Alan Lopez

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The burden of a new global health agenda | 

Flickr, Oliver Erdmann

A massive study of death, disability and disease on Earth, coordinated out of Seattle and to be officially published in The Lancet on Friday, could do for global health something like what Galileo did for the solar system.

It’s called the Global Burden of Disease (technically, the Global Burden of Disease, Injuries and Risk Factors Study 2010) and it is, like its earlier incarnations dating back to 1990, almost guaranteed to provoke and disrupt the international community’s approach to improving global health.

The good news is that people, in general, are living longer.  The bad news is more of them seem to be fatter, still smoking too much and suffering from disabilities.

Just as the 16th century astronomer Galileo – much to the dismay of the religious orthodoxy of the time – displaced Earth from its celestial prominence in favor of the Sun, the new Global Burden of Disease may displace infectious disease from its position as the categorical center of the global health universe.

Think the top three killers in the world are scourges like AIDS, tuberculosis and malaria? Think again, of heart disease, respiratory infections and stroke.

Think preventing death is the best way to tell if we’re winning the war on disease? You better think again about that as well since rates of obesity, chronic pain, injury and mental illness may say more….

Chris Murray

“We were surprised by many of the findings,” said Chris Murray, one of the founders of the study and director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

“The simple purpose of this study has always been to provide the best scientific evidence on patterns of disease and disability to help us make sense of what’s happening out there and set priorities,” Murray said.

Sounds simple enough. So why did it take some 500 researchers more than five years to do it? Continue reading

If 7 billion people are living on Earth, how many are dying? | 

Flickr, aldinegirl87

One of the big news items this week was that the global human population was expected to reach 7 billion with a baby born on Halloween, according to a gang of UN statisticians.

That was yesterday. Today is Day of the Dead, or Día de los Muertos in Mexico.

So let’s talk about dying.

No, this is not a Malthusian strategy for popluation control. What we will examine is  how death actually causes population growth — and how little we know about why people die.

This will lead us into a discussion about a technique known as “verbal autopsies,” which some Seattle scientists are working to refine, and a new phone app that could help reduce the global birth/death burden on the planet.

It is truly a killer app.

First, it needs to be said that we can’t really know when the global population will have precisely crossed the 7 billion person threshold. In fact, as the BBC notes, we may be off by many months — or even years — in either direction with this estimate.

Secondly, we are equally in the dark about how and why people die, about 50 million per year. Most countries around the world have very poor mortality statistics.

But one thing we do know for certain is that those countries with the highest mortality rates are also the countries with highest population growth.

Huh? Yes, you read that right. Continue reading

Why is mental illness so low on the global health agenda? | 

Flickr, by Dierk Schaefer

Seattle recently hosted a big international meeting in which many of the world’s leaders in the fight to improve health met to parse data, debate statistical methods and struggle toward consensus aimed at informing the global health agenda.

Given this focus on data, are the biggest contributors to the global burden of disease also getting the most attention and resources?

Consider two major causes of death and disability worldwide — maternal mortality and mental illness.

Today, the international community, or at least the global health community, has made reducing the number of maternal deaths and complications in childbirth worldwide a top priority. The Gates Foundation has made this a primary mission of its global health program. This priority, which really targets both mothers and children, represents two of the UN’s eight Millennium Development Goals.

Maternal health is wisely regarded as a critical, high-value goal for global health because of the important (and not always measurable) magnified benefits to a family and community that come from focusing on women’s reproductive health and the health of newborns.

Yet, surprisingly, mental illness actually kills and maims more young mothers worldwide.

Continue reading

Mental Illness Disease Burden a Surprise To Everyone, Researcher Recalls | 

Albert Einstein said the key to solving a problem is in how you define the problem. If critical problems in global health are poorly defined, or left out of the equation, it’s going to be hard to solve them.

On Tuesday, I wrote that mental illness is often neglected when we talk about global health. I mentioned how Paul Bolton, a tropical medicine doctor working in Thailand, was converted in the 1990s from a focus on treating physical disease to expanding mental health therapies in the developing world.

Flickr, by Dierk Schaefer

Neon Brain

In short, Bolton read the 1990 Global Burden of Disease report, which was really the first comprehensive, quantitative assessment of the primary causes of death and disability worldwide. Mental illness, it turned out, was a much bigger problem than had been thought.

“Globally, neuro-psychiatric conditions are estimated to account for almost 30 per cent of all YLDs (years of life lost to disability), far in excess of any other specific category,” 1990 Global Burden of Disease report.

Yesterday, I talked to one of the author’s of Bolton’s conversion — Alan Lopez, head of population health at the University of Queensland in Australia and a professor of global health at the UW. Continue reading