Kuntoro Global Burden and Current Issue of PH 050315

GLOBAL BURDEN OF DISEASE AND
CURRENT ISSUES OF PUBLIC HEALTH

1
PROF KUNTORO, MD, MPH, DRPH

D E PA R T M E N T O F B I O S TAT I S T I C S A N D P O P U L AT I O N S T U D Y,
A I R L A N G G A U N I V E R S I T Y S C H O O L O F P U B L I C H E A LT H
kuntoro global health sphmu ns 2/18/2018

SUBTOPIC
2
Global Burden Of Disease

Current issues of public health
(SDGs)
Population growth
Urbanization
Climate change
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GLOBAL BURDERN OF DISEASE

Definition
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 Burden of disease is a measure used to assess and

compare the relative impact of different diseases and
injuries on populations.
 A measure, like incidence rate, prevalence rate, fertility
rate.
 For assessing and comparing.
 Impact, not output or outcome
 Relative impact, not absolute impact
 Different diseases, injuries, we add risk factors
 On population  related to population study

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 It quantifies health loss due to disease and

injury that remains after treatment,
rehabilitation or prevention efforts of the
health system and society generally.
 Australian Institute of Health and Welfare
(https://www.aihw.gov.au/burden-of-
disease/ - 240314)

DISEASE, IMPACT :
INJURY
IMPACT
TREATMENT, ASSESSMENT :
REHABILITATION, HEALTH LOSS ?
PREVENTION HEALTH
IN HEALTH SYSTEM OR BENEFIT ?
SOCIETY
kuntoro global health sphmu ns 6 2/18/2018

7
 People suffered from various diseases

 Various diseases put different amount of disease burden
on populations.
 Burden of disease is burden that a particular disease
process has in a particular area as measured by cost,
morbidity, and mortality.
 Burden of disease is quantified by summary measures of
population health.

Summary measures of population health
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1. Health expectancy
2. Health gaps

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DISABILITY ADJUSTED LIFE YEAR (DALY)

DALY
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 Combining the number of years of healthy life lost due to

disability and the number of years of healthy life lost due
to premature death
 One DALY for one lost year of health life
 may be used for comparing different diseases, injuries,
and risk factors
 may compare and contrast conditions that cause few
deaths but much disability and illness with conditions
that cause many premature deaths

DALY
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 Formula :
 DALY = YLD + YLL
 YLD is a measure for non-fatal burden
of disease
 YLL is a measure for fatal burden of
disease

YLL (The years of Life Lost)
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 The number of deaths multiplied by the standard life

expectancy at the age at which death occurs.
 Formula :
 YLL = N x L
 N = number of death
 L = standard life expectancy at age of death in years
 YLL measure the incident stream of lost years of life due to
deaths, an incidence perspective has also been taken for the
calculation of YLD in the original Global Burden of Disease
Study for year 1990 and in subsequent WHO updates for years
2000 to 2004.

YDL (The years Lost Due to Disability)
19
 To estimate YLD for a particular cause in a particular time

period, the number of incident cases in that period is
multiplied by the average duration of the disease and a
weight factor that reflects the severity of the disease on a
scale from 0 (perfect health) to 1(death).
 Formula :
 YLD = I x DW x L
 I = number of incident cases
 DW = disability weight
 L = average duration of case until remission death (years)

Prevalence Years Lived with Disability (PYLD)
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 Formula :
 PYLD = P x DW
 P = number of prevalent cases
 DW = disability weight

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 PYLD may also be calculated using the prevalence of the

disease in the study year multiplied by its disability
weight.
 Prevalent YLD provide an indication of the burden of
disease that is relevant to service utilization or
expenditure.
 Prevalent YLD reflect the burden of disability over tha
current year due to cases arising in preceding years and
persisting into the current year(that is, prevalent cases).

Non-fatal burden:years lived with disability(YLD)
22
 Example of asthma :
 Most of impact of asthma is on physical functioning and
on the ability to perform social roles.
 For asthma, the largest component of the DALY is “years
lived with disability (YLD).
 The term “ disability” refers to health states other than
ideal good health and may be short term(ex: a day with a
common cold) or long term(ex: chronic arthritis pain).

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 To calculate YLD for incident cases occurring in the study

year, an estimation of the incidence of the disabling
disease or injury for the specified time period is required.
 Incident YLD are calculated by multiplying the number of
incident cases of disease by the duration of the disease
(from year of incidence to year of remission or death) and
a disability weight associated with that disease.
 Incident YLD are useful for estimating the potential
value to be gained by preventing an incident case of a
disease.

Disability weight
25
 There are several methods for developing disability

weights that reflect the burden of disease relative to other
conditions, injuries, or risk factors.
 The methods involve valuation exercises in which
participants make judgments about where a condition lies
in a continuum between perfect health and death.
 Disability weight gives indication of the severity of the
disease on a scale from 0 (perfect health) to 1 (death).

Adjustment for comorbid conditions
27
 At the same time, an individual may suffer from two or

more conditions.
 In this case, we apply disability weight corrections for
coexisting health states.
 Disability weight for each condition or health state are
generally derived in isolation and may not be summed to
account for comorbid conditions.
 Corrections for coexisting health states or “comorbidity”
must be derived empirically.

28
 Example in Australia study : hospital data and various

surveys were used to estimate the probabilites of
coexistence for each of the possible combinations of
health states.
 They were modelled using an approach which accounted
for dependence between health states  groups of
conditions being more likely to coexist due to common
causal pathways (Begg et al., 2007)

Fatal burden: years of life lost due to premature death(YLL)
29
 DALY may be considered as a health gap measure.

 The gap between current patterns of mortality and and an
ideal scenario where everybody survives into old age.
 Mortality gap is used for calculating the years of life lost
due to premature death (YLL).
 Mortality gap is defined by using internationally
recognized standard.
 It is provided by the Coale and Demeny West level 25 and
26 model life tables

30
 The remaining life expectancy at each age from those

model life tables is taken as “ the ideal length of life for a
person at that age.
 To calculate YLL, each death is multiplied by this
remaining life expectancy.
 A young death is associated with the greater loss than a
death at older ages.

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CURRENT ISSUES OF
PUBLIC HEALTH

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1.GLOBAL HEALTH
2. SDGs

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1. GLOBAL HEALTH

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WHAT WE ARE GOING TO DO

REGARDING TO GLOBAL HEALTH ?

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a) Learning about the history of global health and

public health intervention that result in the
current conditions of global health
b) Identifying the current major health problems
and threats globally
c) Recommending solutions for health workers
globally that face various health problems.

The American Heritage Dictionary
37
 Public Health is the science and practice of protecting

and improving the health of a community as by:
Preventive medicine
Health education
Control of communicable diseases
Application of sanitary measures
Monitoring of environmental health.

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THE MEANINGS OF GLOBAL HEALTH

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 Global health talks about health in the

population setting globally.
 Global health emphasizes health condition that
may have impact on political and economic
situation globally.
 Global health includes area of study, research,
and practice that may be used for improving
health and achieving equity in health for all
people globally.
40
 Global health deals with improving

health, reducing disparities, and
protecting against global threats
regardless national borders.
 Example in the area of mental health we
recognize Global Mental Health.

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 International agencies that support global

health are WHO, UNAIDS, UNICEF,World
Food Program (WFP), World Bank.
 The major initiative for improving global
health is UN Millenium Declaration 
MDGs (Millenium Development Goals)
after 2015 the world will implement
Dhaka Declaration.
42
 Global health emphasizes determinants and

distribution of health in international contexts
from several perspectives:
 Medicine describes the pathology of diseases and
promotes prevention, diagnosis, and treatment.
 Public health emphasizes the health of
populations.
 Epidemiology helps identify risk factors and causes
of health problems.

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Demography provides data for policy decisions.

Economics emphasizes the cost-effectiveness
and cost-benefit approaches for the optimal
allocation of health resources.
Other social sciences such as sociology,
development studies, anthropology, cultural
studies, and law may help understand the
determinants of health in societies.

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MAJOR PUBLIC HEALTH PROBLEMS

AND THREATS GLOBALLY

1. Infectious Diseases
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Tuberculosis, including Multidrug-

resistent tuberculosis
Malaria
Childhood Pneumonia
Childhood diarrhea
New and emerging infectious diseases

2. Transition Diseases
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Cardiovascular disease
Obesity
Lifestyle diseases related to
smoking, alcohol, drug user
Mental and psychological
illness
3. Health Threats
47
World hunger
Displaced and refugee populations
Maternal mortality
Motor vehicle injury and mortality
Occupational workplace safety
Landmines

4. Health threats related to environmental and social
determinants of public health
48
oPopulation growth
oGlobal climate change and
natural disasters
oPollution (air, water)
oGovernmental corruption
49
oPolitical instability
oRegional conflict
oNuclear threats
oBiological/chemical terrorism
oEconomic inequity
50
NEWLY RECOGNIZED PATHOGENS OR

DISEASES SINCE 1981

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 Avian influenza
 Amaythamebiasis  skin infection in
immunocompromised patients (HIV/AIDS)
 Australian bat Lyssavirus
 Babesiosis  malaria-like parasitic disease
 Bartonella henselae
 Coronaviruses/Severe acute respiratory syndrome (SARS)
 Ehrlichiosis
 Hantavirus pulmonary syndrome
 Helicobacter pylorii

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 Hendra or equine morbilli virus

 Hepatitis C virus
 Hepatitis E virus
 HIV/AIDS
 Human herpesvirus 8
 Human herpesvirus 6
 Human T-cell lymphtropic virus 1
 Human T-cell lymphtropic virus 2

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Borrelia burgdoferi
Microsporidia (Encephalitozoon
cuniculi, hellem,bieneusi)
Nipah virus disease
Parvovirus B19
Variant Creutzieldt-Jacob disease
54
VACCINE-PREVENTABLE DISEASES

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Diseases Year
Smallpox 1798
Rabies 1885
Typhoid 1896
Cholera 1896
Diphtheria 1923
Pertussis 1926
Tetanus 1927
Tuberculosis 1927
Influenza 1945

56
Diseases Year
Poliomyelitis 1955
Measles 1963
Anthrax 1970
Meningitis 1975
Hepatitis B 1981
Hepatitis A 1995
Varicella 1995
Rotavirus 2006
Human papilloma virus 2005

57
DISTRIBUTION OF SELECTED DISEASES

GLOBALLY

58
INFECTIOUS DISEASES

66
CHRONIC DISEASES
AND CANCER

72
2. POST MDGs

WORLD DEVELOPMENT IN THE FUTURE
73
 DURING 2000 – 2015 EACH COUNTRY ACHIEVES

THE GOALS DIFFERENTLY
 VARIOUS FACTORS MAY DELAY THE GOAL
ACHIEVEMENTS PARTICULARLY IN
DEVELOPING COUNTRIES
 ONE PROMINENT FACTOR IS POPULATION
DYNAMICS THAT HAS NOT YET BEEN
CONSIDERED IN THE BEGINNING OF MDGs
 IT IS PROPOSED DAKHA DECLARATION


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GLOBAL BURDEN OF DISEASE AND

CURRENT ISSUES OF PUBLIC HEALTH

PROF KUNTORO, MD, MPH, DRPH

kuntoro global health sphmu ns 2/18/2018

Global Burden Of Disease

GLOBAL BURDERN OF DISEASE

kuntoro global health sphmu ns 2/18/2018

 Burden of disease is a measure used to assess and

kuntoro global health sphmu ns 2/18/2018

 It quantifies health loss due to disease and

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 6 2/18/2018

 People suffered from various diseases

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

DISABILITY ADJUSTED LIFE YEAR (DALY)

kuntoro global health sphmu ns 2/18/2018

 Combining the number of years of healthy life lost due to

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

 The number of deaths multiplied by the standard life

kuntoro global health sphmu ns 2/18/2018

 To estimate YLD for a particular cause in a particular time

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

 PYLD may also be calculated using the prevalence of the

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

 To calculate YLD for incident cases occurring in the study

kuntoro global health sphmu ns 2/18/2018

 There are several methods for developing disability

kuntoro global health sphmu ns 2/18/2018

 At the same time, an individual may suffer from two or

kuntoro global health sphmu ns 2/18/2018

 Example in Australia study : hospital data and various

kuntoro global health sphmu ns 2/18/2018

 DALY may be considered as a health gap measure.

kuntoro global health sphmu ns 2/18/2018

 The remaining life expectancy at each age from those

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

kuntoro global health sphmu ns 2/18/2018

WHAT WE ARE GOING TO DO

kuntoro global health sphmu ns 2/18/2018

a) Learning about the history of global health and

kuntoro global health sphmu ns 2/18/2018

 Public Health is the science and practice of protecting

kuntoro global health sphmu ns 2/18/2018

THE MEANINGS OF GLOBAL HEALTH

kuntoro global health sphmu ns 2/18/2018

 Global health talks about health in the

 Global health deals with improving

kuntoro global health sphmu ns 2/18/2018

 International agencies that support global

 Global health emphasizes determinants and

kuntoro global health sphmu ns 2/18/2018

Demography provides data for policy decisions.

kuntoro global health sphmu ns 2/18/2018

MAJOR PUBLIC HEALTH PROBLEMS

kuntoro global health sphmu ns 2/18/2018

Tuberculosis, including Multidrug-

kuntoro global health sphmu ns 2/18/2018