Module 4 Flashcards
fundamentals of population/public health
Provide the maximum benefit for the largest number of people
need for priorities
- Health resources are finite (limited)
- Each prioritisation has an opportunity cost
- Rationing involves ethical (what communities want/need) as well as evidence-based judgement
- difficult to compare outcomes
(can only compare mortality and hospitalisation rates but not all who are diseased (reduced QOL compared to those without) die and some are not able to access/afford hospital care and thus not counted) - Tension between: Individual (clinical services) vs population needs (population health services)
reasons for GBD
- Data (measures of calculating or identifying mortality and hospitalisation data) on the burden of disease (and injury) from many countries were incomplete/limited
- Available data largely focused on deaths
=> little information on non-fatal outcomes (disability) - (Tension between) Lobby groups can give a distorted image of which problems are most important
- 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”
Lobby groups
form of advocacy with the intention of influencing decisions made by the government by individuals or more usually lobby groups
- whether a condition is prioritised or not often depended on power of the lobby groups to be able to lobby
GBD reason simplified
needed a way to measure/have a comparable measure to look at health conditions across the board from a global context
aims of GBD
- To use a systematic approach to summarise 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 (not just counting the number but also when they happen) as well as non-fatal outcomes (i.e., disability) when estimating the burden of disease
in countries where data is not available…
GBP project identifies a comparable country and then use computational methods to estimate the disease burden in those countries
=> trying to get a real global picture rather than just keeping them out
What GBD looks at
- number of deaths but also WHEN a person dies in relation to life expectancy in a particular country
- non-fatal outcomes (disabilities)
Disability adjusted life years (DALYs)
summary measure of population health that combines data on premature mortality (YLL) and non-fatal health outcomes (YLD) to represent the health of a particular population as a single number which can be used in comparisons between diseases
DALYs enable comparisons between diseases to
- prioritise health interventions
- monitor health interventions
- assess changes of disease burden over time
DALY =
YLD + YLL
YLL
years of life lost
- Represents mortality by counting the years lost due to premature death caused by a disease
(Years lost due to dying before reaching the average life expectancy–ideal age–in a particular country)
YLL =
no. deaths from disease in a year x years lost per death relative to an ‘ideal age’
YLD
years lived with disability
- Represents morbidity by counting the years lived with the disease
YLD datapoints
- no. cases with non-fatal outcome (impairment) from disease
- average duration of non-fatal outcome until recovery/death
- disability weight
disability weight
scale between 0 (full health) and 1 (death)
- GDB Project has a huge team of medical experts that look at possible diseases/disabilities and give each a weight
DALY represents a lost healthy life year
- year in perfect health = 0
- year of life lost due to death = 1
- year with disability = between 0 and 1
cause
reason for death/disability (health outcome)
risk
reason for cause
income
- based on world bank definition
- inequities from a global scale
group 1 conditions
- communicable (infectious) diseases
- perinatal conditions
communicable disease example
diarrhoea, TB, measles, HIV/AIDS, malaria
perinatal conditions example
problems in pregnancy, childbirth, early life
group 2 conditions
- non-communicable diseases (NCDs)
- chronic diseases