Global burden of disease
Able to define the global burden of disease and the relevant concepts
o Disability-adjusted life years (DALYs)
This quantifies the number of years of life lost (YLL) due to disease & premature death
and the number of years of life a person lives with disability caused by the disease (YLD)
DALY = YYL (mortality) + YLD (morbidity)
YYL = years of life lost to (early) death
YLD = years of life of a person with disability caused by the disease
o Global burden of disease study
A systematic effort to quantify the comparative magnitude of health loss due to disease,
injuries and risk factors by age, sex, and geographies for specific time points
- <1990 no state of health in the world
- 1990 commissioned by the world bank
- 2000 commissioned by the WHO: burden of disease unit
- 2010 collaboration between 7 institutions
o WHO classifications of NCDs and CDs
Group 1 Communicable disease > one that can be spread from one person to another
through a variety of ways including:
- Physical contact with an infected person
- Contact with a contaminated surface or object
- Bites from insects or animals capable of transmitting the disease
- Transmission via the air
Group 2 Non-communicable disease > chronic diseases, four main groups:
- Cardiovascular diseases
- Cancers/neoplasms
- Chronic respiratory diseases
- Diabetes
Group 3 injuries, including road traffic accidents, falls, violence and homicide (mental
health problems)
Able to describe demographic and epidemiologic transitions
Demographic > shift from a stable population of high fertility and high mortality to a more
stable population of low fertility and low mortality.
Epidemiologic > infectious and parasitic diseases > receding pandemics > degenerative
and man-made diseases (become more prevalent as society’s undergo evaluations) >
delayed degenerative diseases.
The shift from infectious diseases to chronic diseases.
Understands shifts/trends in global burden of disease
o Such as the double and triple burden of disease
Double burden of disease > the onset of significant burden from NCD’s while the burden
from CD’s remains high.
Triple burden of disease > the onset of significant burden from NCD’s while the burden
from CD’s remains high plus other conditions/causes:
- Increased accidents, suicides, homicides
- Self-harm, substance use
- Mental disorders
Other causes of double and triple burden of disease >
- Population: growth, aging, demographic/epidemiological transitions
- Globalization: for example increased mobility risk of infections as well as travelling
lifestyles creates more access to fast food
- Urbanization: increased risks of infections in urban cities
- Climate change: less crop yields, more air pollution related diseases
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, Understand why the burden of disease is measured and how to
measure/calculate it
Why is the burden of disease measured:
- Policy/enabling environment > Change and develop policies to improve population
health, compare health of populations, and identify/quantify health inequalities
- Organizational > Ensure attention to implement health interventions, and to
provide debates on priorities
- Community > Social aspects,
- Individual/population > burden of death, screening, and diagnostics, social aspects
Measures of frequency and calculations:
Morbidity (condition of having a disease) > two indicators
- Incidence = (number of new cases of disease during a specific time frame/total
population at risk) * 1000
o Calculating incidence is a measure of risk of a disease in a population
- Prevalence = (number of existing cases/total population) * 1000
o Calculating prevalence measures the burden of disease in a population
Mortality (deaths from disease) > four indicators
- Neonatal MR = number of infant deaths (<28 days old) / 1000 live births in a given
year
- Infant MR = number of deaths in infancy (<1 year) / 1000 live births in a given
year
- Child MR = probability that newborn will die before 5-year-old / 1000 live births
- Maternal MR = number of women who die as a result of pregnancy or childbirth
complications / - 100,000 lives births in a given year
Measures of severity > disability/impairment: no disability 0 <> 1 death
Why is it important to understand and measure GBD?
- Understand the shifts and trends in diseases – and to focus on what is crucial and
important
- Evidence to guide: policies, funding, resources, practices, efforts
- Improve health and well-being of individuals
- Focus on specific diseases based on the population
Social determinants of health
Be able to define social determinants of health
SHOD are the non-medical social factors that influence health outcomes.
- Includes the conditions in which people are born/work/live etc. (shaping conditions
of daily life)
- The forces and systems including economic policies and system, development
agendas, social norms/policies, and political systems
- Influences of health inequities
Be able to apply a social determinants of health framework to
understand health outcomes
Conceptual frameworks help to understand complex situations. It helps to identify what
social determinants are at play, how these influence health outcomes and provide
potential starting points for interventions.
- Dahlgren rainbow model > health determinants as layers with the individual
lifestyle factors in the center & broader societal factors as the outer layers
- CSDH > address health inequities globally it emphasizes that health outcomes
worsen as SES decreases
Understand how health inequities arise and the importance of social
justice in addressing these health inequities
Health inequalities = differences in the health of individuals or groups, which are
measurable.
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