The Lancet’s Global Burden of Disease Study (GBD), first published more than 10 years ago, is the most comprehensive worldwide observational epidemiological study to date. It describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels.

Since its inception, every new iteration of the GBD has reflected improvements in data quality and quantity that showed ever-increasing health worldwide. The editors of the journal now observe that GBD 2017 “shatters this comforting trend of gradual improvement” and instead shows plateauing mortality rates on a background of faltering and uneven progress, era-defining epidemics, and significant shortages of health workers.

Instead of the progress updates we have become accustomed to, GBD 2017 comes as an urgent warning signal from a fragile and fragmented world.Lancet editorial

In 2017, global adult mortality rates decreases plateaued, and, in some cases, mortality rates increased. Conflict and terrorism have become two of the fastest growing causes of death globally (increasing by 118% between 2007 and 2017).

Additionally, the world faces epidemics such as opioid dependence, noncommunicable diseases, depression, and dengue fever.

• Opioid dependence has grown to an unprecedented scale, with 4 million new cases in 2017 and 110,000 deaths.

• Non-communicable diseases accounted for 73% of all global deaths in 2017, with over half of all deaths (28·8 million) attributable to just four risk factors: high blood pressure, smoking, high blood glucose, and high body-mass index.

  Obesity prevalence has risen in almost every country in the world—leading to more than a million deaths from type 2 diabetes, half a million deaths from diabetes-related chronic kidney disease, and 180,000 deaths related to non-alcoholic steatohepatitis (an advanced form of non-alcoholic fatty liver disease caused by buildup of fat in the liver).

• In 2017, depressive disorders were the third leading cause of years lived with disability after low back pain and headache disorders.

• Deaths from dengue fever, a disease often associated with struggling development and urbanization, increased substantially in most tropical and subtropical countries, rising from 24,500 deaths globally in 2007 to 40,500 in 2017.

Estimates show that substantial differences in health for men and women that underlie the overall headline figures are still pervasive. Whereas deaths among adult men are stagnant in many parts of the world, and, in some areas, mortality has increased, women are living longer but with more years in poor health.

The greatest sex differences in outcomes—substance use disorders, transport injuries, and self-harm and interpersonal violence—0are socially driven, suggesting that more attention and action are needed.

This edition of the GBD included estimates of health worker density for the first time. These show that the global shortage and unequal distribution of health workers requires urgent attention in order not to undermine attainment of the Sustainable Development Goals (SDGs).

The authors estimate that only half of all countries had the health-care workers required to deliver quality health care (estimated at 30 physicians, 100 nurses or midwives, and five pharmacists per 10,000 people). Although many European countries have highly resourced health workforces, countries across sub-Saharan Africa, southeast Asia, south Asia, and some countries in Oceania were estimated to have the greatest shortfalls.

Crucially, GBD 2017 estimates that no country is on track to meet all of WHO’s health-related SDGs by 2030. Under-five mortality, neonatal mortality, maternal mortality, and malaria indicators had the most countries with at least 95% probability of success. However, for many other targets—including child malnutrition and violence reduction goals—no country in the world has attained the pace of change that is required for these goals to be met.

—Lancet editorial

The Lancet is an independent, international weekly general medical journal founded in 1823 by Thomas Wakley, an English surgeon. He gained fame as a social reformer who campaigned against incompetence, privilege and nepotism. He was also a radical Member of Parliament and a celebrated coroner.