Rutgers researchers identify impacts of Russia-Ukraine war on hospitals

A study involving international collaborators highlights the realities facing health care systems in regions impacted by combat

RUTGERS UNIVERSITY

Rutgers researchers, aided by international collaborators, have tracked the devastation war has made on Ukraine’s hospital system.

Hundreds of hospitals in Ukraine have been forced to close or operate at a reduced capacity since Russia’s invasion of the Eastern European country in February 2022. Damage, destruction and supply shortages caused by the war have impaired the nation’s hospital system and taken a serious toll on human health.

In a study published in JAMA, Rutgers researchers and collaborators from the United States, Pakistan and Ukraine collected and compared data on hospital services provided both during the period preceding the current conflict (before Feb. 23, 2022) and during the war (Feb. 23, 2022 through May 30, 2023). Before the invasion, there were about 720 hospitals in Ukraine. By April 2023, 450 hospitals were still operating. Of these 450 hospitals, 74 hospitals from 12 of Ukraine’s 24 oblasts (provinces) not under Russian occupation participated in the study.

“The war has devastated Ukraine’s hospital system, leaving it ill-equipped to meet the needs of a population in crisis,” said Ubydul Haque, an assistant professor at Rutgers Global Health Institute and in the School of Public Health and lead author of the study. “This research helps illuminate the realities facing hospitals in war-affected regions—and their dire need for support.”

The researchers found while services related to emergency medical care increased, there were reductions in the number of hospitals offering laboratory testing (13 percent), tobacco education (13 percent), cancer screening (24 percent), gynecological services (26 percent), rehabilitation services (27 percent), pharmacy services (25 percent), and telehealth programs (36 percent).

Hospitals also reported supply-chain disruptions impacting essential equipment and pharmaceuticals, shortages of laboratory test kits, delayed delivery of crucial medications, medication storage problems caused by power outages, reductions in staff numbers and increased hours hospital staff were required to work. Maternal and newborn health were negatively affected, and there was a decrease in the availability of essential services, including ambulances, defibrillators, ventilators and hospital beds, including intensive care unit beds.

Some impacts of the war on hospital functioning, and what those impacts mean for health, remain to be seen. The researchers noted that because some regions in active war zones were inaccessible to the study, the most affected areas may be underrepresented, and the hundreds of hospitals that were destroyed or unable to operate couldn’t be represented in the data. In addition, the study found the war reduced access to vaccines, which may lead to higher incidences of infectious diseases.

“The weakening of Ukraine’s hospital system means that health care workers not only are struggling to meet emergency needs but also to provide essential preventive care, as well as ongoing care for chronic conditions,” said Haque. “This can have many negative long-term implications for the health of the people of Ukraine.”

The study’s coauthors from Rutgers include Emily S. Barrett and Nancy Fiedler of the School of Public Health and Environmental and Occupational Health Sciences Institute and Miraj Ahmad of the Department of Cell Biology and Neuroscience in the School of Arts and Sciences.

International collaborators who contributed to the study included several institutions in Ukraine: Kharkiv National Medical University, Poltava State Medical University, Overseas Council – United World Mission, National Aerospace University and Sumy State University.

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JOURNAL

JAMA

DOI

10.1001/jamahealthforum.2024.0901 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War

ARTICLE PUBLICATION DATE

17-May-2024

COI STATEMENT

Dr Espinoza reported personal fees from Sanofi outside the submitted work. Dr Barrett reported grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

 

Ukraine blackouts caused by malware attacks warn against evolving cybersecurity threats to the physical world

UNIVERSITY OF CALIFORNIA - SANTA CRUZ

On a cold winter night in 2016, Ukrainians experienced the first-ever known blackout caused by malicious code (malware) designed to autonomously attack the power grid. One-fifth of Kyiv’s citizens were plunged into darkness as attackers used malware to target the capital city’s power grid. Six years later, in the early months of the ongoing Russia-Ukraine war, a second attack attempted to combine kinetic and cyber attacks to take down Ukraine’s power grid.

Malware attacks against physical infrastructure have long been a looming threat in the realm of cybersecurity, but these two in Ukraine were the first attacks of their kind, and have received little attention from the academic community. Carried out by a Russian intelligence agency against Ukraine, they warn of the evolution of cyber attacks to the built world, and highlight the need to better understand and defend against this type of malware. 

A new paper presents the first study into how Industroyer One and Two, as these malware attacks are called, operated and interacted with the physical power system equipment. The paper is set to be presented on May 20 at the IEEE Symposium on Security and Privacy (the Institute of Electrical and Electronics Engineers flagship conference on cybersecurity) and was lead by a team of UC Santa Cruz students including Luis Salazar, Sebastian Castro, Juan Lozano and Keerthi Koneru, and advised by Associate Professor of Computer Science and Engineering Alvaro Cardenas. 

“I want to emphasize how vulnerable our systems are — I don’t know why this hasn’t been more impactful in terms of security awareness, and also policy and planning,” Cardenas said. “When you see a nation state designing malware to take down the power grid of another country, that seems to be a big deal. Our critical infrastructures are vulnerable to these kinds of attacks, so we need to be better prepared to defend.”

Understanding Industroyer One and Two

The malware used in the 2016 attack has been named Industoyer One, and the similar but distinct malware used in 2022 was dubbed Industroyer Two. The Five Eyes, an intelligence alliance including Australia, Canada, New Zealand, the United Kingdom, and the United States, have attributed both of these attacks to the GRU, which is Russia’s military intelligence agency.

The first attack can be seen as example of intimidation and a flex of power without warfare, Cardenas said, while the second is a look into warfare in the modern world 

“It’s an example of modern war in that it combines physical and cyber attacks,” Cardenas said. “It’s not an isolated event, these events in the cyber world and physical world are reinforcing each other to create the most damage they can. After our paper was accepted, we received notice of yet another attack that targeted Ukraine’s power grid simultaneously with a cyber attack and a kinetic attack.”

The malware attacks are not only the first and only examples of cyber attacks against a power grid, but are part of only a small number of known malware attacks against physical infrastructure in general. 

The first example of a malware attack against physical infrastructure was the Stuxnet attack discovered in 2010 and deployed some years earlier with the intention to destroy the centrifuges of a uranium enrichment plant in Iran. Before that, malware attacks had only targeted classical computing systems like IT and financial systems. 

The Industroyer attacks caused hours-long local blackouts. These types of attacks require operators to fix the problem locally and reconnect back to the main systems, and are far less catastrophic than a system collapse, in which an error cascades through the “bulk” system and could bring down an entire country’s power grid. 

“These attacks were able to create local blackouts, but so far, there hasn't been a system-wide collapse. An attack that can collapse the grid  will be far more dangerous as the whole country would be without power for several days,” Cardenas said.

Creating a sandbox for study

The UCSC researchers are not the only to study the two attacks, but Cardenas’ team found that the industry white papers did not provide satisfying answers about how the details of the malware operated and interacted with the equipment controlling the infrastructure. Their report is the first to detail exactly how the malware interacted with the physical world. 

Cardenas was able to obtain copies of the malware, which enabled the researchers to build a sandbox — a software environment that fooled the malware into thinking it was within the industry-specific environment of the Ukrainian power grid so the researchers could understand exactly how it interacted with the system. They emulated a power grid operator’s control room with remote connections to substations, as well as a substation network with local connections to electrical equipment. Their sandbox is openly available for other researchers to use. 

Using the sandbox, the researchers found similarities between the attacks, but observed a clear evolution in the malware. 

Both of the Industroyer attacks were completely automated, meaning once they were deployed there was no human involvement, and breached areas of the power grid which were designed to be disconnected from the internet to provide them higher security. Both attacks compromised a Windows computer in a substation or control room to manipulate the status of circuit breakers in the grid.

Industroyer One acted like a swiss army knife in that it could attack both older systems operating with serial lines as well as modern systems operating with modern communication systems. It was developed without a specific target and could attack directly from within a grid substation or from the control center hundreds of miles away. It expected configuration files from the system itself to guide its attack. However, these characteristics did not mean it was without flaws.

“It had this flexibility of attacking from everywhere, but we also found that it had a lot of bugs,” Cardenas said. “There were several implementation bugs that didn’t follow the protocol. Maybe it was [meant to be] very targeted, but we tested with several different types of equipment and it worked with some and not with others because of the bugs.”

Industroyer Two, on the other hand, was very specific, with its targets baked into the malware itself, eliminating the need to read configuration files. The researchers could see that it was targeting three IP addresses which coordinated with specific devices, presumably to control circuit breakers in specific substations. The bugs that were present in Industroyer One were eliminated. 

“Maybe it was because over time they had time to polish the malware to get rid of the bugs, but they also knew better what they were after,” Cardenas said. 

In observing how the Industoyer attacks targeted varied numbers of circuit breakers, the researchers found that different types of disconnection attacks can have different results in the power grid. They found that counterintuitively, shutting off all circuit breakers at once doesn't cause these big problems, as disconnecting load and generation at the same time balances out the system. More strategic attacks might aim to create imbalances, which can cause larger problems for the bulk system.

Planning future defense
 
Overall, this evolution observed in the Industroyer attacks shows that malware attacks are becoming stealthier. While both attacks targeted computers housed within control centers, researchers believe that future attackers could try to control “intelligent electronic devices” (IEDs) embedded within the systems themselves. While there is no malware targeting these for now, they might make attractive targets in the future as hackers could send them malicious commands while having them report back to the human operators that everything is working properly. 

While the Industroyer attacks happened geographically far from the United States, the distance does not ensure safety. 

“The attacks could happen here, or pretty much anywhere in the world,” Cardenas said. “Systems are now all controlled by computers and have pretty much the same technology.” 

With this in mind, the researchers are working to configure their sandbox into what is called a “honeypot,” a type of decoy software that pretends to be a working system in the operational network of a utility. System operators know not to use this decoy, so if activity is seen in the honeypot they will know it comes from an outside attacker, alerting them to the attack. 

The researchers are designing their honeypot to be generic enough to work in various control systems, such as oil refineries or water treatment systems, in addition to functioning in power grids. 

They also plan to facilitate the incorporation of AI assistants into operating networks, which would help decode and respond to attacks in real time when they occur.  

Collaborators on this project included Cardenas’ Ph.D. students Luis Salazar, Sebastian Castro, Juan Lozano, and Keerthi Koneru, as well as Emmanuele Zambon at the Eindhoven University of Technology, Bing Huang and Ross Baldick at the University of Texas at Austin, Marina Krotofil at Information Systems Security Partners, and Alonso Rojas at the Axon Group.  

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DOI

10.1109/SP54263.2024.00162 

ARTICLE TITLE

A Tale of Two Industroyers: It was the Season of Darkness

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news

 

Pagan-Christian trade networks supplied horses from overseas for the last horse sacrifices in Europe

Evidence demonstrates burst of human and animal mobility

CARDIFF UNIVERSITY

 

IMAGE: 

RECONSTRUCTION OF THE RITUAL SACRIFICE OF A HORSE AT PAPROTKI KOLONIA, MODERN POLAND.

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CREDIT: MIROSŁAW KUZMA.

Horses crossed the Baltic Sea in ships during the Late Viking Age and were sacrificed for funeral rituals, according to research from Cardiff University.

Published in the journal Science Advances, studies on the remains of horses found at ancient burial sites in Russia and Lithuania show that they were brought overseas from Scandinavia utilising expansive trade networks connecting the Viking world with the Byzantine and Arab Empires.

Up to now, researchers had believed sacrificial horses were always locally-sourced stallions. But these results reveal horses from modern Sweden or Finland travelled up to 1,500 km across the Baltic Sea. The findings also show that the sex of the horse was not necessarily a factor in them being chosen for sacrifice, with genetic analysis showing one in three were mares.

A scientific technique called strontium isotope analysis was used on horse teeth from 74 animals to identify where they had originated. Soil, water and plants have a chemical make-up reflecting their underlying geology. The chemical signature is absorbed by animals on consumption and remains locked in the hard enamel of their teeth, allowing archaeologists to trace their life journeys hundreds of years later.

Horse sacrifices were highly visible and symbolic public rites across pagan prehistoric Europe, persisting the latest among the Baltic tribes, up to the 14th century AD. Offering pits might include multiple horses, single complete horses, or partial animals. In many Baltic cemeteries horses were buried separately from humans, but there are numerous examples of horses with overlain human cremations.

Lead author Dr Katherine French, formerly of Cardiff University’s School of History, Archaeology and Religion, now based at Washington State University, said: “This research dismantles previous theories that locally-procured stallions were exclusively selected for sacrifice. Given the unexpected prevalence of mares, we believe the prestige of the animal, coming from afar, was a more important factor in why they were chosen for this rite.

“Viking Age trade routes stretched from modern Iceland, Britain, and Ireland in the West all the way to the Byzantine and Arab Empires in the East. The presence of a trader’s weight in one horse grave points to the key role of horses in these vibrant trade networks.”

Co-author Dr Richard Madgwick, also based at Cardiff University’s School of History, Archaeology and Religion, said: “Pagan Baltic tribes were clearly sourcing horses overseas from their Christian neighbours while simultaneously resisting converting to their religion. This revised understanding of horse sacrifice highlights the dynamic, complex relationship between Pagan and Christian communities at that time.”

This project received funding from the EU Horizon 2020 scheme, Polish Ministry of Science and Higher Education, National Geographic Society, Society for Medieval Archaeology, Alexander von Humboldt Foundation, Deutsche Forschungsgemeinschaft, and Cardiff University.

Reconstruction of a sacrificial horse deposit at Paprotki Kolonia, modern Poland.

CREDIT

Mirosław Kuzma.

Project lead Dr Katherine French uses column chromatography to collect strontium isotopes from horse dental enamel samples.

Project lead Dr Katherine French uses column chromatography to collect strontium isotopes from horse dental enamel samples.

Dr Katherine French investigates a horse mandible to select a dental sample at the University of Białystok.

Dr Katherine French Cardiff Un [VIDEO] | 

Dr Katherine French, formerly of Cardiff University’s School of History, Archaeology and Religion, now based at Washington State University, explains the aims of the project.

Dr Richard Madgwick Cardiff Un [VIDEO] |

Dr Richard Madgwick, also based at Cardiff University’s School of History, Archaeology and Religion, explains the results of their research.

JOURNAL

Science Advances

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Biomolecular evidence reveals mares and long-distance imported horses sacrificed by the last pagans in temperate Europe

ARTICLE PUBLICATION DATE

17-May-2024

 

Study: Large language models can’t effectively recognize users’ motivation, but can support behavior change for those ready to act

Large language model-based chatbots can’t effectively recognize users’ motivation when they are hesitant about making healthy behavior changes, but they can support those committed to take action, say University of Illinois Urbana-Champaign researcher

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, NEWS BUREAU

 

IMAGE: 

LARGE LANGUAGE MODEL-BASED CHATBOTS CAN’T EFFECTIVELY RECOGNIZE USERS’ MOTIVATION WHEN THEY ARE HESITANT ABOUT MAKING HEALTHY BEHAVIOR CHANGES, BUT THEY CAN SUPPORT THOSE WHO ARE COMMITTED TO TAKE ACTION, SAY INFORMATION SCIENCES DOCTORAL STUDENT MICHELLE BAK AND INFORMATION SCIENCES PROFESSOR JESSIE CHIN.

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CREDIT: COURTESY MICHELLE BAK

CHAMPAIGN, Ill. — Large language model-based chatbots have the potential to promote healthy changes in behavior. But researchers from the ACTION Lab at the University of Illinois Urbana-Champaign have found that the artificial intelligence tools don’t effectively recognize certain motivational states of users and therefore don’t provide them with appropriate information.

Michelle Bak, a doctoral student in information sciences, and information sciences professor Jessie Chin reported their research in the Journal of the American Medical Informatics Association.

Large language model-based chatbots — also known as generative conversational agents — have been used increasingly in healthcare for patient education, assessment and management. Bak and Chin wanted to know if they also could be useful for promoting behavior change.

Chin said previous studies showed that existing algorithms did not accurately identify various stages of users’ motivation. She and Bak designed a study to test how well large language models, which are used to train chatbots, identify motivational states and provide appropriate information to support behavior change.

They evaluated large language models from ChatGPT, Google Bard and Llama 2 on a series of 25 different scenarios they designed that targeted health needs that included low physical activity, diet and nutrition concerns, mental health challenges, cancer screening and diagnosis, and others such as sexually transmitted disease and substance dependency.

In the scenarios, the researchers used each of the five motivational stages of behavior change: resistance to change and lacking awareness of problem behavior; increased awareness of problem behavior but ambivalent about making changes; intention to take action with small steps toward change; initiation of behavior change with a commitment to maintain it; and successfully sustaining the behavior change for six months with a commitment to maintain it.

 The study found that large language models can identify motivational states and provide relevant information when a user has established goals and a commitment to take action. However, in the initial stages when users are hesitant or ambivalent about behavior change, the chatbot is unable to recognize those motivational states and provide appropriate information to guide them to the next stage of change.

Chin said that language models don’t detect motivation well because they are trained to represent the relevance of a user’s language, but they don’t understand the difference between a user who is thinking about a change but is still hesitant and a user who has the intention to take action. Additionally, she said, the way users generate queries is not semantically different for the different stages of motivation, so it’s not obvious from the language what their motivational states are.

“Once a person knows they want to start changing their behavior, large language models can provide the right information. But if they say, ‘I’m thinking about a change. I have intentions but I’m not ready to start action,’ that is the state where large language models can’t understand the difference,” Chin said.

The study results found that when people were resistant to habit change, the large language models failed to provide information to help them evaluate their problem behavior and its causes and consequences and assess how their environment influenced the behavior. For example, if someone is resistant to increasing their level of physical activity, providing information to help them evaluate the negative consequences of sedentary lifestyles is more likely to be effective in motivating users through emotional engagement than information about joining a gym. Without information that engaged with the users’ motivations, the language models failed to generate a sense of readiness and the emotional impetus to progress with behavior change, Bak and Chin reported.

Once a user decided to take action, the large language models provided adequate information to help them move toward their goals. Those who had already taken steps to change their behaviors received information about replacing problem behaviors with desired health behaviors and seeking support from others, the study found.

However, the large language models didn’t provide information to those users who were already working to change their behaviors about using a reward system to maintain motivation or about reducing the stimuli in their environment that might increase the risk of a relapse of the problem behavior, the researchers found.

“The large language model-based chatbots provide resources on getting external help, such as social support. They’re lacking information on how to control the environment to eliminate a stimulus that reinforces problem behavior,” Bak said.

Large language models “are not ready to recognize the motivation states from natural language conversations, but have the potential to provide support on behavior change when people have strong motivations and readiness to take actions,” the researchers wrote.

Chin said future studies will consider how to finetune large language models to use linguistic cues, information search patterns and social determinants of health to better understand a users’ motivational states, as well as providing the models with more specific knowledge for helping people change their behaviors.

 

 

Editor’s notes: To contact Michelle Bak, email chaewon7@illinois.edu. To contact Jessie Chin, email chin5@illinois.edu.

The paper “The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change” is available online. DOI: doi.org/10.1093

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JOURNAL

Journal of the American Medical Informatics Association

DOI

10.1093/jamia/ocae057 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change

 

A new ‘rule of biology’ may have come to light, expanding insight into evolution and aging

Living things usually prefer stability to conserve energy and resources, but instability might also play a vital role, says USC Dornsife molecular biologist John Tower.

UNIVERSITY OF SOUTHERN CALIFORNIA

 

IMAGE: 

IN THIS COMPUTER SIMULATION OF A SELF-REPLICATING STRUCTURE, THE PINK SQUARE REPRESENTS THE SIGNAL TO DEGRADE THE CONNECTION BETWEEN THE “PARENT” STRUCTURE (LEFT) AND ITS “OFFSPRING” (RIGHT). THIS DEGRADATION IS AN EXAMPLE OF A BENEFICIAL INSTABILITY IN BIOLOGICAL STRUCTURES.

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CREDIT: COURTESY OF JOHN TOWER

By Darrin S. Joy

A molecular biologist at the USC Dornsife College of Letters, Arts and Sciences may have found a new “rule of biology.”

A rule of biology, sometimes called a biological law, describes a recognized pattern or truism among living organisms. Allen’s rule, for example, states that among warm-blooded animals, those found in colder areas have shorter, thicker limbs (to conserve body heat) than those in hotter regions, which need more body surface area to dissipate heat. 

Zoologist Joel Allen formulated this idea in 1877, and though he wasn’t the first or the last to present a rule of biology, his is one of just a handful to gain acceptance among scientists. 

Now, John Tower, professor of biological sciences at USC Dornsife, believes he has uncovered another rule of biology. He published his idea on May 16 in the journal Frontiers in Aging.

Life may require instability

Tower’s rule challenges long-held notions that most living organisms prefer stability over instability because stability requires less energy and fewer resources. For instance, hexagons appear frequently in nature — think honeycombs and insect eyes — because they are stable and require the least amount of material to cover a surface. 

Tower centers his rule on instability, specifically a concept called “selectively advantageous instability,” or SAI, in which some volatility in biological components, such as proteins and genetic material, provides an advantage to cells.

Tower believes SAI is a fundamental part of biology. “Even the simplest cells contain proteases and nucleases and regularly degrade and replace their proteins and RNAs, indicating that SAI is essential for life,” he explains.

He says SAI also plays a key role in evolution.

As cells go about their business, building and degrading various unstable components, he explains, they will exist in one of two states — one state with an unstable component present and one state in which the unstable component is absent. 

Natural selection may act differently on the two cell states. “This can favor the maintenance of both a normal gene and a gene mutation in the same cell population, if the normal gene is favorable in one cell state and the gene mutation is favorable in the other cell state,” he says. Allowing this genetic diversity can make cells and organisms more adaptable.

SAI may be at the root of aging — and more

Selectively advantageous instability may also contribute to aging. Creating and then replacing the unstable component within cells comes at the cost of materials and energy. Breaking it down may also require additional energy.

Also, since SAI sets up two potential states for a cell, allowing normal and mutated genes to co-exist, if the mutated gene is harmful, this may contribute to aging, Tower says.

In addition to evolution and aging, SAI has other far-reaching implications.

“Science has been fascinated lately with concepts such as chaos theory, criticality, Turing patterns and ‘cellular consciousness,’ says Tower. “Research in the field suggests that SAI plays an important role in producing each of these phenomena.” 

Because of its apparent ubiquity in biology and its far-reaching implications, SAI may be the newest rule of biology, he says.

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JOURNAL

Frontiers in Aging

DOI

10.3389/fragi.2024.1376060 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Selectively advantageous instability in biotic and pre-biotic systems and implications for evolution and aging

ARTICLE PUBLICATION DATE

16-May-2024

 

Global life expectancy to increase by nearly 5 years by 2050 despite geopolitical, metabolic, and environmental threats, reports new global study

INSTITUTE FOR HEALTH METRICS AND EVALUATION

Global Burden of Disease 

The latest findings from the Global Burden of Disease Study (GBD) 2021, published today in The Lancet, forecast that global life expectancy will increase by 4.9 years in males and 4.2 years in females between 2022 and 2050.

Increases are expected to be largest in countries where life expectancy is lower, contributing to a convergence of increased life expectancy across geographies. The trend is largely driven by public health measures that have prevented and improved survival rates from cardiovascular diseases, COVID-19, and a range of communicable, maternal, neonatal, and nutritional diseases (CMNNs).

This study indicates that the ongoing shift in disease burden to non-communicable diseases (NCDs) – like cardiovascular diseases, cancer, chronic obstructive pulmonary disease, and diabetes – and exposure to NCD-associated risk factors – such as obesity, high blood pressure, non-optimal diet, and smoking – will have the greatest impact on disease burden of the next generation.

As the disease burden continues to shift from CMNNs to NCDs and from years of life lost (YLLs) to years lived with disability (YLDs), more people are expected to live longer, but with more years spent in poor health. Global life expectancy is forecasted to increase from 73.6 years of age in 2022 to 78.1 years of age in 2050 (a 4.5-year increase). Global healthy life expectancy (HALE) – the average number of years a person can expect to live in good health – will increase from 64.8 years in 2022 to 67.4 years in 2050 (a 2.6-year increase).

To come to these conclusions, the study forecasts cause-specific mortality; YLLs; YLDs; disability-adjusted life years (DALYs, or lost years of healthy life due to poor health and early death); life expectancy; and HALE from 2022 through 2050 for 204 countries and territories.

“In addition to an increase in life expectancy overall, we have found that the disparity in life expectancy across geographies will lessen,” said Dr. Chris Murray, Chair of Health Metrics Sciences at the University of Washington and Director of the Institute for Health Metrics and Evaluation (IHME). “This is an indicator that while health inequalities between the highest- and lowest-income regions will remain, the gaps are shrinking, with the biggest increases anticipated in sub-Saharan Africa.”

Dr. Murray added that the biggest opportunity to speed up reductions in the global disease burden is through policy interventions aimed to prevent and mitigate behavioral and metabolic risk factors.

These findings build upon the results of the GBD 2021 risk factors study, also released today in The Lancet. This accompanying study found that the total number of years lost due to poor health and early death (measured in DALYs) attributable to metabolic risk factors has increased by 50% since 2000. Read more on the risk factors report at https://bit.ly/GBDRisks2021.

The study also puts forth various alternative scenarios to compare the potential health outcomes if different public health interventions could eliminate exposure to several key risk factor groups by 2050.

“We forecast large differences in global DALY burden between different alternative scenarios to see what is the most impactful on our overall life expectancy data and DALY forecasts,” said Dr. Stein Emil Vollset, first author of the study who leads the GBD Collaborating Unit at the Norwegian Institute of Public Health. “Globally, the forecasted effects are strongest for the ‘Improved Behavioral and Metabolic Risks’ scenario, with a 13.3% reduction in disease burden (number of DALYs) in 2050 compared with the ‘Reference’ (most likely) scenario.”

The authors also ran two more scenarios: one focused on safer environments and another on improved childhood nutrition and vaccination.

“Though the largest effects in global DALY burden were seen from the 'Improved Behavioral and Metabolic Risk’ scenario, we also forecasted reductions in disease burden from the ‘Safer Environment’ and ‘Improved Childhood Nutrition and Vaccination’ scenarios beyond our reference forecast, said Amanda E. Smith, Assistant Director of Forecasting at IHME. “This demonstrates the need for continued progress and resources in these areas and the potential to accelerate progress through 2050.”

“There is immense opportunity ahead for us to influence the future of global health by getting ahead of these rising metabolic and dietary risk factors, particularly those related to behavioral and lifestyle factors like high blood sugar, high body mass index, and high blood pressure,” continued Dr. Murray.

Notes to editors

For interview requests, journalists may contact ihmemedia@uw.edu. For full study results, including the paper and related tables, finalized PDFs are available at https://bit.ly/GBD2021Forecast, embargoed until 23:30 UK, 6:30 p.m. EDT on May 16, 2024. The post-embargo link for the paper is https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00685-8/fulltext. An infographic summarizing the study’s findings can be found at https://bit.ly/4byxttL. Data tables containing estimates from the study are available at https://ghdx.healthdata.org/record/ihme-data/global-life-expectancy-all-cause-mortality-and-cause-specific-mortality-forecasts-2022-2050.

About the Institute for Health Metrics and Evaluation

The Institute for Health Metrics and Evaluation (IHME) is an independent research organization at the University of Washington (UW). Its mission is to deliver to the world timely, relevant, and scientifically valid evidence to improve health policy and practice. IHME carries out its mission through a range of projects within different research areas including the Global Burden of Diseases (GBD), Injuries, and Risk Factors; Future Health Scenarios; Cost Effectiveness and Efficiency; Resource Tracking; and Impact Evaluations.

IHME is committed to providing the evidence base necessary to help solve the world’s most important health problems. This requires creativity and innovation, which are cultivated by an inclusive, diverse, and equitable environment that respects and appreciates differences, embraces collaboration, and invites the voices of all IHME team members.

About the Global Burden of Disease Study

The Global Burden of Disease Study (GBD) is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 11,000 collaborators across more than 160 countries and territories. GBD 2021 – the newly published most recent round of GBD results – includes more than 607 billion estimates of 371 diseases and injuries and 88 risk factors in 204 countries and territories. The Institute for Health Metrics and Evaluation coordinates the study.

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JOURNAL

The Lancet

ARTICLE PUBLICATION DATE

16-May-2024