DALYs for 291 Diseases and Injuries 1990-2010

Christopher JL Murray, Institute Director

The Royal Society, 14 December 2012

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Outline

Four Key Patterns

Leading Causes of Burden

Regional and National Variations on the Themes

Future Directions

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Three Ds Explain Rapid Changes in Global Health Patterns

1) Demographic transition is shifting burden from children to young adults.

2) Disease transition is leading to a larger fraction of deaths from non-communicable diseases.

3) Disability transition is shifting the burden of disease to conditions that cause disability but not substantial mortality.

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Change in Percent of DALYs Due to NCDs 1990-2010

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Disability Transition: Share of DALYS Due to YLLs and YLDs by Region, 1990 and 2010

1990 2010

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Fourth Pattern: the Majority of Burden in sub-Saharan Africa is Still from MDGs 4, 5 and 6

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Outline

Four Key Patterns

Leading Causes of Burden -- DV

Regional and National Variations on the Themes

Future Directions

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Uncertainty Varies by Cause

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Decomposing Change in DALYs Into Population Growth, Population Aging and Changes in Age-Specific Rates

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Outline

Four Key Patterns

Leading Causes of Burden

Regional and National Variations on the Themes -DV

Future Directions

Leading Causes of DALYs by Country, 2010

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Outline

Key Global Findings

Three Drivers of Rapid Transition

Regional and National Variations

Future Directions

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Sustaining and Expanding the GBD as a Global Public Good

1) Vision: provide the world access to continuously updated country level assessments of the burden of disease over time for all major diseases, injuries and risk factors using the latest available evidence.

2) As new evidence on descriptive epidemiology is published, collected through surveillance systems or released in reports, this evidence should be rapidly incorporated in the GBD country, regional and global estimates and made widely available.

3) Methodological innovations or studies that provide new insights into etiology or causation should also be adopted when the evidence is compelling.

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Expanding the Scope of the GBD

1) Including forecasts for disease burden (mortality, causes of death, prevalence, YLDs, YLLs, DALYs) by country for the next 15-25 years.

2) Track health expenditure at the national level by disease and injury categories.

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Relating Burden to What Health Systems Do

1) Estimate the DALYs averted through current health service provision. How many DALYs are averted through the 12.7 million US outpatient visits and 3 million bed-days for cellulitis?

2) What are opportunities for public health, primary care and referral care for averting DALYs that are not occurring.

3) Provide an integrated framework for understanding at a detailed level changes in health and the role of public health and medical care in contributing to these changes.