Global Health
Chapter four
Global burden of disease
There are some 7 billion people in the world and hundreds of millions experience disease or
injury each year. Taken as a whole, the combined pain, suffering, loss of productivity and
unrealized hopes and dreams are our world’s burden of disease.
The burden of disease approach is a systematic, scientific effort to quantify the comparative
magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geography for
specific points in time.
The burden of disease can be thought of as a measurement of the gap between current health
status and an ideal situation where everyone lives into old age, free of disease and disability.
“The purpose of the research into the global
burden of disease was not only to measure and describe the health of the world but also, and
more important in many ways, to explain why these events and phenomena have occurred.”
The Global Burden of Disease study, begun in 1992, involved 100 collaborators in more than
20 countries. It attempted to quantify disease and injury burden of over 100 conditions and make
projections out 30 years for 500 consequences or results of these conditions.
The Global Burden of Disease Study 2010 (GBD 2010) has three related but distinct uses:
1. to provide a coherent picture of which diseases, injuries, and risk factors
contribute the most to health loss in a given population;
2. to compare population health across communities and over time;
3. and to help guide an assessment of where health information systems are strong or
weak by identifying which data sources are missing, are of low quality, or are
highly uncertain
Global Burden of Disease Surprises-2020
1. Rapid rise of chronic disease
73% of GBD by 2020
2. High level mental illness
3.7% of GBD – depression
3. Violence, war, injuries
12% deaths worldwide
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41% deaths < 20 years, USA
4. Alcohol and Tobacco
Tobacco #1 instigator
Fastest gain, underdeveloped nations
5. Significant increase in cancer
Number 1 killer in many countries
Reasons to measure burden of disease
Assign priorities between different public health problems.
Compare strategies on a single public health problem in terms of impact.
Choose health interventions that target different health problems with different strategies.
Health risks
Although there are many possible definitions of “health risk”, it is defined here as “a factor that
raises the probability of adverse health outcomes”. The number of such factors is countless.
Burden of disease and global risk factors
Five leading risk factors identified in this report (childhood underweight, unsafe sex, alcohol use,
unsafe water and sanitation, and high blood pressure) are responsible for one quarter of all deaths
in the world, and one fifth of all DALYs.
Burden of disease and global risk factors
The leading global risks for mortality in the world are:
High blood pressure (responsible for 13% of deaths globally),
Tobacco use (9%),
High blood glucose (6%),
Physical inactivity (6%), and
Overweight and obesity (5%).
These risks are responsible for raising the risk of chronic diseases such as heart disease, diabetes
and cancers. They affect countries across all income groups: high, middle and low.
The leading global risks for burden of disease as measured in disability-adjusted life years
(DALYs) are:
Underweight (6% of global DALYs) and
Unsafe sex (5%), followed by
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Alcohol use (5%) and
Unsafe water, sanitation and hygiene (4%).
Three of these risks particularly affect populations in low-income countries, especially in the
regions of South-East Asia and sub-Saharan Africa. The fourth risk – alcohol use – shows a
unique geographic and sex pattern, with its burden highest for men in Africa, in middle-income
countries in the Americas and in some high-income countries.
Life span vs. Health Span
Lifespan
Number of years lived
Health Span
Number of healthy years lived
We increasingly appreciate that disease and disability can significantly limit an individual's
productivity and happiness and radically alter individual, family and community well being.
Examining “Lifespan” and “Health Span”
Impact on: “Lifespan” “Health Span”
Cause % Total % Total
Deaths Disability
Malnutrition 11.7 15.9
Malnutrition is responsible for approximately 12% of total deaths worldwide, radically altering
global “lifespan,” but affects “health span” to an even greater degree, contributing nearly 16% of
the world’s total disability.
Four Key Drivers of Rapid Changes in Global Health Patterns
Demographic transition – increasing population size, substantial increase in the average
age in most regions and falling death rates.
Cause of death transition – fraction of deaths or years of life lost shifting from
communicable, maternal, neonatal and nutritional to non-communicable diseases and
injuries despite the HIV epidemic.
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Disability transition – steady shift to burden of disease from diseases that cause disability
but not substantial mortality.
Risk transition – shift from risks related to poverty to behavioral risks.
The risk transition
As a country develops, the types of diseases that affect a population shift from primarily
infectious, such as diarrhea and pneumonia, to primarily non-communicable, diseases such as
cardiovascular disease and cancers. This shift is caused by:
Improvements in medical care, which mean that children no longer die from easily
curable conditions such as diarrhea
The ageing of the population, because non-communicable diseases affect older adults at
the highest rates
Public health interventions such as vaccinations and the provision of clean water and
sanitation, which reduce the incidence of infectious diseases.
Major risk factors
Changing Disease Burden
Expected to Decrease
Lower respiratory infections
Diarrheal disease
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Perinatal conditions
Measles
Congenital anomalies
Malaria
Malnutrition
Anemia
Expected to Increase
Depression
Heart disease
Traffic accidents
Chronic obstructions/
pulmonary disease
War, violence, suicide
HIV
Lung cancer
Change in 20 leading causes of daly at global level, 2000 to 2011
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The Global Burden of Disease
“The burden of disease is the great oppressor, perhaps the single greatest cause of loss of
personal freedom. Now, more than any other time in human history, we can influence this great
oppressor with our actions. We have it within our power to improve the health of people on the
earth.”
DALY
The disability-adjusted life year (DALY) is a measure of overall disease burden,
expressed as the number of years lost due to ill-health, disability or early death.
DALY "extends the concept of potential years of life lost due to premature death...to
include equivalent years of 'healthy' life lost by virtue of being in states of poor health or
disability. In so doing, mortality and morbidity are combined into a single, common
metric.
One
Disability Adjusted Life Year
“One year lost to poor health.”
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A DALY is a health outcome measure with two main components
Quality of life reduced due to a disability
Lifetime lost due to premature mortality
It is essential to understand what the DALY-concept measures and how it is constructed. Burden
is measured along two dimensions: time lived with disability and time lost due to premature
mortality.
DALYS due to living with disability
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a
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Global Health
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Some basic Definitions
u
r Impairment: loss or abnormality of psychological, physiological, or anatomical structure
i
t or function
y
Disability: any restriction or lack of ability to perform an activity in the manner or within
the range considered normal.
Handicap: disadvantage resulting from impairment or disability that limits or prevents the
fulfillment of a role that is normal (depending on age, sex, social, and cultural factors).
Disease Impairment Disability Handicap
Polio Paralyzed legs Inability to walk Unemployed
Mild mental
Brain injury Difficulty learning Social isolation
retardation
Industrialization and Urbanization
Dietary changes lead to:
Higher levels of obesity, diabetes and heart disease.
Smoking, high fat diets and poor exercise habits accompany industrialization and
urbanization.
Developed Nations:
Resources to challenge harmful changes
Developing Nations:
No resources to cope
NB: Poor people are often sick because they are poor, and sometimes poor people are poor
because they are sick.”
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