Global health is improving, but young people remain exposed to new risks

The latest global study on the burden of disease (Global Burden of Disease 2023) reveals a general improvement in global health after the COVID-19 pandemic, but highlights an emerging crisis among young people. While life expectancy is returning to its pre-pandemic level overall, deaths related to drug and alcohol use, mental health disorders, and suicide are increasing in several regions. Researchers call for stronger prevention efforts to address these behavioral risks, which are compounded by socioeconomic inequalities and changing lifestyles. These dynamics illustrate the influence of what some experts call the commercial determinants of health—the set of industrial and economic strategies that contribute to the spread and consumption of products such as tobacco, alcohol, and ultra-processed foods.

The study Global Burden of Disease 2023 (GBD), conducted by the Institute for Health Metrics and Evaluation (IHME, University of Washington) and published in The Lancet, is the most comprehensive overview of global health after the pandemic. It draws on more than 55,000 data sources from civil registration, censuses, and national surveys, covering nearly 300 causes of death and disease. The indicators used – life expectancy, years of life lost, and years lived with disability – make it possible to assess the evolution of the health burden in all 204 countries and territories of the world, according to their level of socio-demographic development.[1].

Significant progress but persistent inequalities

THE Global Burden of Disease 2023 confirms a significant improvement in global health after the pandemic. In most countries, life expectancy has returned to its pre-2020 level, marking an end to the global health crisis. Researchers observe a significant decline in mortality from infectious diseases and continued progress in maternal and child health, particularly the decline in neonatal deaths and acute respiratory infections, which nevertheless remain among the ten leading causes of health loss worldwide.

This global rebound, however, masks profound disparities between regions. Average life expectancy still varies by more than twenty years depending on the level of socio-demographic development: it reaches approximately 83 years in high-income countries compared to 62 years in sub-Saharan Africa. These gaps reflect the unequal distribution of resources, health infrastructure, and prevention, but also the persistence of contexts marked by poverty, conflict, or weak health systems.

In countries with low socio-demographic indexes, premature mortality remains dominated by non-communicable diseases, including cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases. The report highlights that, despite progress made against infectious diseases, the burden of chronic diseases is increasing in less well-resourced regions, where prevention and screening policies remain limited.

Researchers also emphasize the determining role of behavioral and environmental risk factors. GBD 2023 identifies five major causes of health loss worldwide: high blood pressure, air pollution (fine particles), smoking, high blood sugar, and being overweight. Together, these risks are responsible for nearly half of the years of life lost or lived with disability each year globally. While health losses associated with most of these risks declined between 2010 and 2023, those related to high blood sugar and high body mass index continue to increase, reflecting the rapid rise of diabetes and obesity in all regions.

Finally, the authors warn of the slowdown in international funding for health. According to them, cuts in development aid risk compromising progress made in the fight against infectious diseases and accentuating structural inequalities between countries. To address this, the report calls for a sustainable strengthening of prevention, epidemiological surveillance, and healthcare systems, essential conditions for consolidating health gains and reducing life expectancy gaps between regions of the world.

A silent crisis among young people

Alongside the progress made globally, the Global Burden of Disease 2023 highlights an alarming finding: the health of young adults has deteriorated in several regions of the world. While mortality is declining overall for most age groups, certain categories of young people are seeing their death rates stagnate or even increase. This trend, particularly marked in North America and Eastern Europe, contrasts with the progress observed in low- and middle-income countries, where infant mortality and infectious diseases continue to decline.

IHME researchers highlight that deaths related to drug and alcohol use and suicide have increased significantly over the past decade. In several high-income countries, these causes are now among the leading sources of mortality among 15- to 24-year-olds. The study identifies a specific deterioration in the psychological well-being of younger generations, exacerbated by social insecurity, deteriorating living conditions, climate instability, and increasing exposure to addictive behaviors. These factors are interacting to form what the report calls an “emerging youth crisis,” marked by an accumulation of social and health risks that threaten the progress made in public health.

The report also reveals that the situation varies greatly by region. In sub-Saharan Africa, the GBD's new analytical methods have corrected significant underestimates: female mortality among 15- to 29-year-olds is 61% higher than previous editions of the report indicated. This result is explained in particular by better consideration of deaths linked to interpersonal violence, obstetric complications, and undiagnosed chronic diseases. In high-income countries, conversely, young women have lower mortality rates but more loss of healthy life years linked to mental disorders, anxiety, and depression.

In the United States and Canada, the GBD notes an increase in deaths among children aged 5 to 14 and a rise in the mortality rate among young people aged 15 to 24 since 2010, breaking with the downward trend observed over the past three decades. Researchers see this as a worrying signal of a weakening of public health policies aimed at young people and a decline in prevention against addictions and mental health disorders.

These converging dynamics reflect a global malaise: younger generations, faced with unstable socioeconomic and environmental contexts, are accumulating new vulnerabilities, which health systems are struggling to address. For the report's authors, this represents a major turning point in global health trends, calling for a rethinking of prevention, education, and psychological support policies in order to limit the progression of risky behaviors and better protect the mental health of young people.

Tobacco remains a major factor in health loss

Smoking remains among the world's leading risk factors for premature death and poor health, alongside high blood pressure, air pollution, high blood sugar, and being overweight. These five risks account for nearly half of the years of life lost or lived with disability worldwide, according to the GBD.

The report highlights that tobacco contributes directly to the burden of noncommunicable diseases, which now dominate global mortality. While health losses from certain risks—such as air pollution and hypertension—have declined since 2010, those attributable to smoking remain stable and continue to weigh heavily on populations, particularly in low-income countries.

For the authors, sustainable reduction in tobacco use remains essential to prevent premature deaths and improve global health. Addressing key behavioral determinants, including tobacco, would prevent a significant portion of avoidable mortality and consolidate the gains made since the pandemic.

Beyond individual behaviors, these results are part of a broader reflection on the commercial determinants of health, that is, the influence exerted by economic actors on consumption patterns and health environments. The availability, advertising, and diversification of products such as tobacco, alcohol, and ultra-processed foods contribute to shaping the risky behaviors observed in the population. Without directly addressing these issues, the GBD 2023 shows that the main factors of health loss are closely linked to global economic and social dynamics. This broader reading of the health burden underlines the importance of integrating the regulation of commercial environments into long-term prevention policies.

©Generation Without Tobacco

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