The document discusses global burden of disease and key concepts in global health. It summarizes that global burden of disease assessments measure years of life lost to premature mortality and disability worldwide. The leading causes of mortality globally are ischemic heart disease, stroke, lower respiratory infections and COPD, while the highest disease burdens come from lower respiratory infections, diarrheal diseases, depression and ischemic heart disease. Noncommunicable diseases like cardiovascular disease are responsible for most deaths globally.

1. “Nothing on earth is more international
than disease”
Paul Russel

2. GGlloobbaall BBuurrddeenn ooff DDiisseeaassee
Sujata Mohapatra,Msc(N)

3. BBrriieeff IInnttrroodduuccttiioonn
World
Outreach

4. HHeeaalltthh
“A state of complete
physical, mental, and
social well-being and
not merely the
absence of disease or
infirmity.”
WHO definition of health

5. GGlloobbaall HHeeaalltthh
Refers to health problems that transcend national borders.
• Problems such as infectious and insect-borne diseases that can
spread from one country to another. It also includes health
problems that are of such magnitude that they have a global
political and economic impact.
Refers to health problems that are best addressed by
cooperative actions and solutions.
• global health problems can move across national borders,.
Cooperation across countries is essential to addressing those
health problems that transcend borders. This includes helping
other countries address their particular health care crises.

6. GGlloobbaall BBuurrddeenn ooff
DDiisseeaassee
 The global burden of disease (GBD) is a comprehensive regional and
global assessment of mortality and disability.
 Developed in 1990 by the WHO.
 Provides information and projections about disease burden on a global
scale. The GBD has three specific aims:
• To systematically incorporate information on non-fatal outcomes into
the assessment of health status.
• To ensure that all estimates and projections were derived on the basis
of objective epidemiological and demographic methods, which were not
influenced by advocates.
• To measure the burden of disease using a metric that could also be
used to assess the cost-effectiveness of interventions. The metric
chosen was the DALY.

7. WWhhyy sshhoouulldd wwee ccaarree??
• Medical missionaries have
been on the forefront of
health in developing nations
for 100’s of years.
• We can enable others to live
more productive and
fulfilling lives.

8. How to Calculate GBD?
GBD = DALY + Mortality
DALY = YLL + YLD
• The overall burden of disease is assessed using the
disability-adjusted life year (DALY), a time-based
measure that combines years of life lost due to
premature mortality (YLLs) and years of life lost due
to time lived in states of less than full health, or years
of healthy life lost due to disability (YLDs).

9. Comparison of the proportional
distribution of deaths and YLL by
region, 2004

10. Burden of disease by broad
cause group and region, 2004

12. WWhhaatt’’ss tthhee wwoorrlldd ddyyiinngg ooff tthheessee ddaayyss??
TTHHEE LLEEAADDIINNGG CCAAUUSSEESS OOFF
MMOORRTTAALLIITTYY

13. CChhrroonniicc DDiisseeaassee
• CDs responsible for 60% of all deaths in 2005.
• >80% of deaths occurred in low to middle income
countries (LMIC).
• NCDs are killing more people in their prime adult
years.
• Surprising fact:
– TB, HIV, and malaria only account for 10% of the global
deaths.

14. Leading Causes of Mortality and Burden of
Disease in world, 2004
MORTALITY DALY
%
1. Ischaemic heart disease 12.2
2. Cerebrovascular disease 9.7
3. Lower respiratory infections 7.1
4. COPD 5.1
5. Diarrhoeal diseases 3.7
6. HIV/AIDS 3.5
7. Tuberculosis 2.5
8. Trachea, bronchus, lung cancers 2.3
9. Road traffic accidents 2.2
10. Prematurity, low birth weight 2.0
%
1. Lower respiratory infections 6.2
2. Diarrhoeal diseases 4.8
3. Depression 4.3
4. Ischaemic heart disease 4.1
5. HIV/AIDS 3.8
6. Cerebrovascular disease 3.1
7. Prematurity, low birth weight 2.9
8. Birth asphyxia, birth trauma 2.7
9. Road traffic accidents 2.7
10. Neonatal infections and other 2.7

15. Major Causes of Death, World, 2004
Source: The Global Burden of Disease: 2004 update, WHO
Disease or Injury
Deaths/
million
% of total
deaths
1 Ischemic heart disease 7.2 12.2
2 Cerebrovascular disease 5.7 9.7
3 Lower respiratory infections 4.2 7.1
4 COPD 3 5.1
5 Diarrheal diseases 2.2 3.7
6 HIV/AIDS 2 3.5
7 Tuberculosis 2.5 1.5
8 Trachea, bronchus, lung cancers 1.3 2.3
9 Road traffic accidents 1.3 2.2
10 Prematurity and low birth weight 1.2 2

16. NNuummbbeerr 11 KKiilllleerr
• Cardiovascular diseases
kill more people each
year than any other.
• In 2004
– CHD killed 7.2 million
people
– Another 5.7 million died
of stroke or another form
of CVD

17. Comparison of Global Mortality, 2004
Source: WHO Fact Sheet, Top 10 Causes of Death

18. Adult mortality rates by major cause
Cardiovascular diseases
Cancers
Other noncommunicable diseases
Injuries
HIVAIDS
Other infectious and parasitic diseases
Maternal and nutritional conditions
Cardiovascular diseases
Cancers
Other noncommunicable diseases
Injuries
HIVAIDS
Other infectious and parasitic diseases
Maternal and nutritional conditions
group and region, 2004
0 2 4 6 8 10 12
0 2 4 6 8 10 12
High income
High income
Western Pacific
Western Pacific
Americas
Americas
Eastern Mediterranean
Eastern Mediterranean
South East Asia
South East Asia
Europe
Europe
Africa
Death rate per 1000 adults aged 15–59 years
Africa
Death rate per 1000 adults aged 15–59 years

19. Percent distribution of age at death by
region, 2004
Source: Global Burden of Disease, 2004 Update, used by
permission

20. Distribution of deaths in the world by
sex, 2004

21. Distribution of age at death and numbers of deaths,
world, 2004

22. MMoosstt ccoommmmoonn NNCCDDss
RRIISSKK FFAACCTTOORRSS

23. GGlloobbaalliizzaattiioonn
• “The increasing interconnectedness of countries and
the openness of borders to ideas, people, commerce,
and financial capital. “ (Lancet, 2003)
• Refers to every aspect of life: cultural, social,
psychological, and political.
• Creates both negative and positive impacts on society
and its health.

24. From the US to …

25. DDeevveellooppiinngg NNaattiioonnss
PPoooorr nnuuttrriittiioonn nnooww aaffffeeccttss aallll ppaarrttss ooff tthhee wwoorrlldd
China Tanzania

26. BBaadd HHaabbiittss sspprreeaaddiinngg

27. MMaajjoorr rriisskk ffaaccttoorrss
• Tobacco use
• High blood pressure
• Alcohol
• Overweight and obesity, physical inactivity
• Cholesterol

28. Source: WHO Report on Global Tobacco Epidemic, 2008, used by
permission
TToobbaaccccoo uussee

29. Liang Liang smoking since
age 1-1/2
Warning! Warning!

30. AAllccoohhooll UUssee
• About 2 billion people consume alcohol.
• Developing countries increasing intake.
• Highest burden in Latin America and Caribbean
(9.7%).
• Lowest in Middle Eastern Crescent (0.4%) and India
(1.7%).

31. WWoorrllddwwiiddee AAllccoohhooll
CCoonnssuummppttiioonn,, 22000088

32. OOvveerrwweeiigghhtt && OObbeessiittyy
The World Health Organization predicts there will be 2.3 billion overweight
adults in the world by 2015 and more than 700 million of them will be obese.

33. PPhhyyssiiccaall IInnaaccttiivviittyy
• Physical inactivity is estimated to cause 2 million
deaths worldwide annually.
• Globally a causal factor in:
– ~ 10-16% of cases each of breast cancer, colon cancers, and
diabetes
– 22% of ischemic heart disease.

34. CChhoolleesstteerrooll
• Suboptimal levels
contribute to ~ 2/3 of the
global CVD risk.
• 4.4 million deaths in
world related to
hyperlipidemia.
• Responsible for 32% of
ischemic stroke and 56%
of IHD.

35. HHyyppeerrtteennssiioonn
• Responsible for 13% of
deaths world-wide.
• Over 26% of adults in
the world had
hypertension in 2000—
expected to jump to 30%
by 2025.
• 2/3 with HTN live in
developing world.

36. AAddeeqquuaattee SSccrreeeenniinngg
&& TTrreeaattmmeenntt
• Still fairly unattained in much of the world.
• Pakistan: >40% of docs prescribed sedatives for HTN!
• Africa: control rates as low as 2%.
• Saudi Arabia: >60% of physicians and nurses in large
teaching hospital had poor knowledge of basic
techniques of BP measurement.

37. TThhee mmaannyy ffaacceess ooff cchhrroonniicc
ddiisseeaassee

38. IIllllnneessss
Top 4 causes of illness worldwide include:
1. Diarrheal disease
2. Pneumonia and other lower respiratory tract infections
 Except in Africa which has high levels of malaria
1. Injuries
2. Complications of pregnancy

39. DDiissaabbiilliittyy
• More individuals have iron-deficiency anemia than
any other health problem in the world.
• Other very common conditions, with varying levels of
severity, include:
– asthma
– arthritis
– vision and hearing problems
– migraine
– major depressive episodes
– intestinal worms.

40. 10 facts on the state of global
health, 2012
• Life expectancy at birth increased globally by 6 years since 1990.
• Around 6.6 million children under the age of 5 die each year.
• Cardiovascular diseases are the leading causes of death in the world.
• Preterm birth is the leading killer of newborn babies worldwide.
• Most HIV/AIDS deaths occur in Africa.
• Every day, about 800 women die due to complications of pregnancy
and childbirth.
• Mental health disorders such as depression are among the 20 leading
causes of disability worldwide.
• Tobacco kills nearly 6 million people each year.
• Almost 1 in 10 adults has diabetes.
• Nearly 3500 people die from road traffic crashes every day.

41. Global projections for selected
causes,2004 to 2030
12
12
10
10
8
8
6
6
4
4
2
2
0
2000 2005 2010 2015 2020 2025 2030
Deaths (millions)
0
2000 2005 2010 2015 2020 2025 2030
Deaths (millions)
Cancers
Ischaemic HD
Stroke
Acute respiratory
infections
Road traffic
accidents
Perinatal
HIV/AIDS
TB
Malaria

42. INTERNATIONAL HEALTH
REGULATIONS (IHR)
Since 15 June 2007, the world has been implementing
the International Health Regulations (2005).
Under the International Health Regulations 2005 (IHR
2005), the World Health Organization is to establish case
definitions for the following four critical diseases:
• smallpox
• poliomyelitis due to wild type poliovirus
• human influenza caused by a new subtype, and
• severe acute respiratory syndrome (SARS).

43. Purpose and scope of IHR
(2005)
The purpose and scope of these Regulations are to
prevent, protect against, control, and provide a
public health response to the international spread of
disease in ways that are commensurate with and
restricted to risks to public health,
and
which avoid unnecessary interference with
international traffic and trade.

44. Ten things you need to do to
implement the IHR
1. Know the IHR; purpose, scope, principles and concepts
2. Update national legislation
3. Recognize shared realities and the need for collective
defences
4. Monitor and report on IHR implementation progress
5. Notify, report, consult and inform WHO
6. Understand WHO’s role in international event
detection, joint assessment and response

45. Contd..
7. Participate in the PHEIC determination and
WHO recommendations-making processes
8. Strengthen national surveillance and
response capacities
9. Increase public health security at ports
airports and ground crossings
10. Use and disseminate IHR health documents
at points of entry

46. IHR procedures and
monitoring
IHR (2005) include many rights and obligations for States Parties.
These cover activities;
Surveillance and response,
Notification and verification to WHO of certain public health
events and risks,
Rules on application of health measures to international
travellers, trade and transportation,
Requirements for sanitary conditions and services at
international ports, airports and ground crossings
Development of minimum public health capacities for
surveillance, assessment, response and reporting for a broad
range of risks throughout the territories of all States Parties.

47. IHR Measures
Notification
Those diseases subject to international health regulation
Diseases under surveillance by WHO
Quarantine
Absolute
Modified
Segregation

49. TThheessee ssmmiilliinngg
ffaacceess mmaakkee aallll
yyoouurr sswweeaatt aanndd
tteeaarrss wwoorrtthh iitt!!

50. QQuueessttiioonnss??