Lecture 27 GBD project (DALYS)

Question 1

Why should we worry about setting priorities?

Answer 1

Lack of resources, evidence based outcomes, opportunity cost, difficult to compare outcomes, individual vs population needs

Question 2

What is opportunity cost?

Answer 2

A decision will benefit some and create a loss for others. We previously chose decisions that would be greater for a larger portion of the population but this results in inequities, so we should start focusing on marginalised groups

Question 3

Why is it difficult to compare outcomes?

Answer 3

Because the impact of disabilities on a persons life is hard to measure, and data from healthcare systems only includes individuals who have interacted with the systems

Question 4

What are reasons for the creation of GBD?

Answer 4

Data about diseases were incomplete, data on non fatal diseases was largely unavailable, lobbying groups distort the importance of diseases, diseases needed to be judged based on the same set of conditions to allocate resources fairly

Question 5

What are the aims of the GBD?

Answer 5

To create a systemic approach for determining the importance of diseases (aids in setting health service and interventions, helps identify at risk groups) and to take into account non fatal diseases. Measured using DALYS = YLL + YLD

Question 6

Whats is DALYs?

Answer 6

A measure of disease based on the combination of years of life lost (compared to average life expectancy) and years of life lived with disease

Question 7

What does YLL represent?

Answer 7

It takes into account the years of life lost to the average life expectancy and also the number of deaths in a year

Question 8

What does YLD represent?

Answer 8

The number of non fatal outcomes, the average life expectancy of those with non fatal outcomes and the disability weight (a year lived with a disability is measured between 0-1)

Question 9

What is group 1 diseases?

Answer 9

Communicable diseases

Question 10

What is group 3 diseases?

Answer 10

Injuries

Question 11

What is group 2 diseases?

Answer 11

Non Communicable diseases

Question 12

What are the global changes in DALYS patterns?

Answer 12

There are more non communicable diseases present on the top 10 diseases globally, and mental disorders have made the list. HIV/AIDS remains a problematic communicable disease

Question 13

What are the DALYs for high income countries?

Answer 13

Non communicable diseases and injuries are predominant

Question 14

What are the DALYs for low income countries?

Answer 14

High contribution of perinatal, nutritional and communicable diseases.

Question 15

What are the changes in projected life expectancy globally?

Answer 15

All life expectancies are increasing, however the inequities are not changing

Question 16

What are the global trends for type 1 diseases?

Answer 16

All communicable diseases are lowering, except for HIV/AIDS which is increasing

Question 17

What are the global trends for type 2 diseases?

Answer 17

All non communicable diseases are increasing

Question 18

What are the global trends for type 3 diseases?

Answer 18

Injuries are increasing

Question 19

What are the major gains of the DALY approach?

Answer 19

Drew attention to the hidden burden of mental health issues and injuries as major public health problems, Recognizes non communicable diseases as an increasing problem in middle and low income countries (its not just a high income country problem)

Question 20

What are challenged in using DALYS to quantify the burden of disability?

Answer 20

Who should decide the disease burdens, whether one set of disease burdens should be applied globally, how the social and physical environments affect disability experience

Question 21

What are the MAJOR challenges in using DALYs to quantify the burden of disability?

Answer 21

Disability weights are considered to be the same as the severity of the disease and do not take into account the individuals social position and location, it represents people with disabilities as a burden

Question 22

Which model does the GBD use?

Answer 22

It uses the medical model, where 1. disabled people are defined by their illness 2. the disease the individuals problem 3. makes disabled people seem like they need care 4. THE DISABLED PERSON IS THE PROBLEM< NOT SOCIETY 5. Control resides within professionals 6. Treatment options are only provided by helpers

Question 23

How should disability be seen as?

Answer 23

It should not be seen as an individual problem but be seen as a social issue caused by policies, practices, attitudes and environment.

Question 24

What does the social model focus on?

Answer 24

Focuses on ridding society of barriers to disabled people, instead of treating the illness.