On 14-15 November, experts gathered to address the mortality crises associated with violence, natural disasters, famine and the growing burden of non-communicable diseases (NCDs). The main objective of the meeting was to review the state of the art in regard to evidence and understanding of crises that cause significant rises in mortality and to discuss how current knowledge on this issue could inform the preparation of mortality estimates.
Organized by the Population Division of UN DESA, the theme of the meeting was “Mortality Crises: Conflicts, Violence, Famine, Natural Disasters, and the Growing Burden of Non-communicable Diseases”. It brought together scholars from, among others, Columbia University’s Mailman School of Public Health, the Harvard School of Public Health, the London School of Hygiene and Tropical Medicine, the London School of Economics, John Hopkins University, the International Rescue Committee, the United States Centers for Disease Control and Prevention, and the World Health Organization.
Challenges in collecting reliable data from areas in conflict and measuring mortality were addressed by Prof. Greenough of the Harvard School of Public Health. Prof. Roberts of Columbia University focused on mortality caused by the conflict in Iraq. Mr. Brunborg from Statistics Norway presented the work carried out by statisticians working for the International Criminal Tribunal for the Former Yugoslavia to buttress the case of the prosecutors in proving the commission of genocide. Prof. Dyson of the London School of Economics talked about the effects of famines and underscored that they not only had an effect on mortality but were also related to major drops in the number of births.
Mr. Mathers of WHO presented a review of the approaches that WHO follows in integrating estimates of excess mortality associated with different crises into their overall mortality estimates. Mr. Pedersen, Research Director of FAFO, Norway, discussed the strengths and limitations of the methods presented.
The presentations were followed by a brainstorming session focusing on methodological issues whose purpose was to identify best practices and discuss whether the use of a harmonized approach was possible when the types of crises were so varied, their impact differed markedly not only between countries but also within national populations, and the nature and quality of the data available were also so different.
The major outcome of the brainstorming session was that more work was needed to assess the strengths of the approaches presented and reduce their limitations. A harmonized approach was not yet a possibility.
The meeting also focused on trends in mortality from non-communicable diseases and of the major risk factors associated with non-communicable diseases. Mr. Mathers presented the estimates currently available on trends in the major non-communicable diseases and the methodology used to assess attributable risk to the different causes of death.
There were separate presentations on the impact of cigarette smoking on mortality trends and differentials by sex in developed countries; on the effects of body weight on survivorship, and on the impact of alcohol use. Special presentations on increasing body weight and its impact on disease prevalence in China and on the different countries of Latin America and the Caribbean followed.
A major finding was that the prevalence of cigarette smoking explains the relatively slow increase in life expectancy that has prevailed in the United States in relation to other European countries and that increases in cigarette smoking among women in the United States explain the declining differences between male and female life expectancy at age 50.
The prevalence of tobacco use is also the major cause of the differences in mortality trends by sex after age 50 among European countries. In the United States, the recent success in reducing cigarette smoking is expected to improve the survival chances of people over age 50 in the next few decades.
With respect to body weight, the data presented showed that obesity was associated with higher prevalence of non-communicable disease, especially diabetes. The evidence also showed that higher mortality was associated with underweight. The lowest levels of risk of disease and death were found among the overweight, that is, the category of people with a body mass index in the category just above that considered normal.
These findings imply that there is more uncertainty about the effect that the increasing levels of body mass in developing countries may have on future mortality than there is in ascertaining the detrimental effect on survival of the increasing proportions of people in middle income countries who smoke.