Lecture 27

Question 1

Global Burden of Disease (GBD) Project: reasons

Answer 1

1. Data on the burden of disease/injury from many countries were incomplete
2. Available data largely focused on deaths, little info on non-fatal outcomes (disability)
3. Libby groups can give a distorted image of which problems are most importnt
4. It’s difficult to decide which conditions are most important and which strategies may be the “best buys”

Question 2

Global Burden of Disease (GBD) Project: Aims

Answer 2

1. To use a systematic approach to summarise the burden of diseases and injury at the population-level based on epidemiological principles and best available evidence
   - To aid in the setting health service and health research priorities
   - To aid in identifying disadvantaged groups and targeting of health interventions
2. To take into account of deaths as well as non fatal outcomes when estimating the burden of disease

DALYs = the measure developed to achieve these aims

Question 3

Global Burden of Disease (GBD) Project: major impacts

Answer 3

Provides comprehensive data on disease, injury, and risk factors, leading to more informed policy decisions, resource allocation, and improved health outcomes.

Question 4

Disability Adjusted Life Year (DALY)

Answer 4

The SUMMARY MEASURE of POPULATION HEALTH that combines data on PREMATURE MORTALITY (fatal) and NON-FATAL HEALTH OUTCOMES to represent the health of a particular population as a single number

A DALY represents a lost health life year

Question 5

Leading causes and risk factors contributing to deaths/disabilities in NZ and globally

Answer 5

Heavily influenced by non-communicable diseases (NCDs)

85% of the leading causes of DALYs come from non-communicable diseases (NCDs) for NZ In 2024

Most of the people in high income countries die after 80

In low income countries, people don’t make it to 40 –> contributing a lot of DELYs to the global burden of disease

Non-communicable is lowest for high income countries

Question 6

Gains of the DALY approach in informing priority setting globally

Answer 6

1. Drew attention to previously hidden burden of mental health problems and injuries as major public health problems
2. Recognises non-communicable diseases (NCDs) as a major and increasing problem in low and middle income countries (not just a rich country problem)

Question 7

Challenges/limitations in using DALYs to quantify the burden of “disability”

Answer 7

1. Disability weights are considered to be the same as the severity of an impairment relating to a disease and do not vary with a person’s social position, where they live, their access to healthcare or any other life circumstance
2. The GBD project criticised for its potential to represent people with disabilities as a “burden”

Question 8

Medical models of disability

Answer 8

Focus: Individual impairment

Causes: Individual conditions, deficits

Solution: Medical intervention, rehabilitation

Perspectives: Individual is dependent and needing to be cured or cared for

Goal: “fixing” the individual

Question 9

Social models of disability: the disabling factor

Answer 9

The INACCESSIBLE ENVIRONMENT

Question 10

Medical models of disability: the disabling factor

Answer 10

The PHYSICAL LIMITATION, needing medical assistance or specialised devices to participate in society

Question 11

Social models of disability

Answer 11

Focus: Societal barriers and attitudes

Causes: Social structures, policies, environmental factors, attitudes

Solution: Removing barriers, creating inclusive environments

Perspectives: Disability as a social construct

Control: The “helping” expert (paternalistic approach)

Goal: Creating a society where everyone can participate fully

Question 12

How to calculate DALY (data elements)

Answer 12

DALY = YLL + YLD
Summary measure = Years of life lost + years lived with disability

Question 13

YYL - Years of Life Lost

Answer 13

Represents mortality by counting the years lost due to PREMATURE DEATH caused by a disease
- The years lost if a person dies before reaching the average life expectancy in a particular country

Question 14

Data points required to calculate YLL

Answer 14

1. Number of deaths from the disease in a year
2. Years lost per death relative to an “ideal” age

Question 15

YLD - Years lived with disability

Answer 15

Represents MORBIDITY by counting the years lived with the disease

Question 16

Data points required to calculate YLD

Answer 16

1. Number of cases with non-fatal outcome with the disease
2. Average duration of non-fatal outcome until recovery/death
3. Disability weight

Question 17

0

Answer 17

A year in perfect health

Question 18

1

Answer 18

A year of life lost to death due to a health condition

Question 19

Between 0 and 1

Answer 19

A year lived with disability

Question 20

DALY enables comparison between diseases to:

Answer 20

1. Prioritize health issues, risks and interventions
2. Monitor health interventions
3. Assess changes of disease burden over time

Question 21

GBD cause

Answer 21

The reason for death/health disability (health outcome)

Question 22

GBD risk

Answer 22

The cause of the cause