- Recognize the rationale for summary measures of population health
- Understand the attributes of mortality, morbidity, and disability as they apply to burden of disease
- Describe various composite measures of burden of disease, their relative strengths and weaknesses, and how they are used in public health literature, World Health Organization reports, and the lay press
- Identify the changing global health risks and effective interventions to prevent disease and injury
- Understand how data on global health measures affect international development, policy change, and their limitations
- Apply the global burden of disease study to understanding poverty and global health inequalities
Measuring the impact of diseases on populations is a prerequisite for determining effective ways to reduce the burden of illness. Traditional methods of quantifying disease in populations, such as incidence, prevalence, mortality, birth rate, and infant mortality rate, do not capture nonfatal health outcomes. In the past 3 decades, significant international effort has been put into the development of composite indicators that include both mortality and morbidity measures to make judgments about the health of populations and to identify which interventions would have the greatest effect.
The growth of aging populations and the increase of associated chronic diseases have provided an impetus to examine nonfatal health outcomes and the associated quality of life. Disability and suffering are difficult to quantify because they involve complex, subjective notions of pain, discomfort, and emotional distress that are interpreted within a social and cultural context. Prior work on health-related quality-of-life (HRQL) measures, measures of utility or preference-weighted measures, the 1980 International Classification of Impairment, Disability and Handicaps by the World Health Organization (WHO), and the later International Classification of Functioning, Disability and Health, a classification of health and health-related domains, laid the framework for the development of morbidity measures that would be incorporated into summary measures of population health.
The benefits of having a common currency to measure the magnitude of health problems include the following abilities:
- Comparing the health of populations
- Monitoring trends over time
- Conducting cost-effectiveness analyses
- Measuring the population-wide benefits of health interventions
Implicit in the applications of these measures is the ability to assess global health inequalities; to inform debates on priorities for health service delivery and for planning, research, and development in the health sector; and to improve public health curricula and training.1
Capturing timely accurate data is a particular concern, especially in resource-poor settings. Mortality information is probably the most widely available kind of health information, obtained through death certificates, vital registration, and verbal autopsy studies, but even this type of data is found to be incomplete and unreliable. An adult who presents with fever, diarrhea, and hypotension to a district hospital and dies before any definitive diagnostic testing may have died from malaria, dysentery, sepsis, and/or acquired immunodeficiency syndrome (AIDS). Data about morbidity presented in the literature are often based on self-perceived or observed assessments, household surveys, and ...