such as heart disease, stroke, diabetes and cancer – some of which have significant genetic triggers. That shift has been particularly marked in Latin America, the Middle East and south-east and even south Asia, he said. The third big finding was, Murray said, “a surprise to us”. That was the sheer extent of disability and the toll it took on people who were living longer but not healthier lives. “The main causes of disability are different from the ones that kill you,” he said. They were mental health problems such as anxiety and depression, musculoskeletal disorders such as arthritis and lower back pain – complained of in every country in the world – anaemia, sight and hearing loss and skin disease. In addition, there was substance abuse. “The rates for these are not going down over time,” he said. “We are making no progress in reducing these conditions.”