Lecture 28. Addressing pop.health determinants and interventions globally

Question 1

what is the reason for studying global health?

Answer 1

inequalities are global

health issues are global

Question 2

Problems before the GBD project

Answer 2

• 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

Question 3

Reasons for GBD project

Answer 3

 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”

Question 4

Aims of the GBD project

Answer 4

1. 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
2. To take account of deaths as well as non-fatal
   outcomes (i.e., disability) when estimating the burden
   of disease
3. Include all countries.If data from a country is not available-> use results from similar country and adjust
   * used DALYs measure

Question 5

DALY( Disability adjusted life years)

Answer 5

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)

Question 6

YLL( years of life lost)

Answer 6

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)

Question 7

what are the key data points required for YLL?

Answer 7

 Number of deaths from the disease in a year

 Years lost per death relative to an ‘ideal’ age

Question 8

YLD( years lived with disability)

Answer 8

Represents morbidity by counting the years lived

with the disease

Question 9

What are the key data points for YLD?

Answer 9

 Number of cases with non-fatal outcome with the disease
 Average duration of non-fatal outcome until recovery/ death
 Disability weight ( 0-1 scale)

Question 10

disability weight scale

Answer 10

0-1 scale, used to describe the “weight” or the severity of an impairment or a disability

Question 11

DALY measurement

Answer 11

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)

Question 12

DALY uses

Answer 12

 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

Question 13

Cause vs risk in GBD terms

Answer 13

Cause- The reason for death/ disability (health outcome). Eg ISH
Risk- The reason for the cause. EG smoking

Question 14

3 groups of diseases in GBD

Answer 14

1. 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)
2. Non-communicable diseases (NCDs) / chronic diseases
   (e.g., heart disease, strokes, cancer, diabetes)
   Group 2 conditions in the GBD project
3. Injury
   Group 3 conditions in the GBD project

Question 15

what is the pattern of leading causes of DALY( diseases)

Answer 15

communicable disease rates are decreasing

non-communicable disease rates are increasing

Question 16

leading causes of DALY in NZ

Answer 16

non-communicable diseases and injury( eg road traffic injury)

Question 17

what is the strength of GBD in relation to age distribution

Answer 17

-it is able to capture not only the Number of death but also the age of death

Question 18

what is major contributor to DALY?

Answer 18

Young people deaths in low-income countries contributes a lot to YLL and thus to DALY

Question 19

Pattern of disease across countries with different income

Answer 19

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

Question 20

projections and trends in disease by cause

Answer 20

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

Question 21

Major gains of the DALY approach in informing priority setting globally

Answer 21

1. Drew attention to the previously hidden burden of
   mental health problems and injuries as major public health problems
2. Recognises Non-Communicable Diseases as a major and increasing problem in low- and middle-income countries (not just a rich country
   problem)

Question 22

Challenges in using DALY to quantify the burden of “disability”

Answer 22

1. 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
2. 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)

Question 23

medical model of disability

Answer 23

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.

Question 24

Social model of Disability

Answer 24

“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.