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Global Burden of Disease and Injury Series the Global Burden of Disease SUMMARY GLOBAL BURDEN OF DISEASE AND INJURY SERIES THE GLOBAL BURDEN OF DISEASE A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 EDITED BY CHRISTOPHER]. L. MURRAY HARVARD UNIVERSITY BOSTON, MA, USA ~tt.'·,~ ~ :lijIoI ~W ~ 'I 1ff ~~ WORLD HEALTH WORLD ORGANIZATION BANK HARVARDSCHOOL OF PUBLIC HEALTH PUBLISHED BY THE HARVARD SCHOOL OF PUBLIC HEALTH ON BEHALF OF THE WORLD HEALTH ORGANIZATION AND THE WORLD BANK DISTRIBUTED BY HARVARD UNIVERSITY PRESS CONTENTS INTRO D U CT I O N I 1. THE GBD ' s A P P RO AC H TO MEASU RING HEALTH STATUS 6 2. H o w T HE WORLD D IEST O DAY 14 ISBN: 0-9655466-0-8 3. DISABILITY: T HE I N VIS I BLE BURD EN 2 0 Library of Congress Cataloging-in-Publication (CIP) Data applied for. 4. THEG LO BAL B URDEN O F DI SEASE I N 1990 S. RISK FACTORS F OR DEATH AND DISABI LI T Y 27 6. LOOKING AH EAD: THE HEA LTH OF THE WORLD IN 2020 3 I 7. FROM THE S E RI ES 40 T able of Contents for Volume I 40 List o f Annex T ables 4 1 Global Health Statistics: Samp le table fro m Volume 11 4 2- The Glo bal Bu rden of Disease and Injury Series 43 This booklet is a summary of the The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in I990 and Projected to 2020, edited by Christopher ].L. Murray and Alan D. Lopez, published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank and distributed by Harvard University Press. It also contains examples of the detailed information on the epidemiology of 240 conditions around the world published in Global Health Statistics: A Compendium of Th e Global Burden of Disease Study and the The Glob al Burden of Disease and Incidence, Prevalence and Mortality Estimates for Over 200 Conditions, by Global Health Statistics would not have been possible with out the financial support Christopher J.L. Murray and Alan D. Lopez, published by the Harvard of the Edna McConnell Clark Foundation, the Rocke feller Foundation, the World School of Public Health on behalf of the World Health Organization and the Bank and the WHO Ad Hoc Committee on Health Research Relating to Future World Bank and distributed by Harvard University Press. Intervent ion Option s. This summary has been prepared by Phyllida Brown . The preparation and printing of the summary were made possible through a grant from the Eli Lilly Foundation and Harvard Medical International. © Copyright 1996 World Health Organization. All rights reserved. "Publication of the Global Burden of Disease and Injury Series marks the transition to a new era...1 firmly predict that by the turn of the century the official reporting of health outcomes in dozens of countries and globally will embody the approach and standards described in this series." INTRODUCTION Dean T.[amison, Professor of Public Health, Uniuer­ sity of California Los Angeles and Chairman, WHO Ad Hoc Committee of Health Research Relating to Future Intervention Optio ns The next two decades will see dramatic changes in the health needs of the world's populations. In the developing regions where four-fifths of the planet's people live, noncommunicable diseases such as depression and heart disease are fast replacing the traditional enemies, such as infectious diseases and malnutrition, as the leading causes of disability and premature death. By the year 2020, noncommunicable diseases are expected to account for seven out of every ten deaths in the developing regions, compared with less than half today. Injuries, both unintentional and intentional, are also growing in importance, and by 2020 could rival infectious diseases worldwide as a source of ill health. These changes are expected because of the rapid aging of the developing world's populations, As a population's birth rate falls, the number of adults relative to children increases, and the population's commonest health problems become those of adults rather than those of children. In China, some other parts of Asia and Latin America, this so-called "epidemiological transition" is already much further advanced than many public health specialists appreciate. In all regions the rapidity of change, and the very large absolute numbers involved, will pose serious challenges to health-care systems and force difficult decisions about the allocation of scarce resources. Yet, until now, many governments have lacked even ktGIOI\IAL GItOUrlNCS the most basic data they needed to inform debate and to assess priorities o ~::i~~~~~.t=:i::~~~lleb~ .;ru lC) 0 ~ ::t:~~j:~~~~~rn fOrA!) Ewl'lom,n -dt tNl't'hi .... fIllf.ahikf,If_\11ff. Auuff. r'-')' ...ANCC1'IH IArAI) for public health . ~=~~~~~~~':i:l:!tErf~ IFSEf 0 ~~~~rs..~~i~~~~~SS) Aftcinv-CIlfAIn iOl:ult\ln dOhrot'" :AI'5r.1 A(t'iClW ",h-uhu;~ IASSI Now, for the first time, this gap has been filled with a landmark o I..dl;l tlNDI Wrin Amtriu ,,"It ,ht Unhhullll.AQ Jl'loNtINDI Amtinc.1l..uin.a)'dQnkfAI.O InckIINt>, AtnrfiqllC'l.,incccuuIM(,UCI publication. Researchers at the Harvard School of Public Health and the C g:~ :~~~: • ~~ ~cJt;; :::~C~ ~'b~~: World Health Organization, with more than 100 collaborators from Ch"",ICUNI Croinanr nloytfl_I('fICotllC.\tO) around the world, have produced a comprehensive, internally consistent and comparable set of estimates of current patterns of mortality and disability from disease and injury for all regions of the world, with projections to the year 2020. The Global Burden of Disease and Injury Series, the ten-volume result of their study, is a unique resource that 2 The Global Burden ofDisease SUMMARY 3 provides policy-makers with their well advanced, suggesting that public health policy, with its traditional first comprehensive picture of the Deaths from emphasis on infectious disease, has not kept pace with events. In addition, it makes a number of startling individual observations. Just four examples world's current and future health noncommunicable needs . are highlighted here: The researchers involved in this diseases are expected to • The burdens of mental illnesses, such as depression, alcohol dependence ambitio us five -year effo rt climb from 28. I million and schizophrenia, have been seriously underestimated by traditional developed a new approach to approaches that take account only of deaths and not disability. While measuring health status. Their a year in I990 to 49.7 psychiatric conditions are responsible for little more than one per cent method quantifies not merely the million by 2020-an of deaths, they account for almost 11 per cent of disease burden number of de aths but also the worldwide. impact of premature death and increase in absolute disability on a population, and • Adults under the age of 70 in Sub-Saharan Africa today face a higher numbers of77 per cent. combines these into a single unit probability of death from a noncommunicable disease than adults of of measurement of the overall the same age in the Established Market Economies. " burden of disease" on the • Men living in the Formerly Socialist Economies of Europe have a population. The series also presents the first estimates of the proportion disturbingly poor, and deteriorating, health status, including a 28 per of mortality and disability that can be attributed to certain risk factors cent risk of death between the ages of 15 and 60. for disea se, including tobacco, alcohol, poor water and san itation, and • By 2020, tobacco is expected to kill more people than any single disease, unsafe sex. surpassing even the HIV epidemic. A TIMELY ASSESSMENT OF GLOBAL HEALTH NEEDS The Global Burden of Disease Far from confirming what was already known, the study offers significant Adults under the age of study (GBD) has involved an surprises. Overall, it shows that the epidemiologica l transition is already estimated forty person-years of 70 in Sub-Saharan Africa effort. An extraordinarily large today face a higher volume of data-on 483 separate Figure I Projected trends in death by broad cause Group, sequelae of 107 diseases and developing regions probability ofdeath from in juries, and 14 million death Developing regions a noncommunicable cenificates--has been subjected 40 to rigorous analysis using both disease than adults ofthe newly developed and well­ same age in the established methods. Volume I, 30 The Global Burden of Disease, VI Established Market summarizes the key concepts, -C ,g Economies. methods and results and Volume I 20 11, Global Health Statistics, VI presents the mass of underlying s: ... epidemiological and demographic data. Details of the remaining eight '"41 Cl 10 volumes, which deal with specific conditions and country-based analyses, are shown on page 43 of this booklet. The burden of disease and injury ha s been calculated for eight O L.L ---L -L- ----J demographic regions (see Map): the Established Market Economies 1990 2000 2010 2020 (largely the OECD countries) (EME); the Formerly Socialist Economies of Europe (FSE);India ((ND); China (CHN I; Other Asia and Islands (OAI); - Noncommunicable diseases Sub-Saharan Africa (SSA); Latin America and the Caribbean (LAC) and Communicable. perinatal. maternal and nutritional conditions the Middle Eastern Crescent (MEC). Burden is analysed by five age groups, - Injuries by sex and by cause. 4 The Global Burden ofDisease SUMMARY 5 This booklet presents the key findings of Volume I. The first section Figure 3 DALYs attributable to diarrhoea. HIV and tobacco. summarizes the concepts and methods involved in developing a single 1990-2020 (baseline scenario) measure of health status. Sections 2 through 5 present the results for the 1990 assessments and section 6 summarizes the 2020 projections.
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