Lecture 28. Addressing pop.health determinants and interventions globally Flashcards
what is the reason for studying global health?
inequalities are global
health issues are global
Problems before the GBD project
- it was difficult to compare health outcomes between countries
- used mortality and hospitalization data to prioritize on a global scale
- > missed out on people with health conditions who do not die, but their life quality is poor because of it
- not everyone with the disease has access to hospital care
- > miss out on people with the disease who do not access hospital care
Reasons for GBD project
Data on the burden of disease (and injury) from many
countries were incomplete( limited resources)
Available data largely focused on deaths; little information
on non-fatal outcomes (disability)
Lobby groups can give a distorted image of which
problems are most important. Prioritization depends on the power of the Lobby group
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 the “best buys”
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
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 deaths as well as non-fatal
outcomes (i.e., disability) when estimating the burden
of disease - Include all countries.If data from a country is not available-> use results from similar country and adjust
* used DALYs measure
DALY( Disability adjusted life years)
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
DALY= YLD( years lived with a disability before recovery or death) + YLL( years of life lost)
YLL( years of life lost)
Represents mortality by counting the years lost due to premature death
caused by a disease
(the years lost if a person dies before reaching the average life expectancy in a particular country)
what are the key data points required for YLL?
Number of deaths from the disease in a year
Years lost per death relative to an ‘ideal’ age
YLD( years lived with disability)
Represents morbidity by counting the years lived
with the disease
What are the key data points for YLD?
Number of cases with non-fatal outcome with the disease
Average duration of non-fatal outcome until recovery/ death
Disability weight ( 0-1 scale)
disability weight scale
0-1 scale, used to describe the “weight” or the severity of an impairment or a disability
DALY measurement
A year in perfect health = 0
A year of life lost due to death = 1
A year with disability = between 0 and 1 ( depends of disability weight)
DALY uses
Enables comparisons between diseases by using one measurement unit
that considers premature death and disability
Enables comparison between diseases to:
prioritize health interventions
monitor health interventions
assess changes in disease burden over time
Cause vs risk in GBD terms
Cause- The reason for death/ disability (health outcome). Eg ISH
Risk- The reason for the cause. EG smoking
3 groups of diseases in GBD
- Communicable diseases (infectious diseases), e.g., diarrhea,
TB, measles, HIV/AIDS, malaria
Group 1 conditions in the GBD project includes communicable diseases
AND problems in pregnancy, childbirth, or early life (perinatal conditions) - Non-communicable diseases (NCDs) / chronic diseases
(e.g., heart disease, strokes, cancer, diabetes)
Group 2 conditions in the GBD project - Injury
Group 3 conditions in the GBD project
what is the pattern of leading causes of DALY( diseases)
communicable disease rates are decreasing
non-communicable disease rates are increasing
leading causes of DALY in NZ
non-communicable diseases and injury( eg road traffic injury)
what is the strength of GBD in relation to age distribution
-it is able to capture not only the Number of death but also the age of death
what is major contributor to DALY?
Young people deaths in low-income countries contributes a lot to YLL and thus to DALY
Pattern of disease across countries with different income
High-income countries- low rate of communicable disease, high rate of NCD
Middle/ low income- a mix of both
Low income- higher communicable disease prevalence, and lower NCD
BUT with GBD we are able to capture a rise in NCDs in lower-income countries as well
projections and trends in disease by cause
Globally:
- a projected increase in NCD in low/middle-income countries
- Group 1( CD and perinatal ) diseases decrease apart from HIV/AIDS
- Group 2(NCD) diseases are increasing
- Group 3 injuries are increasing
Major gains of the DALY approach in informing priority setting globally
- Drew attention to the previously hidden burden of
mental health problems and injuries as major public health problems - Recognises Non-Communicable Diseases as a major and increasing problem in low- and middle-income countries (not just a rich country
problem)
Challenges in using DALY to quantify the burden of “disability”
- Disability weights are considered to be the same as the
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 was criticized for its potential to represent
people with disabilities as a ‘burden’
-the weight of the same disease will be different in different countries
Questions to ask:
• 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 do the physical and social environment influence disability
experiences?( in different countries the infrastructure is different, some might not accommodate the disability as well as others)
medical model of disability
Thought to be taken up by GBD project
• 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 (and justifies the way in which disabled
people have been systematically excluded from society)
• The disabled person is the problem, not society.
• Control resides firmly with professionals
• Choices for the individual are limited to the options provided and
approved by the ‘helping’ expert.
Social model of Disability
“Disability” is no longer seen as an individual problem but as a
the social issue caused by policies, practices, attitudes and/or the
environment.
The social model focuses on ridding society of barriers, rather
than relying on ‘curing’ people who have impairments.
