Hans Rosling at Global Health – beyond 2015



a cracking start for you ladies and gentlemen none other than Professor Hans Rosling from the Karolinska Institute professor thank you very much for allowing me to make an overview of global health can I have my my wish there we are I was thinking about the European Song Festival and I would like to start very vulgar ly with the world disease ranked list and when we measure diseases how bad they are how big enemies they are we don't count death because death is very different if it occurs in a 75 year old person or if it occurs in a 20 year old person we cannot compare deaths or one disease with death of another that's why we have to compare what says their healthy life years lost that's much better and number 15 is iron deficiency can you imagine it's on the list is the cheapest disease to treat in the world it's rust iron tablets and it still made it to the list 14 is tuberculosis diabetes birth asphyxia that is bad assistance or no assistant during birth and the child get brain damage for life or die depression is on place 11 10 is graphic injury it's climbing COPD it's chronic obstructive pulmonary disease its lungs destroyed by cigarette smoking to put it bluntly preterm birth also bad assistance at birth if you would merge together those newborn diseases they would almost be on top but they are separated in different groups back pain huh back pain number 7 a head or tuberculosis because we measure not only death we measure healthy life years and everyone who had had a terrible back pain for three month know that more half of life was lost those month wasn't it and there's so much suffering so much suffer from back pain and from the skeleton and muscles you know so they are up there all this is from the global burden of disease 2010 recently came out coordinated by the Institute of Health metrics and evaluation in Seattle published largely in lon set of minor importance more importantly brilliant website where you can see all this long said disorder cumbersome to read all this that if you doubt what you see on the web you can read answer sorry Richard malaria that's why we expect to find it but what are the five big ones and why do I have different colors well in the global burden of disease the diseases are lumped into three groups with terrible terms non communicable disease all these acute or chronic diseases that has nothing with bugs to do like cancer most of cancer actually just and and and and cardiac disease and so on the disease of older age mainly injury is green and red is those diseases linked to extreme poverty infections maternal during pregnancy newborn and nutrition so what is now number five HIV not surprising terribly still there today in the poor countries in Africa low-income countries in Africa it's only half of those who need medicine that gets it that data is not compiled in a good way so we can see half do not even get one tablet that's why we still have many dying from HIV the transmission rate is slowly coming down diarrhea is there diarrhea the big killer stroke hypertension high blood pressure is a major global health problem today and number two what is number two pneumonia so what do we have left the winner the main enemy we have it's myocardial infarction coronary heart disease in the world today that's the success for global health you understand you don't die of diarrhea and pneumonia you survive to get myocardial infarction that's a step forward I rather die in myocardial infarction tomorrow than having died in diarrhea as a child isn't it so this is Webber and look I got a vision what what all these diseases are about when I looked at this graph what do humans do what do you mean do human breathe huh so they get bugs in their lungs they eat so they get bugs in their gut and then they have to pump around the blood so that it reach the brain so that we can have sex it's really the main functions of humans you know that also can cause us the diseases so we had to do all these things in safe ways and in in in good environment otherwise otherwise we can catch these terrible diseases now if these are the five bigs for all people in the world if you look at one age group and one six one gender it's very different and I wanted to show you young women or teenage girls 15 to 19 here number five they still iron-deficiency now I get even more angry teenage girls should be functionally limited by not having enough iron in their diet or don't be getting iron tablets number four is back pain number three is anxiety these disorders number two is suicide number one is depression it points a very grim situation for young women in this world doesn't it and it shows how dangerous is if you just look at the big global burden we have to look at specific age group this is for the entire world the main cause of death in women 15 to 19 years old is suicide today in the world and those suicide is not long depression it's panic it's anger it's worth because they cannot do what they want with their life they are forced by families and societies to do do other things now which is the big one of these groups if we now aggregate non communicable diseases the injuries or those diseases of poverty which is the biggest one in the world well this is Sweden it's all blue you see it's all these noncom you read is only down there very few infections accidents and injuries are up there and we have all these diseases of older age and the dark blue of those who are increasing the light blue are decreasing so this one appeared is decreasing cardiovascular and circulation less myocardial infarction cancer slowly going down these one are increasing what can be inspected in this country we are going to get depression when we get old we are going to get osteoporosis but if we get dementia we'll forget it it is it's sort of it's sort of very safe to study medicine and work in health service if we take a one-day one disease we increase another one but it's also much better to live to old age and it's really difficult and it's a challenge to take a care of old people in the best of ways and that goes far beyond medicine how you do that this is Congo it's all red it's all red it's still in fresh infections here infections this is new borne diseases this is nutritional diseases malaria down here is going back that is little lighter you know and and this is Vietnam and Vietnam is mainly blue they are getting control of infections injuries is still big but they are now getting cancer psychiatric diseases myocardial infarction problem with osteoporosis neurological diseases so where's the world average is the world average more like Congo like Vietnam or like Sweden red this infection the poor country has a lot of infections and maternal and newborn diseases and nutritional diseases and that decreases over here and then these more chronic or more on communicable diseases they increase as you go here where's the world average the world is here actually it's there this is very interesting isn't it if this is the world average with a little more than half blue today the non communicable diseases takes away more healthy years from the world population than those diseases our poverty do this is really the progress this is the increase of life expectancy but they are also causing lots of suffering it's not people living to 75 or 80 before getting myocardial infarction or stroke they get it at 55 at 65 that's why they lose healthy life years and they get paralysis they get hemiplegia after the stroke it's really suffering because they don't have treatment or the right treatment for blood pressure so if this is if this is in the world Vietnam is then closer to it's between the world average and sweeter Vietnam such a success story it must be in India not to reach this point and let me show you how this happened in 1800 all the countries were down here each bubble is a country the size is population the color show where in the world they are in the regions here here life expectancy from 30 50 70 and 90 and here how much money they have I want to admit one one special character of me I love money I really love money because having trained in public health I know how to use it and I have found out that money is the best determinants of health if you use it well if you don't use it well it can even worse in the health situation but if you use it well so let's see what happened in the world already in 1800 riches was United Kingdom and then the Netherlands and then United States and then Germany and you see riches was also healthy but they only lived 40 years has the world become a better place here we go as years passed by the riches got richer and they got slightly healthier and here here a pasture and came and the industrially produced soap and primary school and they went gradually up and there we are but the countries and the colonial domination was still there and here I was born it was a strange world most of the people were still down here with 40 China had 40 years life expectancy India 36 years life expectancy no no and up here up here was the Netherlands this was Sweden here and the United States was just becoming the richest in the world and then during my lifetime this happened it's quite fantastic isn't it but still Congo is down there and now Norway is much richer than Sweden it's difficult to bear but but we have we have to face it huh but we are on poor in health now let me show you one thing with this if I compare these ones I'll do it like this here you have the same graph I have Congo down in the corner here remember mainly infectious diseases maternal and newborn diseases and nutritional Vietnam is up there and they are already into non communicable disease it means the low life expectancy here is caused by high child mortality due to those infections malnutrition and lack of service at pregnancy and newborn in the poor countries already here the countries are into the same diseases as in Sweden you could say that in Vietnam they live more like the poor but they die like the rich and then Sweden lucky Sweden 200 years of peace we are up there and the other countries are in between so as you move from down there from infections malnutrition and lack of delivery service and new on service and you move up here you know you get more and more chronic diseases and up there is osteoporosis and dementia are waiting for us now what does this mean for what countries have to do it's quite interesting that when you compare when you compare Vietnam and Sweden where do we have Sweden here and I go back into history you can see that Vietnam has been very successful in health they got healthy much at a much lower economic level than Sweden achieved the same else they're almost world champion in health in light-weight group that not so much money they can still produce a lot of health there are countries with almost the same economic situation like the Sudan here like Pakistan here like like Djibouti down here which has the same amount of money but they haven't had the same access to school health service education promotion of Health vaccinations as the other other countries and also water and sanitation I've been dealt with well in Vietnam so what does this mean mean for the future well remember all blue they are non communicable mainly infections and those diseases related to pregnancies and Vietnam in the middle now this is Vietnamese we'd initial ated mind you this year Vietnam had the same economic level as we then had 1900 they are 110 years of the Sweden in economy 110 years whereas the health situation in Vietnam is like Sweden 1972 it's a 70 years difference in the health status compared to the economy that means they run into those diseases of cancer psychiatric diseases strokes at a very low income level in how much does the Health Service in Sweden cost it's 10% of our gross national product and we have about Sweden today have about more than $30,000 so that means that the health service in Sweden is like the entire economy in Vietnam if you Vietnamese would say we like the Swedish health services sort of good we'll provide that for our people in equity they have no money left no food no clothes no house no nothing just health service and this mind you this is purchasing power dollar it's not exchange rate dollar some honest thing I was in Vietnam it was very cheap there no no that has been taken care of this is purchasing power its enormous ly what the human success we are I would say we in health are more successful than those in economy we should be proud of what we have achieved we shouldn't think it's miserable today we are still have challenge enough to continue and there are two billion still in poverty which have all these red areas of infections on but we have achieved a lot but it's an enormous challenge to deal with those non communicable diseases because there's not money for medical service so the most important is prevention stop smoking smoking is catching up like this in these countries now and it's causing increasing suffering every year and if you have reached such a good health as Vietnam had due to good public health in the past you are obliged to continue with public health measure as your main action against the non communicable diseases there's no way you can start the advanced medical service as we have in Sweden I have here in my pocket an extra hip if I should have get problem during the lecture I have a hip here fifteen thousand Swedes get a hip replacement every year fifteen thousand during their lifetime 15% of the Swedes get a hip replacement quite an advanced surgery very good results is this a human right no no no no this can only be human right at Sunday morning at Monday morning is all about budget cost eighty thousand crowns eighty thousand crowns twelve thousand dollars and and and and and this is very very important to realize that the sort of advanced services we have now now is only affordable if you have money Vietnam cannot provide this and there's a lot of people needing this all over the world they have to be very smart and very clever in how they do at this situation so perhaps the most important for the countries that have got out of poverty and that part of global health happened in India so I said the global health action of the month was the Supreme Court of India the first of April 2030 how can how can a court be important for health well they ruled between these two persons these are two interesting persons Daniel vasila has been the leader of Novartis one of the major European drug companies and this is Hamid Yousef leader of the major drug company in India and they have been fighting about a good drug developed by it was not planned it would have been clever if it was planned yes I mid Yusuf I'm here I should have done it like that I never thought about huh so he's very angry he said you're a pirate you are making my drug huh to the Indians I'm not a pirate I can pay you I respect your patent I'm willing to pay for a license but you're a monopolist that kill people and it went all the way to the Supreme Court should he have the right to produce it why is it important because mrs. Bolen got left Kimia and Gleevec as novi artists call it is a wonderful drug it's those drugs not to me – it's a new smashing drugs that save people from live Kimia and it costs sick the US dollar per day it's a lot of money and yousuf in supply he makes it for $5 a day and she looks much more interesting when she sees that but count five dollar a day three hundred days $1500 that's the income per person in India it's still too much can you imagine you lower the cost that much it's still too much to treat and the government cannot afford to provide this free it's made my voluntary actions and so on but it's really real a problem to deal with this when these drugs came in Sweden we had a better economy we were lucky we had an economic growth that bent in the same rate as the development of medical technology but but still today we don't get everything in Sweden you know where the limit is for human rights in Sweden is here six teeth you get free Titan implant from seven onwards you pay yourself very clear one year ago it was five it was moved Human Rights was improved in Sweden with runty no country – they can afford everything for everyone so this is the global burden of the sea so why do I say that even if this is the biggest this is of strategic most important extreme poverty is strategically or more important and I will show you why look here I have to go there and I have to do this and I'll do this this here and then full screen child mortality hundred dying per thousand born two hundred three hundred that's 30% die number of children per woman two four six 1962 Western world or industrialized countries few children low mortality developing world's many children high mortality the only intermediate with Cuba and Singapore otherwise it was really two countries what has happened what has happened has the world improved it's quite amazing isn't it it's quite amazing almost the whole world are down here but Afghanistan is there and Congress yet they still mister why is this important it's important because five children are born one died four survived the population of Afghanistan and Congo doubles in twenty years it's the worst ignorant of the young Swedes we find is they think that child mortality keep controls of population growth is the other way around child mortality maintains population growth it maintains the situation in the families where they dare not get only two children so that they can give them a real good life they must have more children and some even need daughters to go and fetch water and firewood extreme poverty is the worst health problem in this world and and and and what we what we are what we are seeing here you can see if we look inside can't look at Ghana Ghana looks as an African country which are down at for children and relatively low child mortality if I split it in its income quintiles the riches in Ghana you know Ghana in Africa across Africa is very successful now the the most educated those with better income they are like Asia but the worst of poorer 20% of Ghana is like Afghanistan that's in successful Ghana you have to have several African countries in your head at the same time success in one and enormous challenge in the other end this is FeO Pia a splitter Theo Pia Addis Abeba today has less children per woman than Sweden and Somali region is worse than Afghanistan that is what in sweden is referred to as Ogaden most are here in between but a few pies enormously successful this rate of change is very fast in FeO Pia and what do the Swedes know about all these success we asked them about how many babies they get in Bangladesh per woman and SCB statistic Sweden asked them in 2011 and the results were this and we in get mind where I work we went into contact with novels another survey companies that perhaps s a B and C that they asked them about Aid at the same time so they got carried away that can't be like that because this is far from correct so we repeated the question two years later and it's almost the same two very qualified companies did this surveys and there we had to compare first we were thinking about going to Norway to compare Swedes to Norway but we went to the take took the ships instead because no region could be too tough for the Swedes so this is the answer of the of the ships the chimps didn't understand the questions so they they had equal yourself to 25% of the ships thought it was 2.5 children per woman in Bangladesh and this is the right answer the ships now four times more about the world health and the Swedes I have no impact whatsoever it's quite serious we discussed the world without knowing it too much debate too little knowledge not that we shouldn't debate but we have to have a balance between knowledge and debate and 20 years ago it was like the Swedes thought there's an enormous progress there's an enormous progress across the world and this is happening with the world population look at what is happening this is the world population today below 15 here fifteen to thirty thirty to forty five forty five to sixty and this is me up there Europe above sixty I'm up here Africa has very many young and fewer older Asia the number of children are stopped growing in the whole world the number of children stopped growing and this is what will happen as you all know the old will die the rest grow fifteen years older and they get their children they all die and they grow older and they get their children they die they grow older and they get their children and then this is the inevitable fill up there is no way we can avoid becoming two billion more in this world two or three billion more because they are already born and there will be twice as many people in Africa as it will be in Europe in the future this can be discussed if poverty alleviation works fast in Africa if family planning contraceptives is made available if women have right if women have education there will be less children in Africa and this is not important on and environmentally it's important on the family level we want people to make their own choices it should be a right to have access to family planning this is a human right contraceptives because human rights should come with a budget human rights should come with a budget if it's no budget it doesn't work this is the difference hip hip replacement when you can afford this we should see that everyone get as they should get in the vaccines and everything we have to realize that there is a limit some people will live older you know but that's not a very major importance so we are seven billion in the world 1 billion in America 1 in Europe 1 in Africa and 4 in Asia and in 40 years from now there will be one more in Asia one more in Africa and then by the end of this century there will be 3 billions in Africa Africa will be 3 times as big as Europe and and if you split this you will see that the Old West will just be 10% of the world population 80% will live in Africa and Asia the best investment option today is to buy a beach piece of the beach in Somalia is the absolutely best you know you if we don't have the imagination of seeing how the change would come the sort of developing world this is the world it will change like this I worked in Mozambique as a medical doctor one of two medical doctors in a district like this and I worked in Sweden in a district like this and I got a traumatic syndrome for the rest of the life due to those two zeros we were hundred times as many doctors in Sweden and there were hundred times as many child deaths in Mozambique and there were tetanus in women that's the younger version on me there on on the photo and and we had the opportunity my wife and I to come back 30 years later it was a miracle how it had improved a better hospital but especially trained people at a level at a professional level there were colleagues there not what had the possibility to get the short education during colonial times independence is so good it's so crucial but it takes time to raise from the low economic level there and this is is the doctor not working there my wife said it was the only time for for many years that I kept quiet for more than one hour just listening he was so wise he was specialized he was so good you know he knew exactly what he could and what he couldn't do and lick the district now had twice the population twice the population but there was now 16 doctors doctors is not so important use that the most important was those medical assistants that were trained to do cesarean sections you know it was really fun a great improvement of Health Service children child F had decreased in spite of doubling population but when I went to the northern part of the district there was still three hundred thousand people that was still – medical doctor and there was the young colleague which knew as little as me when I was there thirty years old poverty extreme poverty reproduce itself you get one billion out of extreme poverty you still have 1 billion there you have to get it faster we have to get extreme poverty away this is extreme poverty I have spent my life researching on this I have the permission of the family to show this photo this is the other side of Africa you saw the success side of Africa that's impressive but still Africa has decades to go and they need to get out of poverty this is the lack of food and to get out of extreme poverty you know health is a very important component and I would jump this one here and I would jump this one there because I want to show you this universal health coverage what is that that is everything for everyone that's not possible this is how it looks today a few persons in the world have almost all health service they need most people in the world don't get most of the service they want and the poorest one to two billion get almost nothing priority number one fill that gap help families get out of extreme poverty get surviving children get two child families then deal with non communicable diseases mainly as prevention and then also that cure with better pricing system of drugs this is my answer for the global health challenge thank you very much let's date yes please amazing huh I want to bio down in front of you I was trained in Indian college that was it you know what changed my mind so I have a question as an Indian Indian can I ask you a question at Gleevec mrs. Barlow you introduced it remember mrs. Barlow yeah okay so how treatment now costs fifteen hundred dollars a year if she gets this she's lucky enough to get the simpler drugs and she still can't afford that right look so what are you saying then professor rustling should we Sweden be limiting the number of hip operations and saving that money and sending it to India for mrs. Barham and others with looking at what are you saying howdy how does everyone here help mrs. Barlow economic growth in India the only thing that we can handle cancer by by treatment and we can get hip replacements economic growth that's why I love money okay and India is grown but India will have to use its money rationale you have which we've seen a lot of Indians we can do well you can recover more taxes but that's not enough they have to add it so mrs. Bolen with that sort of treatment will still depend on donations but donations have to come within India for that the world should continue to assist India with vaccines contraceptives the basics so that can reach out in the rural areas that's the most important so Sweden's eight money doesn't go to mrs. varlam nope okay I don't think that is relevant because there's much more important at present another question from the audience sorry to interrupt Froy it's from Susan Martin thank you if you're here where are you yes I hope you're here hi Susan so he's her question is still haunts with the money available what should we be tackling first then which is what you're about to answer and we we need to plan long term interventions I asked the Minister of Health in Vietnam 15 20 years ago how can you be so healthy when you're so poor and she answered grandmother can read is absolutely amazing half of this fall in child mortality can be explained by female literacy and mind you the mean number of years in school for men in the world is 8 and for women it's 7 it's in the poorest countries where girls no don't go to school we have to get everyone to school of Swedish aid money today the only thing which is allocated for primary school is 1% 1% get children into school see I go outside health so even more important than vaccines is education electricity electricity lowers child mortality as much as vaccine but then the basic preventive service vaccines treatment for the major infectious diseases a better newborn care and assistance for women during pregnancies and access to contraceptives did they fall down here where all the contraceptives you know which India has done India now has two point four children per woman and the number of children below age of 8 is not growing any longer in India in the South in India the 1.2 billion mighty country which will be the leading nation in the world because it's the biggest country that speaks English let's hope no no no it's going that way going for international moderators from India who speak English let's hope as we grow for 1.2 billion people in this world huntress thing we have one more follow-up question which is is there any other way than economic growth as it may conflict with the idea of sustainability and that comes from Victoria Lyndon economic growth pays for schoolteachers economic growth pays for cesarean sections economic growth pays for electricity and all the way to washing machines that the whole world will ask for there's not one single person here that hand wash their sheets and there gee that's where everyone will reach it's the richest 1 billion that has to use resources so they can be shared that way with by all 10 billion it's the richest 1 billion that should change first and they have to change partly by behavior partly by more efficient energy use and partly by inventing new new energy sources which are green this is the change that happened don't ask others to hand wash and stay out of school in order for yourself to do nothing very clearly put Professor Riesling thank you so much for getting us going thank you

17 comments

  1. He's so happy to have heart diseases at nr. 1. Pure statistician. We need more people like him.
    May he rest in statistically significant piece.

  2. That part where he mentions knowledge with regards to debate. The understanding of ones own knowledge limitations… There is alot of debate but often lack of knowledge..so.. This understanding of ones own knowledge limitations is good place to start in order to get things more in the right direction…

  3. I'm a HUGE fan of Hans Rosling – he has a fantastic way of presenting complicated global health facts in a way that is completely accessible.

  4. I want to know where mr. Rosling gets his chimps because there's a shit tonne of elected ones in our parilament and they couldn't find a banana if it was shoved right in their face.

  5. Can anyone tell me which analytical tool/ software used in the video to show the change in population year wise and country wise (at 10:50 )

  6. The talk was very good but the moderator drive me crazy, why the hell is she interrupting him when he is answering the questions?…

  7. Amazing talk by Hans Rosling – for a long term Investor like me this is GOLD! – I already planned a trip to some of these mad-growth countries to buy properties/land/companies. 

  8. Dear Professor Rosling, your talk is an eye opener, especially for a Global Health student like myself. Thanks very much, but me and my friends need guidance for contribution as professionals.Please advise.

  9. We elected the government that does this to its citizens. And we keep them in office, Republicans and Democrats. Is this evidence of epidemic dementia in the U.S.?

  10. The new employee works part-time, has no health insurance, and no vacation. If they are lucky they get food stamps. Old, sick people must work at jobs that don't exist! Experience, skill and knowledge are too costly. The Tea Party tells the sick, both young and old, to Drop Dead! Unless you are rich. You can have health care as long as your money lasts.

  11. Is there more dementia and depression in the U.S. than in Western Europe? In the U.S. we are living longer so we must work more years. Since Ronald Reagan was president, pensions disappeared, Social Security has been underfunded, individual investment portfolio have been decimated by market trends (manipulations). Over 40 workers face more discrimination at work and when they apply for work. The over 40 crowd gets laid off/fired/downsized so a younger person can be hired for less money.

  12. I don't know if I would say it was luck that moved economic development apace with health technology. Sweden, and the rest of the West, was inventing that technology with its new wealthier economy. Other countries can now capitalize on the R&D investment of the Swedes, Americans, Germans, Brits, etc. They are getting a short cut thanks to pre-existing work. You can't consider them in isolation.

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