Lecture 27: Global Burden of Disease (GBD) Project Flashcards
why should we worry about setting priorities?
- health resources are finite
- rationing involves ethical as well as evidence-based judgement
- there will always be an opportunity cost
- difficult to compare outcomes
- individuals vs population needs
reasons for the gbd project?
many projects were based on mortality data that didn’t reflect the quality of life.
- there was little information about non-fatal outcomes (disability)
- data was incomplete from many countries because they weren’t important in those countres
- lobby groups gave a distorted image of which problems are the most important.
- unless the same approach is used to estimate burden, it is difficult to decide which conditions are the most important.
what is the aim of the gbd?
- use a systematic approach to summarise burden of disease and injury at the pop level
- to aid in setting health services + health research priorities
-to aid in identifying disadvantaged groups + targeting of health interventions - takes into account fatal + non fatal outcomes when estimating the burden of disease
- the measure developed is called dalys (disabiliy of adjusted life years) which represents a lot healthy life year
what is the daly equation?
years of life lost (yll) + years of life lived with disability (yld)
what is years of life lost?
represents mortality by counting the years lost before reaching the average life expectancy
equation: number of deaths for certain age * number of years lost
what is years lived with disability?
represents morbidity by counting the years lived with the disease
- average duration of non-fatal outcome until recovery/death
disability weight: 0 is perfect health, 1 is death
what does daly enable?
comparison between diseases to..
prioritise health issues, risks and interventions
monitor health interventions
assess changes of disease burden over time
gbd terms
cause: reason for death/disability
risk: cause of cause
communicable disease: infectious disease that spreads), also prenatal conditions (childbirth, early life, pregnancy)
non-communicable disease: chronic illness
injury: group 3 conditions in the GBD project
trends in dalys from 1990 to 2019
perinatal, nutritiounal and communicable disease became much less
non communicable disease became much more
mental disorders are now included (before it was just mortality)
burden of disease by broad cause
most low income countries die from perinatal, nutritional and communicable diseases
high income countries die from non-communicable diseases
project trends in death by cause
group 1: decreasing (except for hivs)
group 2: increasing
group 3: increasing
what are the advantages of daly
- drew attention to previously hidden burden of mental health problems + injuries as major health problems
- recognises non-communicable diseases as a major and increasing problem in low and middle income countries
challenges of daly
- disability weights are considered to be the same as the severity of an impairment relating to a disease, and do not var with a persons sep, where they live, their access to healthcare/any other life circumstance
- gbd project was criticised for its potential to represent people with disabilities as a ‘burden’
**who should decide what weights should be assigned to which disabilities?
medical model of diability
- disabled ppl are defined by their illness
- individual problem, not societys problem
- dp = depedent + needing to be cured/cared for –> justifies the way in which disabled ppl have been systematically excluded from society
- control resides with professionals
- choices for individual are limited to options provided, and approved by the helping expert.
social model of disability
- disability is no longer seen as individual problem, but as a social issue caused by policies, practices, attitudes and environment
- focuses on ridding society of barriers rather than relying on ‘curing’ people who have impairments.
