Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Locational Characteristics of Dry Ports in Developing Economies: Some Lessons from Northern India

NG A. K. Y. and CETIN I. B. Locational characteristics of dry ports in developing economies: some lessons from Northern India, Regional Studies. Contemporary economic development has triggered the importance of establishing distribution centres at appropriate locations in developing economies. However, so far, academic studies addressing this issue are rather scarce. Hence, by investigating dry ports within two industrial clusters in Northern India, this paper investigates the locational characteristics of distribution centres in developing economies. Analytical results indicate that the spatial dynamics of dry ports in developing economies are different from Western, advanced economies due to geographical diversifications, the different paces of regional development and local practices. This paper also suggests that dry ports in developing economies are more cluster (rather than supply chain) oriented

Port governance reforms in diversified institutional frameworks: generic solutions, implementation asymmetries

Bringing in neo-institutional perspectives, this paper investigates the recent corporatisation process of three seaports in Asia and Europe. We focus on whether the newly established seaport governance structures follow a path largely affected by the local/national institutional frameworks and the political traditions in place. Findings confirm that path-dependent decisions largely preserve the institutional characteristics of local/national systems, resulting in implementation asymmetries when different countries seek generic governance solutions.

A new risk quantification approach in port facility security assessment

Abstract Terrorist attacks in the past decade had raised concern that terrorists capable of the suicide hijackings of airplanes could readily adapt such capabilities to maritime targets like ports. Although a large number of port security control measures have been proposed which have greatly enhanced security performance, the voice of requiring further justification on their effectiveness from various maritime stakeholders remains strong. Indeed, different ports around the world still have very diversified practices and standards regarding “secure” facilities, with a generally accepted assessment methodology found wanting. Despite the existence of previous research works, few have been done to address this issue, which clearly exposes a significant research gap. Understanding such deficiency, this paper introduces a novel fuzzy evidential reasoning approach to facilitate the quantitative analysis of port facility security assessment (PFSA). To achieve it, the major key security performance indicators (KSPIs) used by designated authorities in port facility security plan are identified; the current PFSA practices are reviewed with particular attention to the grades used by port operators when assessing the KSPIs; and a fuzzy evidential reasoning approach is applied to quantify port facility security risks and to conduct the cost benefit analysis of the associated security control measures

Across the waves: a bibliometric analysis of container shipping research since the 1960s

International audienceThe paper investigates collaborative and semantic patterns that emerged between 1967 and 2013 about the theme of container shipping based on a corpus of 294 articles published in scholarly journals within the fields of transportation, supply chain, economics, geography, regional planning and development, and operations research. An analysis based on the co-occurrence of title words allows identifying dominant sub-themes and their evolution. Main results point to the gradual diversification of container shipping research, from the dominance of economics towards a more trans-disciplinary set of approaches which integrate port-related activities and multimodal networks. Yet, disciplinary specialization remains strong up to nowadays so that container shipping research remains rather fragmented. While co-authorships have increased over time, they remain polarized by few, weakly connected research battalions. Our study suggests that research on container shipping would benefit from more frequent contacts between such communities to foster in-depth cross-disciplinary studies and fundamental cooperation

Maritime Undergraduate Students: Career Expectations and Choices

The following study presents an inquiry into understanding the motivating factors of students to enroll in a maritime university and to further continue with a career in the maritime industry. By collecting data from 378 undergraduate students enrolled in various maritime programs (navigation, electromechanics, electrical engineering, and economic engineering in transport), we aimed to better understand the profiles of students, their information sources, interest, and the prospects of associated programs where they are enrolled. As such, this study seeks to enable educators and industry practitioners to better understand the educational and career paths chosen by undergraduates in the maritime field. It can align the students’ expectations with program delivery. We examined students’ perceptions and assessments according to the program they are enrolled in. Taking into account the fact that there is a world low attraction for maritime careers, the results of this study are useful for maritime education and training (MET) providers during the design and marketing campaign of the educational program to attract students. Additionally, the findings are useful for public administration and the Ministry of Education’s analysis of expanding educational and research programs, as well as for Ministry of Labour forecasting. Employers from the maritime industry can find useful the main motives for which a graduate would choose to work in this sector, business field, or a related business. Moreover, industry practitioners and academia can expand the study at a larger scale, comprising more countries and taking into account national and regional characteristics

Cooperation or competition? Factors and conditions affecting regional port governance in South China

Hong Kong is an international port heavily influenced by the ‘active non-interventionist’ policy and, until very recently, segregated from China's national/regional planning due to its special political and economic status. However, the port is now facing considerable challenges, notably increased trade between China and overseas markets, challenges from neighbouring ports, notably Shenzhen and Guangzhou, the increasing importance of intra-Asian trade and the economic turmoil in 2008, which accelerated the industrial transformation of the Pearl River Delta (PRD) in South China. Hence, Hong Kong is compelled to undergo strategic changes, notably its gradual integration into China's national and regional planning, and to integrate itself within the PRD so as to establish a system with different PRD ports that is functionally complementary to each other. How such a newly developed regional port cluster should develop, notably the division of responsibilities of cargo flows between Hong Kong and other PRD ports, however, is still rather ambiguous. By developing a game theory model and calibrated on the basis of the PRD context, this article investigates the factors and conditions affecting regional port governance in South China, notably alliance formation for ports serving partially overlapping hinterlands. This article serves as an important step in developing an effective, fully integrated regional transportation system within the PRD, and to help it to become an efficient logistics hub in the Asia-Pacific region

Climate change and the adaptation strategies of ports: The Australian experiences

Abstract Being nodal points along supply chains, ports affected by climate change would create substantial costs to the global economy and welfare, and thus it is extremely important to ensure that ports can develop effective adaptation strategies. However, there are many uncertainties, as the dynamics between climate change and ports can diversify between different regions. Against this background, through exploratory case studies of four ports in Australia, this paper investigates climate change and the adaptation strategies of ports, with a special focus on port infrastructures and the day-to-day operational impacts. Research findings indicate that, while port managers recognize climate change as an issue which requires closer attention, adaptation strategies have remained segregated and piecemeal. This highlights the fact that effective adaptation solutions are not just about physical layouts and engineering projects, but the need to fundamentally transform the current management and planning practices of ports. It is a timely reminder to port policymakers and managers on the need to refine how effective decisions should be made for the challenges posed by climate changes in the future. In this regard, further research on this topic is urgently required