Global burden of disease Flashcards
Why should we worry about priorities in population health
Health resources are limited
2)Each prioritization has an opportunity cost
Rationing involves ethical as well as evience based judgement
“Difficult to compare outcomes”
“individual” vs (clinical services)vs ppopulation needs (population health services)
Why was the GBD project created
Data on the burden of disease and injury from many countries were incomplete
available data largely focused on deaths, and there is little information on non-fatal outcomes like disability
Lobby groups can give a distorted image of which problems are most important as they influence awareness/funding
Unless the same approach is used to estimate the burden of different conditions, it is difficult to decide which conditions are most important and which strategies may be best buys
What are the Aims of the GBD project
To use a systematic approach to summarize the burden of diseases and injury at the population-level based on epidemiological principles and best available evidence
1) to aid in setting health service and health research priorities
to aid in identifying disadvantaged groups and targeting of health interventions
To take account of the deaths as well as non-fatal outcomes when estimating the burden of disease
What is a DALY
Disability-Adjusted Life Year
A summary measure of population health that combines data on premature mortality and non-fatal health outcomes to represent the health of a particular population as a single number
How are DALYs calculated
DALY=YLD+YLL
YLD-years lived with disability,
YLL years of life lost (measured from expected life years of a country)
A year in perfect health =0
A year of life lost due to death=1
A year with disability=between 0 and 1
Years of Life lost
represents mortality by counting the years lost due to premature death casued by a disease
(The years lost if a person dies before reaching the average life expectancy in a particular country)
Years lived with disability
represents the morbidity by counting the years lived with the disease
Number of cases with non-fatal outcome with the disease
average duration of non fatal outcome until recovery
Disability weight
What are the advantages
Enables comparisons between diseases by using one measurement unit that compares premature death as well as disability
Enables assessment of changes of the disease burden over time
What is meant by the demographic transition
as countries have developed economically, average life expectancy has increased and fertility rate has decreased
What are the Major gains of the DALY approach in informing priority setting globally
1) Drew attention to previously hidden burden of menatl health problems and injuries as major public health problems
2) Recognizes Non-communicable diseases as a major and increasing problem in low and middle-income countries 9not just a rich country problem)
What are some challenges in using DALYs to quantify the burden of disability
who should decide what weights should be assigned to various disabilities
Is it reasonable to apply one set of disability weights globally?
Do all people with a particular level of disability have similar opportunities to be part of society
How does physcial and socail environment influence disability experiences?
2 Major challenges in using DALYs to quantify the burden of disability
Disability weights are considered to be the same as the severity of an impairment relating to a disease/health condition and do not vary with a person’s social position, where they live, their access to healthcare or any other life circumstance
THE GBD project is criticized for its potential to represent people with disabilities as a burden
These issues highlight differences in the way that disability as a concept is sometimes viewed
What is the medical model of disability
Disabled people are defined by their illness or medical condition
regards disability as an individual problem
promotes the view of a disabled person as dependent and needing to be cured or cared for=this justifies the way in which disabled people have been systematically excluded from society
The disabled person seen as the problem not society
Control resides firmly with professionals
Choices for the individual are limited to the options provided
Social model of disability
Disability is no longer seen as an individual problem but as a social issue caused by policies, practices, attitudes and the environment
The social model focuses on ridding society of barriers rather than relying on curing people who have impairments
