Obesity, conflict, and mental illness contribute most to the ill health and mortality of the world’s population – especially in the U.S., according to the annual Global Burden of Disease study published this month in The Lancet and funded by The Bill & Melinda Gates Foundation.

There’s good news and bad news in this research: on the upside, people are living longer. On the downside, there’s a lot of morbidity – that is, sub-optimal health – in those years. The study examines both YLLs (years of life lost) and YLDs (years lived with disability).

“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates. But we’ve been much less motivated to address issues leading to illnesses,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, quoted in Reuters summary of the report.

Let’s dissect the 3 key factors underlying the global disease burden:

Diet and food: Diets low in whole grains, fruit, nuts and seeds, fish oils and high in salt were the most common risk factors, contributing to cases of obesity, high blood pressure, high blood sugar and high cholesterol. Here is Newsweek’s take on eating badly causing death and disability.    Men’s Health magazine was more direct, asserting that, “Your crappy diet is literally killing you.”

Conflict: Deaths due to terrorism and war increased by 143% since 2006 to over 150,000 in 2016. These deaths were concentrated in the Middle East and North Africa. Mortality due to gun deaths grew by 5.7% to 161,000 for deaths due to firearm assaults, and 4.3% for suicide-by-gun (67,500 deaths) over the ten years.

Mental illness: 1.1 billion people living with psychological or psychiatric disorders and substance abuse problems in 2016. Major depressive disorders ranked in the top 10 causes of ill health in all but four countries worldwide. Depression is a major cause of non-fatal disease burden, driving substantial morbidity around the world.

Over 2,500 researchers from 130 countries collaborated on this study, led by the IHME.

Health Populi’s Hot Points:  In the U.S. and 72% of the world, most deaths are due to non-communicable diseases which can be prevented or postponed through lifestyle choices and behaviors. Diabetes is growing around the world owing to several factors including aging, greater exposure to lifestyle-related risk factors, and high BMI. Treatment improvements are increasing lifespans for people with diabetes, but those increased life-years can often be coupled with other chronic conditions and financial stress on national health systems, leading to people living longer, but with disabilities often preventing folks from their pursuits of happiness — those YLDs are a looming threat for the U.S. healthcare system, public and individual health.

Take diabetes, which is epidemic around the world and, to be sure, in the U.S. New research that will be presented tomorrow at the meeting of the European Association for the Study of Diabetes in Lisbon, Portugal found that millions of Americans with type 2 diabetes and pre-diabetes are at risk for chronic kidney disease, and diabetes-related blindness.

And while cancer death rates are falling due to the use of new and effective treatments, new research learned, there’s more work to be done in preventing cancer’s onset — namely smoking cessation, limiting environmental hazards, and improving nutrition. Note that 7 million people died globally due to tobacco use, the GBD study calculated.

What bolsters health are investments in social determinants and primary care, which are key for both physical and mental health. As health reform discussions continue in the U.S., this GBD research, and the criticality of social determinants and accessible primary care on-ramps, must be considered.

As an example of a wonderful initiative just launched to tackle the GBD, Dr. Tom Frieden, former director of the CDC, and Michael Bloomberg, my favorite ex-healthcare mayor, have come together to fund Resolve, a $225 million program co-sponsored by the Gates Foundation and the Chan Zuckerberg Initiative.