The Global Burden of Disease (GBD) study is the most important report card for human health. It has revolutionized our understanding of what kills us and, crucially, what makes us sick.
Looking at its reports from the first study (reflecting 1990 data) is fascinating. Reviewing the brand new GBD 2023 report (released in October 2025) is insightful. Together, they create a 30-year film of humanity’s evolving health challenges.
This is the complete story. It compiles the dynamic trends over three decades. It provides a specific deep dive into what the latest GBD 2023 data means for the world and for Nepal.
Part 1: The GBD Story — A 30-Year Journey Through Global Health
Before the GBD, we only counted what killed people. The groundbreaking innovation of the GBD 1990 was the Disability-Adjusted Life Year (DALY). It is a single metric for one lost year of “healthy” life. It combines dying early, which is measured as Years of Life Lost (YLLs). It also considers living in poor health, represented by Years Lived with Disability (YLDs).
For the first time, the “hidden burden” of non-fatal conditions was recognized. Conditions like depression and low back pain were given the same weight as killers like heart disease. Here’s how the story unfolded.
Era 1: The 1990s — Unveiling the “Hidden Burden”
The first GBD report showed a world sharply divided. High-income countries were burdened by heart disease, while low-income regions like Nepal were dominated by CMNN diseases:
- Communicable (diarrhea, TB)
- Maternal & Neonatal
- Nutritional (malnutrition)
Era 2: The 2000s-2010s — The Relentless Rise of NCDs
With each new report (GBD 2010, 2017, 2019), a relentless trend emerged. Non-Communicable Diseases (NCDs) were marching up the ranks everywhere. Countries like Nepal entered the “double burden” phase. They are still fighting infections. Now they are also being hit by heart disease, stroke, diabetes, and COPD.
Era 3: The COVID-19 Shockwave (GBD 2021)
The GBD 2021 study captured the most violent health disruption in a century. For the first time, an infectious disease—COVID-19—became a top global killer. It caused the largest drop in life expectancy since WWII.
Era 4: The Post-Pandemic Reality (GBD 2023)
The latest report shows a world rebounding from the pandemic. However, it faces an entrenched NCD crisis. This crisis is now supercharged by metabolic risks (obesity and diabetes).
The 30-Year Trend in a Snapshot: Top 5 Global DALYs
This table visualizes the entire story.
| Rank | GBD 1990 | GBD 2019 (Pre-Pandemic) | GBD 2023 (Post-Pandemic) |
| 1 | Lower Respiratory Infections | Ischemic Heart Disease | Ischemic Heart Disease |
| 2 | Diarrheal Diseases | Neonatal Disorders | Stroke |
| 3 | Neonatal Preterm Birth | Stroke | Neonatal Disorders |
| 4 | Ischemic Heart Disease | Lower Respiratory Infections | Diabetes |
| 5 | Measles | Chronic Obstructive Pulmonary Disease (COPD) | Lower Respiratory Infections |
What you’re seeing is the history of modern health. There is a clear shift from fighting microbes (1990) to fighting metabolism (2023). Diabetes is entering the top 5 for the first time.
The GBD study is the largest and most comprehensive effort to quantify health loss across places and over time. This helps health systems improve and eliminates disparities.
— Institute for Health Metrics andEvaluation (IHME)
Part 2: GBD 2023 Deep Dive — The World vs. Nepal
Now, let’s zoom in on the brand-new GBD 2023 data. It shows that while the world is fighting a metabolic crisis, Nepal is facing a unique and devastating “double burden.” This burden is driven by a threat that sets it apart.
Visualized: Top 5 Causes of Health Loss (DALYs)
This table compares the world’s top 5 health burdens to Nepal’s, and the difference is staggering.
Table 1: Top 5 Causes of DALYs (Health Loss), GBD 2023
| Rank | Global | Nepal (Top Causes of Death & Disability) |
| 1 | Ischemic Heart Disease | Chronic Obstructive Pulmonary Disease (COPD) |
| 2 | Stroke | Ischemic Heart Disease |
| 3 | Neonatal Disorders | Stroke |
| 4 | Diabetes | Lower Respiratory Infections |
| 5 | Lower Respiratory Infections | Neonatal Disorders |
Source: Synthesized from GBD 2023 collaborator publications (2025) and the “GBD 2023 Country Profile: Nepal” (2025).
Analysis: What This Table Tells Us
- Nepal’s Shocking Outlier: COPD is #1. This is the single most important finding. While the world’s biggest burden is the heart, Nepal’s is the lungs. Chronic Obstructive Pulmonary Disease (COPD) being the number one cause of all health loss is a significant national anomaly.
- A “Triple Burden” for Nepal: Nepal’s top 5 shows it is fighting a war on three fronts, a “triple burden” of disease:
- Environmental/Respiratory: COPD (#1) & Lower Respiratory Infections (#4)
- Cardiovascular (NCDs): Ischemic Heart Disease (#2) & Stroke (#3)
- Neonatal: Neonatal Disorders (#5)
Nepal isn’t just transitioning from infectious to chronic diseases; it’s being crushed by both, plus a massive environmental burden.
The “Why”: Unmasking the Top 5 Risk Factors
So why is Nepal’s profile so different? The GBD data provides the “smoking gun.” It analyzes the risk factors. These include behaviors, environmental exposures, and metabolic changes that drive the diseases.
Table 2: Top 5 Risk Factors (Driving DALYs), GBD 2023
| Rank | Global | Nepal |
| 1 | High Systolic Blood Pressure | Particulate Matter Pollution (Air Pollution) |
| 2 | Particulate Matter Pollution | High Systolic Blood Pressure |
| 3 | High Fasting Plasma Glucose (Diabetes) | Smoking (Behavioral) |
| 4 | Smoking (Behavioral) | High Fasting Plasma Glucose (Diabetes) |
| 5 | Low Birthweight & Short Gestation | Low Birthweight & Short Gestation |
Source: Synthesized from GBD 2023 collaborator publications (2025) and the “GBD 2023 Country Profile: Nepal” (2025).
Analysis: The Story Behind the Sickness
- Air Pollution is Nepal’s #1 Threat. There it is. The “GBD 2023 Country Profile: Nepal” confirms that air pollution (particulate matter) is the single leading risk factor for all death and disability in the country. This directly explains why COPD is the #1 DALY cause and why IHD and stroke are so high (pollution is a major risk factor for all three).
- A “Syndemic of Inhalation”: Look at Nepal’s risks: #1 Air Pollution and #3 Smoking. This combination creates a synergistic epidemic, or “syndemic,” of inhalation. This deadly duo is the primary engine behind Nepal’s massive respiratory and cardiovascular burden.
- The Metabolic Menace is Here: The “double burden” is confirmed. High Blood Pressure (#2) and High Blood Sugar (#4) are also top-tier risks. This shows that Nepal is simultaneously battling a modern metabolic crisis on top of its severe environmental one.
- The Unfinished Agenda: Low Birthweight remains in the top 5 for both the globe and Nepal, a stark reminder that strengthening primary healthcare, maternal nutrition, and neonatal services is a non-negotiable, foundational priority.
Part 3: Conclusions & The Path Forward
The #1 Threat: Why Air Pollution is Nepal’s Public Health Emergency
The GBD 2023 data is an undeniable call to action. Air pollution is not a secondary “environmental” issue in Nepal; it is the paramount public health crisis.
This burden comes from two main sources:
- Ambient Air Pollution: Particulate matter from vehicles, brick kilns, and transboundary smoke that blankets valleys like Kathmandu.
- Household Air Pollution: The continued reliance on burning solid fuels (wood, dung) for cooking and heating indoors.
This “double-hit” of pollution, inside and outside the home, is why Nepal has such a devastatingly high rate of COPD.
Key Takeaways for Nepal’s Health Policy
The GBD 2023 study is not just a report; it’s a diagnostic tool. Here are the key takeaways for Nepal:
- Priority 1: Tackle Air Pollution. The data is clear. Any national health plan that does not have a multi-sectoral strategy to tackle ambient and household air pollution is missing the #1 driver of death and disability.
- Re-orient Health for COPD: The health system must be equipped to handle the COPD crisis, which is already the #1 burden. This means investing in spirometry at the primary care level, ensuring access to inhalers, and running aggressive smoking cessation programs.
- Fight the “Double Burden”: Nepal cannot choose. It must strengthen primary care for mothers and children (to fight neonatal disorders) while also building capacity to manage chronic NCDs (hypertension, diabetes, heart disease).
- Prepare for the Metabolic Wave: The high ranking of high blood pressure and diabetes is the warning sign for the next public health wave. Population-wide screening and access to affordable, long-term medication are essential.
Resources: Key GBD 2023 Reports (Published 2025)
These are the primary GBD 2023 “capstone” papers for researchers, policymakers, and health professionals. They are published in The Lancet and hosted by IHME.
- Main Burden Paper (DALYs & HALE):
- GBD 2023 Diseases and Injuries Collaborators. (2025). Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the GBD Study 2023. The Lancet.
- URL: https://www.healthdata.org/research-analysis/library/burden-375-diseases-and-injuries-risk-attributable-burden-88-risk-factors
- Mortality & Life Expectancy Paper:
- GBD 2023 Causes of Death Collaborators. (2025). Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet.
- URL: https://www.healthdata.org/research-analysis/library/global-burden-292-causes-death-204-countries-and-territories-and-660
- Demographics Paper:
- GBD 2023 Demographics Collaborators. (2025). Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950–2023: a demographic analysis for the Global Burden of Disease Study 2023. The Lancet.
- URL: https://www.healthdata.org/research-analysis/library/global-age-sex-specific-all-cause-mortality-and-life-expectancy-estimates
References
- GBD 2023 Causes of Death Collaborators. (2025). Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet.
- GBD 2023 Diseases and Injuries Collaborators. (2025). Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the GBD Study 2023. The Lancet.
- Institute for Health Metrics and Evaluation (IHME). (2025). Global Burden of Disease (GBD) 2023. https://www.healthdata.org/gbd/2023
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