Why are epidemiologists branding COVID-19 a ‘global syndemic’?

High blood pressure, high blood sugar, high body mass index (BMI), and elevated cholesterol combined with a rise in deaths from cardiovascular disease indicate the world might be approaching a turning point in life expectancy gains, researchers says.
 
The latest findings from the 30-year Global Burden of Disease Study (GBD) show that while people are living longer globally, they are living more years in poor health.
 
That includes Australia, where life expectancy stands at 82.9 years – a 5.9-year increase since 1990 – compared to healthy life expectancy of 70 years, which only increased by 4.1 years in the same period.
 
The research, published in The Lancet, analysed 286 causes of death, 369 diseases and injuries, and 87 risk factors in 204 countries and territories.
 
It found that disability caused by non-communicable diseases (NCDs) and injuries has become an increasingly large share of the global disease burden, and is attributed to more than half of all health loss in Australia.
 
Ischaemic heart disease emerged at the leading cause of poor health in Australasia in 2019, followed by lower back pain, falls, chronic obstructive pulmonary disease (COPD), and depressive disorders.
 
The top five risk factors for death in Australia were high systolic blood pressure (contributing to an estimated 25,500 deaths), dietary risks (21,600), tobacco use (20,100), high BMI (18,700), and high blood sugar (17,700) – bringing Australia’s long-term decline in cardiovascular disease to a halt.
 
Senior author, Laureate Professor Alan Lopez is the Rowden-White Chair of Global Health and Director of the Global Burden of Disease Group at the University of Melbourne.
 
Given Australia’s ageing population, he told newsGP what raises concern is not the volume of chronic disease per se, but the rate at which it is growing.
 
‘The important indicator is the rate, and the rate of key chronic diseases like heart attacks and strokes has been declining for many decades. But that stopped about five or six years ago,’ Professor Lopez said.
 
‘So while we’ve had long term gains, we’re having short term pain.
 
‘Australian life expectancy has not increased in the past five years.’
 
Overall rates of death among 15–49 year olds in Australia declined by 31%; however, rates of death due to drug use disorders rose by 55.2%, as did those due to endocrine, metabolic, blood, and immune disorders (75.2%).
 
With several risk factors and NCDs associated with increased risk of serious illness and death from COVID-19, the pre-pandemic research also gives insight into how well countries were prepared to tackle the virus.
 
Professor Lopez said while Australia’s public health response has been comparatively successful at controlling the virus’ spread and resulting mortality, he has concerns around risk factors for severe disease.
 
‘What Australia has been doing has been working and setting Australia aside from many European countries, North America and so on,’ he said. ‘What Australia has done less well, has been controlling some of the main chronic disease risk factors, particularly obesity, which has ballooned in Australia in the last two to three decades.
 
‘That [is what] we think is driving a lot of the stagnation in life expectancy.
 
‘We’re now beginning to see the health effects of this one-third of the Australian population being obese, and another one-third being overweight.’
 
The top five global risks associated with the highest number of deaths in 2019 were high systolic blood pressure (10.8 million deaths), tobacco (8.71 million), dietary risks (7.94 million), air pollution (6.67 million), and high fasting plasma glucose (6.50 million).


Laureate Professor Alan Lopez says the increasing rate of chronic disease is concerning.
 
In light of the research, epidemiologists are referring to a ‘global syndemic’ – the aggregation of chronic diseases, social inequalities, and COVID-19.
 
With most of the risk factors preventable and treatable, the researchers are calling for urgent action to ensure more robust health systems, healthier people, and preparedness to deal with future pandemic threats.
 
Recent research commissioned by the US Chamber of Commerce showed increased investment in NCD prevention and treatment would have both social and economic benefits.
 
But any policy changes, Professor Lopez says, need to be guided by investment into public health and behavioural research.
 
‘When you look at the gradient of these behaviours, the prevalence … from the better off right down to the least well off sectors of society in Australia, you see a very strong gradient that these unhealthy behaviours of smoking, of obesity, of alcohol misuse are all generally clearly more concentrated in the lower socio economic groups,’ he said.

‘So this is the challenge, understanding what it is that drives these groups of people to adopt these behaviours and trying to do something to mediate that.

‘That requires a fundamental rethink of the way that health policies are being formulated, that it needs to be much more targeted, needs to be much more understanding of the behavioural drive in people that leads them, encourages them, to adopt these poor lifestyle habits.’
 
RACGP Acting President Associate Professor Ayman Shenouda told newsGP that GPs are best placed to play a leading role in this space.
 
‘When you look at the top five risk factors for death in Australia in 2019 – high blood pressure, dietary risks, tobacco use, high BMI, and high blood sugar – we can see that GPs are central to efforts in preventing and treating chronic disease,’ he said.
 
‘With heart conditions, diabetes and COPD being major factors for the severity of COVID-19, many in our community are at increased risk.
 
‘What this research provides is even greater support for the RACGP’s calls for greater investment into general practice.’
 
Professor Lopez agrees.
 
‘GPs are tremendously important,’ he said. ‘The key way to reach the population is through the GP network … given the volume of contacts with GPs.
 
‘This is the way for GPs to be more informed and more active, and aggressive perhaps in trying to control and encourage people to change behaviours. We’ve seen that in smoking, for example, where at the end of World War II 70% of Australian men smoked – today, less than 15% do.
 
‘So you can change behaviour, but you need agents to do that, and GPs are respected purveyors of knowledge. I think they could be better equipped, and be given greater responsibility in this area.
 
‘While the immediate global public health priority is understandably the rapid control of the COVID-19 pandemic, these findings about the state of the world’s health are a wake-up call.’
 
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