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Summary Global differences in disease and treatment from minor drug intervention
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DRUG INTERVENTIONCOURSE: GLOBAL
DIFFERENCES IN DISEASE
AND TREATMENT
Cases, practical’s and lectures
, Lecture 1: Burden of Diseases and its transitions
TO PREDICT, PREVENT AND MANAGE HEALTH CHALLENGES ;
1. Measure health and disease status
a. Burden of diseases studies can support our understanding of the main health
problems:
i. GBD( global burden of disease)study from the institute for health metrics
and evaluation and other academic partners
1. Regional estimates from 1990 on health loss from hundreds of
diseases, injuries and risk factors.
ii. WHO global health estimate
1. Comparable assessment of mortality and loss of health due to
diseases and injuries for all regions of the world.
iii. State of health in the EU
1. Comparative data and insights into health and health systems in EU
countries.
iv. CBS Centraal bureau voor de statistiek
1. National reports on health and care published in the Netherlands.
v. CDC
1. Annual data summaries present analyses of health topic or present
new information on methods measurement issues published in the
US.
b. In these studies you can find information on:
i. Death;
1. Mortality
ii. Diseases;
1. Morbidity and disability
iii. Risk factors;
1. Attribute or exposure that increase the likelihood of developing a
disease or injury ( underweight, unsafe sex, tobacco and alcohol
consumption)
iv. Determinants of health;
1. Underlying characteristics that shape the health of individuals and
communities(the social and economic environment → work and
education)
c. Global health indicators, how is health and disease measured?
i. Proximal
1. Direct measure of health events (Deaths, diseases, immunized
children)
ii. Distal
1. Indirect measure (Education, poverty, sensation)
iii. Objective
1. Quantifiable and independent of individual experiences(deaths
,diseases, life expectancy)
iv. Subjective
1
, 1. Self-related/ perceived health(reported health state, psychological
state)
v. Health expectancy
1. Estimate of life expected to live healthy(disability free life
expectancy, disability adjusted life expectancy)
vi. Health Gap
1. Provided info on years of healthy life lost( disability adjusted life
years/DAILY, years of life lost/YLL)
d. Pro’s
i. Improvements in methodology
ii. Valuable estimates for comparison an monitoring of health and risks
iii. Mean to monitor progress towards meeting SDG agenda(Standard
Development Goals) → It is important that you align with the global
efforts(grants).
iv. Increasing attempt to include more conditions and risk factors
v. Highlight the need for improvements in data collection and management
vi. Increased transparency
vii. Include uncertainty intervals → You know the range of the study
e. Cons
i. Lack of information
ii. Low quality data (not complete or consistent
iii. Limited spatial resolution (country)
iv. Limited temporal resolution(only specific time points, new research)
v. Limited stratification (age, sex)
vi. Different methodologies for collection and analysis ( different reporting and
classification of mortality , disease and disabilities)
vii. WHO and GBD have different methodologies and resources
viii. Who estimated more death (29% of the average of the 2 estimates)
ix. A difference of 450,00 deaths in 2015)
2
, 2. Understand health and disease trends
a. How does the disease change and what does the future hold
i. Transitions models describe:
1. Life expectancy at birth
2. Child mortality rates
3. Causes of deaths
4. Excess deaths by country
5. Daily’s per risk factor
6. Predictions for the rank of diseases by the amount of deaths
ii. Major changes in the last 50 years
1. Mortality has decreased across all age groups
2. <5 mortality → around (or under) 5 million
3. Deaths from infectious disease largely decreased
4. 74% of estimated deaths in 2019 from non-infectious diseases
5. Among injures increase death from conflict and terrorism
6. Increase levels of obesity
7. Increase prevalence of mental health conditions
iii. Factors important to understand when looking at the transitions models:
1. Place → Where does this data come from?
2. Time → When was this data collected?
3. Categories → What category of disease am I looking at Is this disease
an infectious/communicable diseases, chronic or non-communicable
disease? (HPV and cancer, obesity)
4. Definition → How is the definition of health changing and how does
this impact our understating of the burden of diseases?
5. Determinants/risk factors → Which determinants should I consider
that change the burden of diseases?
iii. Changes in the burden of disease are affected/described by:
a. Changes in the burden of disease are affected by the demographic
transitions (increase in number and age of people) and the epidemiologic
transitions (shift in disease patterns).
b. The shift in the major causes of death from infectious diseases to chronic
and degenerative diseases associated with a long-term decline mortality.
3
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