Academic journal article Bulletin of the World Health Organization

The Global Burden of Disease in 1990: Summary Results, Sensitivity Analysis and Future Directions

Academic journal article Bulletin of the World Health Organization

The Global Burden of Disease in 1990: Summary Results, Sensitivity Analysis and Future Directions

Article excerpt

A basic requirement for evaluating the cost-effectiveness of health intervention s is a comprehensive assessment of the amount of ill health (premature death and disability) attribut able to specific diseases and injuries. A new indicator, the number of disability-adjusted life years (DAL Ys), was developed to assess the burden of disease and injury in 1990 for over 1 00 causes by age, sex  and region. The DALY concept provides an integrative, comprehensive methodology to capture the entire  amount of ill health which will, on average, be incurred during one's lifetime because of new cases o f disease and injury in 1990. It differs in many respects from previous attempts at global and regional health situation assessment which have typically been much less comprehensive in scope, less detailed, and l imited to a handful of causes. This paper summarizes the DALY estimates for 1990 by cause, age, sex and region.  For the first time, those responsible for deciding priorities in the health sector have access  to a disaggregated set of estimates which, in addition to facilitating cost-effectiveness analysis, can be  used to monitor global and regional health progress for over a hundred conditions. The paper also shows how  the estimates depend on particular values of the parameters involved in the calculation. 

Introduction

Three perceived needs of the international public health information system motivated the design and implementation of the Global Burden of Disease (GBD) study reported here, which was undertaken collaboratively by WHO and the World Bank as background for the World Bank's World development report 1993: investing in health[1]. The first is that if, ten years ago, one had summed the various estimates of mortality, by cause, for children and adults, they would have equalled several times the total deaths at each age. Through the efforts of the World Health Organization, stimulated in part by the World Bank's health sector priorities review, the estimates for deaths by cause under age 5 have been rationalized[2]. Through a consultative process, the estimates for major causes of child mortality generated by WHO technical programmes now add up to the total mortality. For adults, however, a consistent set of estimates of mortality by cause did not exist prior to this study. Furthermore, claims about adult mortality by various disease advocates have not been scrutinized. The most detailed review of adult health, the World Bank's study on adult health in developing countries[3], indicated the weakness of measurements of adult mortality levels and causes. Providing a plausible, internally consistent, set of estimates of mortality by cause was an important goal for this exercise.

Second, most discussions of international public health priorities ignore issues of disability. For some, disability is considered only a problem for societies that have already undergone the epidemiological transition and where mortality rates are low. Considerable efforts have been made in recent years to measure disability, both by the United Nations and through national research projects[4-13]. While these works are important advances in the measurement of disability, they have not much influenced the debate on health priorities - in large part because the burden of disability by cause or that part of it which is amenable to specific health interventions has not been measured. Estimating the amount of life lived with a disability and its relative significance vis-a-vis premature mortality by cause was thus a second major goal of the study.

Third, too often health planners or decision-makers are faced with a multitude of health problems and priorities for action. The disease or health problem with the most vocal or eloquent advocates often garners the most attention. Some problems, however, do not have ready advocates and continue to be ignored. A major justification for the Global Burden of Disease study was to provide a process through which every disease or health problem would be evaluated in an objective fashion. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.