June 20, 2019

Who and what will kill you?

By Barend ter Haar.

When a man starts shooting around to kill people he doesn’t know, for terroristic purposes or just because he is crazy, he receives all the public attention he is looking for but does not deserve. This poses a challenge for governments.

Will they take a high profile in order to look vigorous and decisive, even when that is exactly what the terrorists hope for, because it heightens their profile too? Or can they withstand that pressure and, while giving high priority to the prevention of such attacks, put these risks into a realistic perspective?

A useful way to put them into a realistic perspective is to look at the reports of the Institute of Health Metrics and Evaluation (IHME), an institute that was founded in 2007 with a large grant of the Bill & Melinda Gates Foundation. This institute produces the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study, based on a database that includes almost 800 million deaths. 

The aim of this study is to compare the effects of diseases and risks that kill people prematurely and cause ill health. It looks both at the direct causes of death, such as diseases, and at the factors that increase the risk of a disease, such as eating too much salt (3 million deaths in 2017).

We will first look at a selection of the direct causes of death in the world in 2016 (round numbers in thousands and as a percentage of all deaths):

  • Heart diseases 17650 32,26 %
  • Cancer   8930 16,32 %
  • Road incidents   1340   2,45 %
  • AIDS   1030   1,89 %
  • Suicide     817   1,49 %
  • Murder     391   0,71 %
  • Conflicts     116   0,21 %
  • Terrorism       35   0,06 %
  • Natural disasters           7   0,01 %

It should be noted that these are global figures and that they vary significantly by country. Terrorists, for example, are mainly active in countries like Afghanistan and Iraq. In rich countries the dominant risk factors are unhealthy diets, smoking and alcohol, while lack of facilities to wash your hands is only a high risk in very poor countries.

Let us now look at the factors that increase the risk of a premature death. Be aware that when two risks interact, the resulting death appears twice. Somebody who is obese might, for example, do little physical exercise. The deaths caused by these two risk factors should therefore not simply be added up.

Number of deaths by a selection of risk factors in 2016
(round numbers in thousands):

  • Smoking 6320
  • High Body Mass Index (obesity) 4530
  • Outdoor air pollution 4090
  • Alcohol use 2810
  • Household air pollution 2580
  • Diet low in fruit 2360
  • Diet low in vegetables 1520
  • Low physical activity 1370
  • Unsafe sex 1100
  • Second hand smoke   884
  • No access to hand washing facility   750

The outcome of very recent research is that unhealthy eating habits and air pollution are probably even more deadly than reflected in the figures of 2016. According to these reports unhealthy eating habits account globally for one in every five deaths, while air pollution reduced global life expectancy in 2017 by an average of 20 months. 

So, who are the people that endanger our life? 

When you have the privilege of living in a rich country, the person you have to fear most is the one that makes you smoke and drink and eat unhealthy, such as too little whole grains (3 million deaths in 2017).  And who is that person?

Air pollution and traffic accidents cannot be simply solved by changing our individual lifestyle, but require action at a local, national or even global level. But also these risks are mainly caused by ourselves and people like us. In short, the people we have to fear most are ourselves.

Does this mean that we can ignore terrorists? Of course not, but we should not grant them the privilege of being made more important than they are.

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