Over the past half century, the world has witnessed remarkable progress in reducing mortality across age groups. Life expectancy at birth increased from 56 years in 1970 to 73 years in 2019, driven by advances in medical care, public health initiatives and declining fertility rates. At the same time, population ageing has reshaped the global demographic profile, with the median age rising from 20 years in 1970 to 29 years in 2019 and projected to reach 36 years by 2050. These trends have brought optimism but also new challenges. While age-specific mortality continues to decline, crude death rates are expected to rise due to demographic shifts, straining health systems and budgets. Against this backdrop, the third Lancet Commission on Investing in Health has analysed mortality patterns and projections to 2050, focusing on priority conditions that account for most global health disparities.
Accelerating and Slowing Mortality Declines
Between 1970 and 2019, age-specific mortality rates declined substantially worldwide. The most dramatic improvements occurred among children, with mortality in ages 0–14 years dropping by nearly 80%. Reductions were also notable in ages 15–49 years (53%), 50–69 years (48%) and those aged 70 years or older (32%). The fastest declines were concentrated in the past two decades. China, central and eastern Europe, and India recorded rapid improvements among children and young adults in the 2010s, while sub-Saharan Africa achieved notable progress in the 15–49 age group. However, not all regions followed this trajectory. In the USA, mortality among those aged 15–49 and 50–69 years increased during the same period, reversing earlier gains. By contrast, older age groups in several regions, including the USA, saw continued reductions. These diverging patterns underscore both successes and persistent vulnerabilities in different health systems.
Demographic Pressures and Rising Crude Death Rates
The global crude death rate (CDR) reached its lowest level in history in 2019 at 7.5 per 1000 population. Yet projections to 2050 show an inevitable rise, driven primarily by ageing populations. While age-specific mortality continues to decline, the increasing share of older individuals exerts upward pressure on overall death rates. By 2050, nearly 70% of global deaths are expected to occur in those aged 70 years or older, compared with 50% in 2019. This trend is most pronounced in high-income regions such as the north Atlantic and China, where up to 90% of deaths could occur in older age groups. Sub-Saharan Africa and central Asia will reach their lowest CDR later than other regions but will also face rising rates over time. The projections highlight the dominant role of demographic change, which outweighs improvements in mortality rates and will shape future demands on healthcare financing, infrastructure and workforce capacity.
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Persistent Disease Burdens and Emerging Challenges
Despite overall progress, disparities remain in cause-specific mortality. From 2000 to 2019, deaths from infectious diseases and maternal and neonatal conditions (I-8) declined sharply, particularly for childhood-cluster diseases, HIV/AIDS and tuberculosis. However, progress slowed for lower respiratory infections, malaria and neonatal conditions, with some regions even recording increases. At the same time, non-communicable diseases and injuries (NCDI-7) grew in prominence, accounting for nearly half of global deaths by 2019. Diabetes stands out as a worsening challenge, with age-specific death rates rising across all regions, especially in central and eastern Europe and India. Atherosclerotic cardiovascular disease and strongly tobacco-related conditions also contributed significantly to the burden. These trends reveal the shifting landscape of global health: while infectious disease control remains crucial, the rising tide of chronic conditions demands long-term adaptation in healthcare systems.
Global health has achieved historic gains, with mortality falling across most age groups and life expectancy steadily rising. Yet the benefits are uneven, with some regions facing stalled or reversed progress and non-communicable diseases gaining ground. The demographic inevitability of ageing populations means that crude death rates will increase, placing greater demands on health financing and service provision. To sustain progress, health systems must adapt by focusing on prevention and treatment of priority conditions, particularly diabetes and cardiovascular disease, while maintaining gains in infectious disease control. The challenge ahead lies not only in continuing to reduce mortality but also in preparing health systems to manage the consequences of longer lives and shifting disease burdens.
Source: The Lancet
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