Module 4: Deciding on Interventions to Improve PopHlth Flashcards
Population/public health goal
Provide max benefit for largest no of people
Why worry about priorities
Health rss are limited
Each prioritisation has an opportunity cost
Rationing involves ethical and evidence-based judgement
Difficult to compare outcome ‘apples and oranges’
Individual (clinical services) vs pop needs (pop health services)
Reasons for Global Burden of Disease (GBD) project
Data on burden of disease and injury from many countries were incomplete
Available data largely focused on deaths; little info on non-fatal outcomes (disability)
Lobby groups can give distorted images of which problems are most important
Unless the same approach is used to estimate burden of diff conditions, it’s difficult to decide which conditions are most important
Aims of GDP project
To use a systematic approach to summarise the burden of diseases and injury at pop level, based on epidemiological principles and best available evidence
- aids in setting health service and research priorities
- aids in identifying disadvantaged groups and targeting of health interventions
To take account of deaths as well as disability when estimating burden of disease
Disability Adjusted Life Years (DALYs)
Specific measure developed to achieve aims of GBD project
A summary measure of pop health combining data on premature mortality and non-fatal health outcomes to represent health of a particular pop as a single number
DALY = ?
YLD + YLL
YLD = years lived with disability
YLL = years of life lost
DALY values
A year in perfect health = 0
A year of life lost due to death = 1
A year with disability = between 0 and 1
YLL (Years of Life Lost)
Represents mortality by counting the years lost due to premature death caused by a disease
i.e. the years lost if a person dies before reaching average life expectancy in their country
YLL = no of 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 years lived with disease
No. of cases with non-fatal outcome with the disease
Average duration of non-fatal outcome until recovery/death
Disability weight (represents severity of impairment)
A DALY represents…
A lost healthy life year
DALYs enable comparisons between…
Diseases by using one measurement unit that compares premature death and disability
Between diseases to:
- prioritise health interventions
- monitor health interventions
- assess changes of disease burden over time
In general, as countries developed economically…
Average life expectancy has increased and fertility rate has decreased
GBD groups
Group 1: Communicable/infectious diseases - includes communicable diseases and perinatal conditions (early life)
Group 2: Non-communicable diseases (NCDs) / chronic diseases
Group 3: Injury
Major gains of DALY approach in informing priority setting globally
Drew attention to 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 mid-income countries (not just rich countries)
DALYs: Challenges - 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 does physical and social environments influence disability experiences?
2 major challenges in using DALYs to quantify burden of ‘disability’
Disability weights are considered to be the same as the severity of an impairment relating to a disease/health condition, and don’t vary with a person’s social position, where they live, access to healthcare etc.
GBD project criticised for its potential to represent people with disabilities as a ‘burden’
Issues highlight differences in the way ‘disability’ as a concept is sometimes viewed - perceptions
Models of disability
Medical model
Social model
Medical model of disability
Disabled people are defined by their medical condition
Regards disability as an individual problem
Promotes view of a disabled person as dependent and needing to be cured or cared for - excluded from society
Control resides firmly 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 an individual problem but as a social issue caused by policies, practices, attitudes and/or the environment
Focuses on ridding society of barriers, rather than relying on ‘curing’ people who have impairments
A higher burden of deaths at a younger age in low income countries contribute…
A lot of YLLs to the global DALY burden
Diff countries use diff measures to prioritise health issues, which leads to…
Difficulty prioritising on a global scale
High vs low income countries - groups of disease
High income - high amount of group 2 (non-communicable) disease
Low income - high amount of group 1 (communicable) disease
Disability weight - legislation
Can diff countries be given the same disability weight?
Which health model is GDP perceived to focus more on
Medical model of disability