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.
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.
Lopez was in town to work with Chris Murray, his long-time colleague and director of the UW’s Institute for Health Metrics and Evaluation, on the new Global Burden of Disease report. He recalled their finding on mental illness.
“Before that, mental health really hadn’t figured in at all,” Lopez said. “It hadn’t been considered a major health issue.”
Lopez and Murray assumed mental health would contribute some to disability rates when they crafted their new health measurement tool (called the DALY) aimed at assessing more than just death rates and obvious disability. But they didn’t expect it to be even close to as high as it turned out to be.
“When we punched in the numbers and hit the button, we were just flabbergasted,” said Lopez. “We suspected mental illness was a contributor to disability, but it turns out to be one of the primary contributors.”
Given the aging populations around the world, he said he would not be surprised to learn from the new Global Burden of Disease analysis that the burden of mental illness has increased since 1990.
Lopez said he believes their findings were used by many in the mental health community to make their case for more attention and funding in this arena. But mental illness appears to still suffer from neglect, he said, when considered in terms of its contribution to global disability.
Oh, and Einstein also said no problem can be solved from the same level of consciousness that created it.