2015/04/13 Leave a comment
Good examples of how big data can help identity the more important issues and the consequent shift in focus from death to disability:
The disconnect between what we think causes the most suffering and what actually does persists today. It is partly a function of success. Diarrhea, pneumonia and childbirth deaths have greatly declined, and deaths from malaria and AIDS have fallen, although far less dramatically. (The charts here show the stunning improvement in health around the world. And here are similar charts tracking progress in hunger, poverty and violence — a big picture that’s an important counterpoint to the constant barrage of negative world news.) This success is partly due to changes made because of the first Global Burden reports.
The downside is that longer lives mean people are living long enough to develop diabetes and Alzheimer’s. “What decline we’re seeing from communicable diseases, we’re seeing a compensatory increase from diabetes,” Murray said. And neurological diseases such as Alzheimer’s now account for twice as many years lived with disability as cardiovascular and circulatory diseases together, Smith writes.
This is not simply because people are living longer. It’s also a function of worsening diet everywhere, as poor societies adopt the processed foods found in rich ones.
The most surprising information, though, came not in measuring deaths, but disability. “Major depression caused more total health loss in 2010 than tuberculosis,” Smith writes. Neck pain caused more health loss than any kind of cancer, and osteoarthritis caused more than natural disasters. For other findings that may surprise you, see the quiz.
The report is a giant compilation of “who knew?”
Based on this information, countries and international organizations have been able to change how they spend their health resources, and some ambitious countries have done their own national Burden of Disease studies.
Iran, writes Smith, found that traffic injury was its leading preventable cause of health loss in 2003, and put money into building new roads and retraining police. It also targeted two other big problems its study found: suicide and heart disease.
Australia, responding to the high impact of depression, began offering cost-free short-term depression therapy .
Mexico was one of the countries making the most use of Global Burden of Disease data, after Julio Frenk became health minister in 2000. Frenk had been Murray’s boss at the W.H.O., and a participant in Murray’s work. He found that Mexico’s health system was targeting the communicable diseases that predominated in 1950, not what currently ailed Mexicans. In response, Frenk established universal health insurance (before that, 50 million were uninsured) and set coverage according to the burden of disease.
The program covered emergency care for car accidents, treatment of mental illness, cataracts, and breast and cervical cancer — all of which had been uncovered, even for people with insurance. “You want to cover those interactions that give you the highest gain,” ]he said.
Murray and company have now branched out beyond diagnosis to measuring treatment: How many people really have access to programs like anti-malaria bed nets or contraception? How much is being spent and what does it buy? Where are the most useful points of intervention? Meanwhile, data from the Global Burden reports is seeping further into health policy decisions around the world — data that saves suffering and money and lives.