[MUSIC] So hello again, my name is Dr. Alessandro Demaio and welcome to the second lecture in your wake on noncommunicable diseases. This lecture is entitled Global Burden of Disease, The Rise NCDs and builds on an earlier lecture that Dan Marovich back at the start of your course gave you on the Global Burden of Disease Study that was released again last year in 2012. But in particular, we're going to focus on one aspect of that and that is The Rise of NCDs and the findings relating to noncommunicable disease globally. But before we do that, we need to just recap on one thing. I want to go over the concept of disability-adjusted life years or DALYs with you one more time, because this is going to be the main indicator that we use to monitor burden and disease outcomes for the risk factors, but also diseases associated within noncommunicable diseases. So disability-adjusted life here, as we explained back at the start of the course includes years of life lost plus years of life lost to disability. That is a normal, healthy life will have a beginning, a middle and an end. If someone dies earlier than expected based on global projections, then we include those years that they lost to death. And if they have times of disability or disease in their life, we use a fraction of a simple measure to work out how many years of life lost to disability that corresponds to, depending on the disease. So those two combined, give us a measure of disability-adjusted life years. If you've forgotten this and go back and have another look at the lecture from earlier in the course, but we'll move on for now. So what is the Global Burden of Disease? Well the Global Burden of Disease is an analysis, which provides a comprehensive and comparable assessment of mortality and the loss of health for all regions of the world. The overall burden of disease is assessed using as I mentioned, disability-adjusted life years or DALYs. The original Global Burden of Disease Study or GBD 1990 study was commissioned by the World Bank in 1991 to provide a comprehensive assessment of the burden of 107 diseases and injuries and 10 selected risk factors for the world and 8 major regions within the world in 1990. The methods of the GBD 1990 study created a common metric to estimate the health loss associated with morbidity and mortality globally. It generated widely published findings and comparable information on disease and injury indices and also gave us a snapshot of incidence and prevalence for diseases around the world's regions. It also stimulated numerous national studies on the burden of disease and these results have been used by government and non-government agencies to inform priorities for research, development, policies and funding since. The principle guiding the burden of disease approach is that the best estimates of incidence, prevalence and mortality can be generated by carefully analyzing all available resources of information in a region or a country and by correcting for biases. So let's have a look now at how the Global Burden of Disease Study works in some more detail. First of all, the Global Burden of Disease studies provide an assessment of the health of the world's populations. They provide detailed regional and global estimates for premature mortality, disability and loss of health for 135 causes by age and by sex. They draw on extensive WHO databases and on the information provided by the Member States. Today, there is great demand for global burden estimates and research and advocacy groups have brought new conditions to the awareness of the public health community. With that in mind, the 2010 Global Burden of Disease Study reviews the magnitude of these conditions, compared to other causes of health burden. The Global Burden of Disease 2010 is significantly broader in scope than the previous versions, particularly 1990. It includes 291 diseases and injuries, 67 risk factors, 1,160 nonfatal health consequences. It estimates for 21 regions, it estimates for 20 age groups and it uses improved methods for the estimation of health state severity weights. Researchers have also significantly improved methods for burden assessment since the original Global Burden of Disease Study in 1990. And so these new tools can markedly enhance the validity of estimations, particularly for ranking risk factors and disabilities. So let's now skip forward and have a look at some of the key findings of the 2010 Global Burden of Disease Study and also compare these to the findings from 1990 and see how the world's morbidity and mortality measure through disability-adjusted life years has changed. So some of the findings of the 2010 Global Burden Disease Study published in 2012, include years lived with disability for 1,160 nonfatal outcomes of 289 diseases and injuries from the 1990 to 2010 region. Also, it gives healthy life expectancies for more than 187 countries. So we've looked at how the Global Burden of Disease Study is structured and why it came about. Let's look at some of the findings. So here on the screen, you see the top 20 causes of deaths across the globe, ranked from 1 to 20 depending on their contribution of global mortality. This is for both sexes and all ages. What you'll notice if you look across the colors to begin with, blue is NCDs, red is infectious diseases and also maternal child health and green is injuries. What you'll notice is that the leading causes of death in 1990 and 2010, the top two in fact haven't changed. They are ischemic heart disease and stroke. COPD has overshot lower respiratory infections to become number three. Lung cancer has increased from number eight, to number five. And across the board, a pretty consistent change has been the increase in rankings for NCDs. At the same time, we've seen a decrease in the ranking of most infectious diseases. Malaria, tuberculosis, diarrhoeal diseases and lower respiratory infections to name a few in the top ten. The standout, obviously, example of running contrary to this is HIV, which we've seen an enormous increase in the last 20 years. If we now change it from global to first developed, we see the first thing that we notice is a dramatic change in the color representation that is a dominance of NCDs. We also notice that the top six causes have largely remained unchanged, although we have seen an increase in these diseases and the mortality caused, the rankings haven't in fact changed. We have seen no dramatic increase in Alzheimer's disease, diabetes and cirrhosis or liver disease and we're seeing slight reductions in stomach cancer and also brain injuries. If now we move to developing countries that remaining on causes of mortality, main rankings. We see a lot more of a dominance of the red colors coming back, so communicable diseases and we see some quite dramatic changes from 1990 to 2010. Stroke moves from number two to number one. Ischemic heart disease moves from number five to number two. COPD remains constant at number three, lower respiratory infections decrease along with diarrhoeal diseases. And as I mentioned earlier, the main one running in contrary to this trend is obviously HIV. We also see a rapid increase in road traffic injuries in developing countries is self-harm, lung diseases, diabetes and hypertensive heart disease among others. And finally here, we're looking at the same tree map diagram. The metric represented in this diagram is in fact, deaths and not disability adjusted life use. So, it's the contribution of the various diseases to mortality. In developing countries, both sexes and all age groups. This is 2010, but we see 10% of total deaths that contributed by ischemic heart disease and around 10% from cerebrovascular disease or stroke. Both of these we combine to make cardiovascular disease. If the contrast is with diarrhoeal diseases. Diarrhoeal diseases contribute around 3.5% of mortality in developing countries. Let's now scale back the time and compare this with a picture in 1990 and we see quite a different picture. Diarrhoeal diseases contribute 7%, so double what they do in 2010. Stroke contributes around 8% percent and ischemic heart disease around 6. So looking across these three diseases and the trends more widely, you can begin to appreciate the change in disease patents, but also global burden contributed by communicable and noncommunicable diseases. So that gives you an idea of the data that's available and the changes in burden of disease measured by the various outcomes across specific regions in globally in the last 20 years. Let's now have a look at some key outcomes of the 2010 Global Disease Study. So in terms of mortality, we found that morality rates are falling pretty much across the board around the world. That globally 52.8 million death occurred in 2010 and this is approximately 13% more than 1990 and 20% more than 1970. The global crude death rates have fallen from 11% to 7% per 1,000 population due to the much larger relatively increase in the world's population from 3.7 billion in 1970 to 6.9 billion in 2010. We've seen an increase in life expectancy from 1970 to 2010. Global male life expectancy at birth increased from 56.4 years to 67.5 years and females from 61 to 73 years. In terms of risk factor burden, the findings indicate that there has been an increase in burden from high blood pressure, high body mass index and high blood sugar. The dietary respect is in physical inactivity collectively, account for around 10% of global disability adjusted life using 2010, which puts them in the same tier as tobacco smoking, alcohol use and childhood malnutrition. In terms of causes of mortality, we've also seen dramatic changes. So the world is witnessing a huge shift in the leading cause of premature death from communicable, maternal, neonatal and nutritional top causes towards noncommunicable diseases. In 1990, 34% of all deaths were due to communicable, neonatal and maternal causes. In 2010 though, these largely preventable conditions account for still one-quarter of the 52 million deaths. The annual number of deaths from noncommunicable diseases have risen by 8 million to 34.5 million or 2 out of 3 deaths in 2010. So now there are a lot of numbers and a lot of ideas, I want to now sort of relate it. How does this link back with your own perspective? And particularly for one of the implications for you as global health practitioners, but also global health in the 21st century. Well first, the health of young people is very important. As more and more children survive into adulthood, if it's really must be, we found from the Global Burden of Disease 2010 study, but efforts really must be intensified to prevent young adult deaths. Young adults, especially men are now dying at very high rates in Eastern Europe, Central Asia and Eastern and Southern Africa, largely due to epidemics of alcohol related mortality in the former regions and HIV in the latter regions. The second one, the big message is that NCDs are here to stay. For this reason, policies that effectively encourage and facilitate lifestyle changes, especially a more balanced diet and increased physical activity would likely have an enormous impact on global health and the health of populations. And finally, the balance of longer lives and healthier lives. Disability-adjusted life years are obviously, a measure of life lost to disability, but also years of life lost. And so from the Globe Burden Disease 2010 study in comparing it to 1990, we really must see that over the next decades, we don't have only a focus on extending lives, which will likely pass the life expectancy mark of 100 years for many countries, but also that we focus on making these latter years increasingly free from disability and disease. And strategies that effectively deal with the increasing burden and their determinants are likely to be cost-effective, but also bring enormous benefits to populations globally. So that's it for me for the Global Burden of Disease talk and I hope you enjoyed it.
