Richard Skolnik – Author of Global Health 101
(A major new study on the burden of disease has just been published. This builds on and updates the data on the burden of disease that appears in Global Health 101. Richard Skolnik, the author of Global Health 101, has recently prepared the following blog post that introduces students and teachers to the new data and how it can be used in conjunction with Global Health 101.)
Almost everyone involved in teaching Global Health makes substantial use of data on the burden of disease. For most of us, this information is central to our teaching. I expect my students at both the undergrad and graduate level, for example, to have a mastery of data on what people get sick and die from, by country income group, age, and sex by the third week of classes. I also expect them to have mastered by then the trends over the last 20 years in the burden of disease by country income group and the projections about where the burden of disease is headed.
Until last week, the most comprehensive and up to date burden of disease data was the Global Burden of Disease and Risk Factors, published in 2006, the WHO Global Burden of Disease 2004 Update, published in 2008, and the WHO Global Health Risks, published in 2009.
On December 13, however, The Lancet released The Global Burden of Disease 2010 and set a new foundation for our work on teaching the burden of disease. The release consists of seven articles, eight comments, one special report, and two pieces of correspondence. The articles include:
- Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010, by H Wang and others
- Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, by R Lozano and others
- Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010, by J A Salomon and others
- Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010, by J A Salomon and others
- Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, by T Vos and others
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, by C J L Murray and others
- A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 by SS Lim and others
The background data for the study and a wealth of related teaching and learning materials, including graphics, interactive tables and figures, and more can be found at the website of the Institute for Health Metrics and Evaluation (IHME).
This burden of disease study was led by the Institute of Health Metrics and Evaluation at the University of Washington in the US, in collaboration with a number of other institutions, including: Harvard University, Imperial College London, Johns Hopkins University, the University of Queensland, the University of Tokyo and the World Health Organization. Hundreds of researchers from all over the world were involved in the study.
The study, the official name of which is: “Global Burden of Disease, Injuries, and Risk Factors Study 2010,” is substantially broader and deeper than the previous burden of disease studies. It examines, for example, 297 burdens of disease and 67 risk factors for 21 regions and 20 age groups. By contrast, the first burden of disease study in 1991 examined ‘only’ 107 conditions and 10 risk factors. The 2006 study grouped countries into low- and middle-income countries as one group and high-income countries as another, as well as by World Bank region, plus a group of high-income countries.
The main findings of the new study, which are summarized nicely in a number of places, suggest that: life expectancy for the world as a whole has gone up by about ten years since 1970; people are dying at older ages, as fewer young children die; and, people are living longer but also spending more years living with injury and illness. In addition, there continues to be a shift toward non-communicable diseases and injury in the global burden of disease, with parts of sub-Saharan Africa being the last places in which there remains a preponderance of communicable diseases. The leading causes of death, years of life lost from disability, and DALYS has changed considerably from 1990 and there have also been a substantial change in the risk factors for the burden of disease. In 1990, for example, the top three causes of DALYs lost were: lower respiratory infections, diarrhea, and pre-term birth complications. For 2010, the top three causes of DALYs lost were ischemic heart disease, lower respiratory infections, and stroke.
The data have changed so substantially, even from the 2006 data, that it is imperative that we ensure our Global Health students work with data from the new burden of disease study. In my undergrad courses, for example, I will ask the students to continue to read the burden of disease chapter from my book, but I will complement that data by having my also students read The Lancet articles and spend time familiarizing themselves with the IHME burden of disease website. In my graduate course, for which I do not use a textbook, I have assigned all of The Lancet series and a thorough review of the data on the IHME website, as well.
It may be another two years before the next edition of my textbook, Global Health 101 is published. In the meantime, I will post on the book’s website updates on the burden of disease that faculty and students can easily use in conjunction with the book.
Rachel Skolnik Light and Kate Schedel provided valuable suggestions on a draft of this blog.
Richard Skolnik is a Lecturer at the Yale School of Public Health, where he teaches global health courses at the undergraduate and graduate levels. Richard was previously an Instructor in Global Health at The George Washington University, the Vice President for International Programs at the Population Reference Bureau, and the Executive Director of the Harvard School of Public Health PEPFAR program. Richard worked at the World Bank from 1976 to 2001, last serving as the Director for Health and Education for South Asia. Richard is the author of Global Health 101 a comprehensive, introductory text on global health.