Module 4 Lecture 27

Question 1

This course is not focusing on individuals…..

Answer 1

Understanding a specific person’s health condition, relevant risk factors and treatment outcomes is the content of clinical or personal health courses where we start by taking an individual’s history

Question 2

Why worry about priorities

Answer 2

• Health resources are finite
• Each prioritisation has an opportunity cost
• Rationing involves ethical as well as evidence based judgement
• It is difficult to compare ‘apples and oranges’
• Individual (clinical services) vs population needs (population health services)

Question 3

Reasons for the GBD project

Answer 3

• Data on the burden of disease (and injury) from many countries was incomplete
• Available data largely focused on deaths; little information of non fatal outcomes (disability)
• 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”

Question 4

Aims of the GBD projects

Answer 4

1) to use a systematic approach (very quantitative) to summarise the burden of diseases and injury at the population level based on epidemiological principles and best available evidence
2) To take account of deaths as well as non fatal outcomes when estimating the burden of disease —> diseases that effect QUALITY of life have been picked out

Question 5

What were the key sources of data for this project

Answer 5

• Vital ‘registration data’
• Disease surveillance systems
• Epidemiological studies and surveys
• Statistical models developed to get best estimates when data were incomplete

Question 6

DALYs definition

Answer 6

A summary measure of population health that combines data on mortality and non fatal health outcomes to represent the health of a particular population as a single number

Question 7

DALYs equation

Answer 7

Years of Life Lost to mortality (YLL = Number of deaths/years lost per death) + Years Lived with Disability (YLD = Incedence of cases witht heir non-fatal outcomes; average duration of non fatal outcomes; disability weight)

Question 8

Group 1, 2 and 3 conditions in the GBD project

Answer 8

Group 1: Communicable diseases e.g. diarrhoea, TB, measles. HIV/AIDS, malaria
Group 2: Non-communicable diseases/chronic diseases e.g. heart disease, strokes, cancer, diabetes
Group 3: Injury

Question 9

Demographic Transition

Answer 9

decline in fertility and mortality rates observed in most developed and several developing countries

Question 10

Epidemiological Transition

Answer 10

characteristic shift in the composition of causes of death and disability from communicable to non-communicable diseases

Question 11

Risk Transition

Answer 11

Changes in risks factor profiles as countries shift from low to higher income countries, where common risks for perinatal and communicable diseases are replaced by risks for non communicable diseases

Question 12

Double burden of disease

Answer 12

In many middle-income countries, previously common risks for perinatal and communicable diseases co-exist with increasing risk for non-communicable diseases

Question 13

Major impacts of GDB approach

Answer 13

• Informed priority setting based on premature death as well as disability
• Avoided biases due to incomplete data and reliance on mortality data alone
• Methods used could be applied to any population
• Non-communicable diseases recognised as a major and increasing problem in low- and middle- income countries
• Drew attention to previously hidden burden of mental health problems and injuries as major public health problems