    Air pollution and climate change

According to WHO, nine out of ten people breathe polluted air every day. In 2019, air pollution is considered by WHO as the greatest environmental risk to health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease.

2. Noncommunicable diseases

Seventy percent of deaths worldwide are due to noncommunicable diseases, such as diabetes, cancer, and heart disease.

According to WHO, the five risk factors driving increases in noncommunicable diseases are tobacco use, alcohol use, physical inactivity, unhealthy diets, and air pollution. 

3. Influenza

The world will face another influenza pandemic – the only thing not known is when it will hit and how severe it will be. Global defenses are only as effective as the weakest link in any country’s health emergency preparedness and response system WHO says. 

4. Fragile and vulnerable settings

Over 22% of the world’s population lives in fragile settings, which are defined as places where access to basic health care is minimal, often due to being in a state of crisis and having poor health services.

Fragile settings exist in almost all regions of the world, and these are where half of the key targets in the sustainable development goals, including on child and maternal health, remain unmet. 

5. Antimicrobial resistance

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy. 

Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment, according to WHO.

6. Ebola and high-threat pathogens

When it comes to responding to a high-threat pathogen such as Ebola, context is “critical,” according to WHO. The way a high-threat pathogen spreads and impacts a rural area might look very different from the way it would look in urban areas or active conflict zones—making it difficult for health systems and governments to prepare an effective emergency response.

WHO’s current watchlist of high-treat pathogens includes Ebola, Zika, SARS, and disease X—a placeholder for any unknown pathogen that could cause an epidemic.

7. Weak primary care

Primary care is supposed to be the most consistent and accessible form of health care a patient has over their lifetime, WHO explains. But when a country lacks adequate primary care facilities, patients lack affordable and comprehensive care for their needs, which can cause everyday health problems to evolve into health emergencies.

8. Vaccine hesitancy

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved. 

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence (including the United States). 

9. Dengue

About 40% of the world is at risk of becoming infected with dengue, a mosquito-borne illness that infects 390 million people each year and kills up to 20% of people with a severe form of the disease, according to WHO.

10. HIV

The progress made against HIV has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment), and providing access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection). 

However, the epidemic continues to rage with nearly a million people every year dying of HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died.

The list provides an overview of the top 10 health threats WHO and the organization’s partners will target under a five-year strategic plan that kicks off this year. According to WHO, the goal is to ensure one billion more people benefit from access to universal health coverage, one billion more people are protected from health emergencies, and one billion more people enjoy better health and well-being.


For Consideration:

  • Does the WHO list of the top Global Health Risks fit with what you consider to be the top health risks facing the United States?
  • Which risks as noted by WHO should be included in the top health risks faced by Americans?  
  • What other issues do you consider to be the Top Health Risks facing the United States?
  • Many of the top risks defined by WHO are “Social and Environmental Determinants of Health.” What is your view on whether these should be considered part of health reform?

Additional Resources:

Visit the World Health Organization’s web page to learn more about the Top Global Health Threats of 2019.

Review this primer on Social Determinants of Health from NEJM Catalyst.

Go deeper on Social Determinants of Health by visiting the Centers for Disease Control and Prevention’s website: Social Determinants of Health: Know What Affects Health

Does Sugar Addiction Impact $1 Trillion in U.S. Healthcare Spending?

This article looks at the explosion of added sugars in our food and drink supply and reports on the health and cost consequences to all.

It is clear that the obesity epidemic is a key issue in the health reform debate as research conclusively shows that it drives significant increases in chronic diseases like coronary heart disease and diabetes.

What is less clear from a science and public policy perspective is the role sugar plays in both obesity and chronic diseases and what, if anything, should be done to regulate or manage its presence in our food and drink supply as part of the health reform debate in the United States.

“Sugar: Consumption at A Crossroads” is a groundbreaking report from the Credit Suisse Research Institute that explores the medical, economic, consumer and public policy implications of global sugar consumption.

Amongst the many data points and in-depth content in the report is this estimate of the economic impact of sugar in the United States:

“30% – 40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.”

The consumption of added sugar (sugar not contained in natural products like fruit or milk) or high-fructose corn syrup (HFCS) has increased dramatically over the last few decades. According to this report:

  • The world daily average consumption of sugar and HFCS per person now averages 17 teaspoons per day, up 46% from 30 years ago. This is the equivalent of 280 calories per day.
  • In comparison, Americans now consume an average of 40 teaspoons per day. As a benchmark, the American Heart Association recommendation for daily sugar intake is six teaspoons for women and nine for men.
  • Added sugars now represent 17% of a normal US diet with 43% of added sugars coming from sweetened beverages.

The report also includes a survey of physicians in the US, Europe and Asia. Key points from the physician view include:

  • 90 percent of the doctors surveyed believe that the sharp growth in type II diabetes and the current obesity epidemic are strongly linked to excess sugar consumption.
  • 82% of the doctors surveyed in the U.S. and Europe believe that sugar calories are handled differently by the body. 
  • On the question “is sugar addictive,” 65% think this is the case.

While medical research has yet to prove conclusively that sugar is the leading cause of obesity, diabetes type II and metabolic syndrome, the balance of recent medical research studies are coalescing around this conclusion. Advances in understanding the negative effects of refined carbohydrates on blood sugar regulation and cholesterol, and the metabolic impacts of fructose, are changing the traditional view that all calories are the same.

From a public policy perspective, governments and regulators have done little to address the impact of sugar consumption. Typical options often discussed, but rarely acted upon, include higher taxation as an attempt to reduce sugar intake while helping to fund healthcare costs related to obesity and diabetes, as well as increased spending on educating and explicit product labeling and warnings.

Worldwide, obesity now kills more people than starvation and malnutrition. The rapid growth of obesity, diabetes and related nutritional issues is arguably America’s top social health concern for which solutions can be devised to slow the growth and improve both health outcomes and costs.

And so, there is an opportunity to bring this social determinant of health into the mainstream of the health reform discussion. It’s a great example of the choices we can make to either continue to spend more money caring for the those medical maladies that come from the over-consumption of added sugars, or investing in a thoughtful response to increasing public awareness to deal with the root causes to slow the trend and improve the health of citizens.


For Consideration:

  • As part of health reform, what role, if any, should government play to address the growing implications in how the rapid rise of sugar impacts health status and eventually health costs?
  • Should sugar be regulated in ways similar to the treatment of other items that impact consumer health such as tobacco products?
  • Do you look at, or monitor, the level of added sugars found in the items you and your family consume? How does personal responsibility come into play when it comes to reducing the impact of sugar becoming a significantly higher portion of the average Americans caloric intake?

Additional Resources:

To go deeper on this topic:

“Sugar: Consumption at A Crossroads” by the Credit Suisse Research Institute

Get the Facts: Sugar-Sweetened Beverages and Consumption from Centers for Disease Control and Prevention (CDC)