Question

What are some potential difficulties/challenges faced by collecting data on the contribution of drugs to the global burden of disease.

Answer 1

Ans) The substantial scientific and policy interest in the methods and findings of the 1990 GBD study, the widespread application of the methods by countries at all levels of health development, and the adoption of the framework as the preferred method for health accounting by international health agencies such as the World Health Organization attest to the critical need for objective and systematic assessments of the disease burden for priority setting in health.

- The vast and comprehensive effort to quantify the disease burden worldwide dramatically changed views about the importance of some conditions, particularly psychiatric disorders, and drew global public health attention to the unrecognized burden of injuries.

- The methodological developments over the past decade, a more systematic approach to collecting key data and research findings on the health of populations, and the results of numerous national and sub-national burden of disease studies have dramatically improved the methodological armamentarium and the empirical base for disease burden assessment, in particular, the comparability of the estimated contributions of diseases, injuries, and risk factors to this burden.

- The 2001 GBD study provides a comprehensive update of the comparative importance of diseases, injuries, and risk factors for global health.

- The study incorporates a range of new data sources to develop internally consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major causes by sex and by eight age groups. Estimates of deaths by cause, age, and sex were carried out separately for 226 countries and territories, drawing on a total of 770 country-years of death registration data, 535 additional sources of information on levels of child and adult mortality, and more than 2,600 data sets providing information on specific causes of death in regions not well covered by death registration systems. Together with the more than 8,500 data sources (epidemiological studies, disease registers, notifications systems, and so on) used to estimate incidence, prevalence, and YLD by cause, the 2001 GBD study has incorporated information from more than 10,000 datasets relating to population health and mortality (see chapter 3). This represents one of the largest syntheses of global information on population health carried out to date.

- Much of the research on the burden of disease undertaken over the past decade or so has relied on the methodological and empirical efforts that defined the 1990 GBD study as a major advance in global public health statistics. Progress in updating the epidemiological basis for assessing the disease burden from the various diseases and injuries of interest has been uneven, although improvements in the data and methods available for assessing global and regional mortality by cause have been substantial, and some advances have been made in the data for, and epidemiological understanding of some major causes of ill health such as HIV/AIDS and diabetes mellitus. Nevertheless, making more reliable estimates of global, regional, and national disease burdens still faces many methodological and empirical challenges. The substantive agenda, mapped out over a decade ago (Murray, Lopez and Jamison, 1994) remains equally valid today and needs to be addressed more systematically if the burden of disease framework is to gain greater acceptance as the international tool for health accounting.

- Assessing and documenting in detail the state of the world's health at the beginning of the millennium is a useful undertaking. This volume will provide scholars today and in the future with a definitive historical record of the leading causes of the burden of disease for major regions of the world at the start of the 21st century. An account of global health at the beginning of the 20th century, or earlier, would no doubt have been of more than just historical interest, but given the methods of scientific interchange and the state of scientific and methodological knowledge at the time, this was impossible.

- In presenting the comprehensive findings of the 2001 GBD study, this volume is, in many respects, a culmination of the effort launched in 1990 and represents the end of the beginning of global disease burden assessments. The widespread use of disease burden concepts by national and international bodies since the first results were published and the heightened interest in improving the basic descriptive epidemiology of diseases, injuries, and risk factors by both countries and agencies has laid the foundations for future population health assessments. As programs and policies to improve health worldwide become more widespread, so too will the need for more comprehensible, credible, and comparable assessments to periodically monitor world health and the success, or otherwise, of measures to promote health and reduce the burden of disease. New initiatives, and perhaps new global institutions, are required to measure the burden of disease worldwide and how it is changing, more reliably than hitherto. So it provides the baseline against which such progress with global health development will be measured.