BERLIN – Global life expectancy rose again in 2023 after a decline during the COVID pandemic with overall life expectancy 20 years higher as compared to 1950. 

But North America and Latin America are seeing higher death rates among adolescents and young adults due to a crisis in mental health – reflected in higher rates of suicide, drug abuse and excessive alcohol consumption. In sub-Saharan Africa, infectious diseases and unintentional injuries also struck young people disproportionately. 

These were among the key findings of the 2023 Global Burden of Disease Study, by the Institute for Health Metrics and Evaluation, published Sunday in the Lancet. 

The report was launched on the opening day of the annual World Health Summit. Some 14,000 people are attending the three-day science and policy event, including 4,000 on site. 

Germany donates $1 billion to Global Fund 

At the WHS opening, the German government announced it would be making a mammoth €1 billion donation to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria for the 2027-2029 period. The Global Fund is in the midst of its triennial replenishment campaign, with the aim of raising $18 billion for the upcoming three-year period. It’s replenishment ‘summit’ is scheduled for 21 November in Johannesburg, on the margins of the G-20. 

“It’s not often that you stand on stage and you get a pledge for a billion euros,” quipped Global Fund head Peter Sands, in accepting the gift. “But this announcement is a really important milestone, setting the tone and a benchmark for other donors.

“We all know that 2025 has been a very tough year,” he added. “We’ve had a lot of complicated geopolitics. We’ve had disruption of funding, a whole range of issues confronting us, and those issues aren’t going to be solved quickly, right? 

“The politics is complicated, the funding is difficult. But we should also look at this as a moment of opportunity in terms of making changes we should have been making anyway,” he said, remarking on how a “fragmented” global health sector could seize the moment to create “efficiencies and greater synergies.”

It’s also a moment of opportunity for harnessing medical innovation, he added, citing the Global Fund rollout of twice yearly injections of lenacapavir (LEN), which WHO recommended in July as a pre-exposure prophylaxis (PrEP) option for HIV prevention. 

“With the emergence of lenacapavir  and the fact that we can roll it out at scale this year, we really have the prospect of bringing AIDS to an end as a public health threat. That is an extraordinarily exciting thing.”

Worrying trends among youths and young adults 

The new GBD report shows that Global life expectancy returned to pre-pandemic levels with 76.3 years of life expectancy for females and 71.5 years for males. That is also  more than 20 years higher compared to 1950. 

Despite this progress, stark geographic differences remain, with life expectancy ranging from as high as 83 years in high-income regions to as low as 62 years in sub-Saharan Africa.

Among adolescents and young adults, the largest increase in deaths was registered among those aged 20 to 39 years-old in high-income North America from 2011 to 2023, mainly due to suicide, drug overdose, and excessive alcohol consumption. During the same period, deaths in the 5–19-year age group also increased in high-income North America, the Caribbean, and Eastern Europe, the report found, with trends in the latter region linked to the ongoing conflict in Ukraine.

Across all ages, mental health disorders are rising steeply, with anxiety disorders increasing by 63% and depressive disorders by 26%. In addition, sexual abuse and intimate partner violence were identified as preventable contributors to depression and anxiety.

The GBD 2023 study highlights the need for policymakers to extend their thinking about health priorities beyond reducing child mortality to adolescents and young adults, IHME experts stressed. 

“The share of burden that is from mental disorders, is going up in all of the World Bank income groups, with the most marked increases actually in low and lower middle income countries, but certainly rises everywhere,” said Chris Murray, IHME director, speaking at a launch panel on the GBD study. 

NCDs now account for nearly two-thirds of mortality and morbidity

The report also underlines how non-communicable diseases (NCDs) now account for nearly two-thirds of the world’s total mortality and morbidity, with ischemic heart disease, stroke, and diabetes leading the way. Researchers also estimate that nearly half of all death and disability could be prevented by modifying leading risk factors, such as reducing high levels of blood sugar and obesity, which is increasing almost everywhere in the world. 

Comparatively, premature deaths from NCDs are much higher in low-and middle-income countries than in developed ones, due to the lack of access to diagnosis and treatment. And in some of the poorest countries, premature deaths from NCDs may even be rising as diets change with the introduction of unhealthy processed foods and more sugary drinks, while physical activity levels also decline .  

In parts of Africa, for instance, deaths from cardiovascular disease may range from 57 to around 70 years of age, while in developed countries, as well as in Latin America and China, the average age is in the range of 70-85.  

Air pollution, lead contamination and heat risks 

Climate-sensitive risks, such as air pollution and heat, are also having an ever-more significant impact on NCDs.  Levels of particulate matter, a major risk for cardiovascular diseases, lung disease and cancer, and the world’s second leading health risk factor overall, were highest in South Asia, sub- Saharan Africa, and North Africa and the Middle East, the GBD study found. 

High temperatures are also exacerbating health vulnerabilities in that same regions that air pollution is a major issue. Particularly in the Sahel, extreme heat is compounding the effects of drought, food insecurity, and displacement.

“If you want the sort of high level view, the number of heat related deaths in 1990 were about 250,000 and there are about 550,000 in 2023,” said Murray. 

New evidence about the burden of lead also shows that heavy metal is playing a much larger role in NCD health risks, than previously understood, Murray added.  And even after unleaded gasoline has become the norm, environmental lead exposures through other pathways, like paints and solvents, continue to make a health impact throughout the life cycle.

“With new evidence from published studies, we realized that the burden from lead [exposure] is now much larger than previously assessed. So lead is now the tenth leading risk factor, and you can see the causes are mostly ischemic heart disease,” Murray said.  

‘Take charge of your own health services’ 

IHME experts also warned about the impacts of the recent sharp cuts in international aid for global health initiatives on decades of disease control efforts. 

“Decades of work to close the gap in low-income regions with persistent health inequities are in danger of unraveling due to the recent cuts to international aid,” said Emmanuela Gakidou, senior author and professor at IHME. “These countries rely on global health funding for life-saving primary care, medicine, and vaccines. Without it, the gap is sure to widen.”

At the GBD launch, meanwhile, Zulfiqar Bhutta, founding director of Pakistan’s Agha Khan University, urged countries and health leaders to “take charge of your own health services”.

“Every country in the world, barring a few, which are heavily indebted countries, has capacity, has the capacity to do more,” he asserted. 

“I think for women and children’s health, the first and foremost thing that would make a difference is domestic financing. I come from a region where we spend far, far more on defense and other expenditures that we do on social systems, on education, on empowering women and girls, improving primary care and universal health.”

Image Credits: E. Fletcher/Health Policy Watch, IHME, IHME , E. Fletcher/HP Watch.