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THE GLOBAL BURDEN OF DISEASE

THE GLOBAL BURDEN OF DISEASE. RICHARD ALLEN WILLIAMS, MD. Professor of Medicine UCLA School of Medicine President/CEO The Minority Health Institute, Inc. Chair, Institute for the Advancement of Multicultural and Minority Medicine Author, Textbook of Black-Related Diseases.

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THE GLOBAL BURDEN OF DISEASE

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  1. THE GLOBAL BURDEN OF DISEASE

  2. RICHARD ALLEN WILLIAMS, MD Professor of Medicine UCLA School of Medicine President/CEO The Minority Health Institute, Inc. Chair, Institute for the Advancement of Multicultural and Minority Medicine Author, Textbook of Black-Related Diseases

  3. KEYNOTE LECTURE Presented to the Association of Nigerian Physicians In the Americas Orlando, Florida June 28, 2007

  4. Outline - 1 • Why cardiovascular health promotion and chronic disease prevention in sub-Saharan Africa? • The “epidemiological transition” and “double burden of disease” in sub-Saharan Africa • Key components of “public health capacity”

  5. Outline – 2 • Application to local program development • Goals and objectives for building local-level capacity in health promotion disease prevention • Becoming a champion for health promotion and chronic disease prevention in sub-Saharan Africa

  6. Methods Used to Measure GBD • Years of Life Lost (YLL): Measures premature mortality • Years of life lived with a disability (YLD) • Disability-Adjusted Life Years (DALY)=YLL +YLD • DALYS provide a measure of the years expected to be lived in full health, lost because of disease or injury • This provides a global metric for assessing and comparing the impact of disease and injury

  7. Table 1Leading causes of premature mortality, disability and disease burden, World, 1990Premature MortalityDisabilityDisease BurdenRankDisease/ injuryYLLs (000s)Cumulative %Disease/injuryYLDs (000s)Cumulative%Disease/injuryDALYs (000s)% of Total1Lower res. inf.10860112.0Depression5081010.7Lower res. inf.1128988.22Diarrhoeal dis.9443422.4Iron def. anaem.2198715.4Diarrhoeal dis.996337.23Perinatal cond.8268131.5Falls2194920.0Perinatal cond.923136.74Isch. heart dis.4159536.1Alcohol use1577023.4Depression508103.75Measles3645040.1COPD11469226.5Isch. heart dis.466993.46Tuberculosis3430443.9Bipolar dis.1414129.5Cerebrovas. dis.385232.87Cerebrovas. Dis.3211547.5Congenital anom1350732.3Tuberculosis384262.88Malaria2803850.5Osteoarthritis1327535.1Measles365202.79Road traffic acc.2616253.4Schizophrenia1218337.7Road traffic acc.343172.510Congenital anom.1941455.6Obs.-comp dis21021339.9Congenital anom.329212.4Source Murray and Lopez (10)1 Chronic obstructive pulmonary disease2 Obsessive-compulsive disorders

  8. Countries with a Critical Shortage of Health Care Providers Kumar P. N Engl J Med 2007;356:2564-2567

  9. HEALTH PROBLEMS IN NIGERIA • Most serious diseases: Malaria, TB, AIDS, Diarrheal Diseases • Schistosomiasis, Yaws, Trachoma, River Blindness, and Guinea Worm are frequent. • 75% of malaria deaths are in children. • 46% of chidren under age 5 are malnourished. • Diarrheal diseases claim more than 200,000 children each year. • 3.5 million people, or 6% of the adult population, have AIDS. 170,000 died in 2001. 5 of every 100 adults have AIDS. • Life expectancy for Nigerians is 47 years vs 78 in US

  10. HEALTH PROBLEMS IN NIGERIA (Cont’d) • 20% of all school-aged children have goiter. • Principal needs: Safe drinking water, better sanitation, more medical supplies and health workers, including MDs. • More immunizations. • More health education to control STDs, etc. • Decreased smoking. • More governmental expenditure on health (Nigeria spends only 2.8% of GDP on healthcare vs 16% in the US).

  11. Deaths in AfricaCommunicable Diseases, Maternal and Perinatal Conditions, and Nutritional Deficiencies Predominate High Child and High Adult Mortality High Child and Very High Adult Mortality Chronic Diseases 25% Chronic Diseases 20% Injuries Injuries Communicable Diseases Communicable Diseases Source: WHO; cited in Mensah. Ethn Dis. 2003;13:4-12

  12. TakingaBiteOutofVector-TransmittedInfectiousDiseases Klempner MS, Unnasch TR, and Hu LT. N Engl J Med 2007;356:2567-2569

  13. TakingaBiteOutofVector-TransmittedInfectiousDiseases Klempner MS, Unnasch TR, and Hu LT. N Engl J Med 2007;356:2567-2569

  14. TakingaBiteOutofVector-TransmittedInfectiousDiseases Klempner MS, Unnasch TR, and Hu LT. N Engl J Med 2007;356:2567-2569

  15. TakingaBiteOutofVector-TransmittedInfectiousDiseases Klempner MS, Unnasch TR, and Hu LT. N Engl J Med 2007;356:2567-2569

  16. TakingaBiteOutofVector-TransmittedInfectiousDiseases Klempner MS, Unnasch TR, and Hu LT. N Engl J Med 2007;356:2567-2569

  17. TakingaBiteOutofVector-TransmittedInfectiousDiseases Klempner MS, Unnasch TR, and Hu LT. N Engl J Med 2007;356:2567-2569

  18. Patients Waiting to Be Seen at the HIV Clinic at Bethesda Hospital in Rural KwaZulu-Natal Province Kumar P. N Engl J Med 2007;356:2564-2567

  19. Patients Waiting to Be Seen at the HIV Clinic at Bethesda Hospital in Rural KwaZulu-Natal Province Kumar P. N Engl J Med 2007;356:2564-2567

  20. Number of Reported Cases of Dracunculiasis Worldwide, 1989-2006 Barry M. N Engl J Med 2007;356:2561-2564

  21. Emerging Guinea Worm Barry M. N Engl J Med 2007;356:2561-2564

  22. Percentage of Total DALYs for Infectious & Parasitic Diseases and CVD Projected to Year 2020, Sub-Saharan Africa CVD accounts for a relatively small % of total DALYs In terms of mortality, CVD also accounts for less than 10% Percent of Total DALYs Murray & Lopez, 1996

  23. The Double Burden of DiseaseDeaths Due to CVD and Infectious and Parasitic Diseases in 30-69 Year-Olds, Sub-Saharan Africa, 1990 Murray & Lopez, 1996

  24. Projected Changes in Ischemic Heart Disease Mortality in Sub-Saharan Africa, 1990 to 2020 125% increase 141% increase Deaths in Thousands Murray & Lopez, 1996

  25. Projected Changes in Cerebrovascular Disease Mortality in Sub-Saharan Africa, 1990 to 2020 126% increase 134% increase Deaths in Thousands Murray & Lopez, 1996

  26. The Five Leading Underlying Causes of Death Among South Africans Between 1997 and 2001 Statistics South Africa, 2002

  27. Percentage of Deaths Due to the Five Leading Underlying Causes of Death, by Sex, South Africa, 1997-2001 Statistics South Africa, 2002

  28. Standard Broad Groups of Causes of DeathMales, South Africa, 2001 Percent of Deaths Statistics South Africa, 2002

  29. Standard Broad Groups of Causes of DeathFemales, South Africa, 2001 Percent of Deaths Statistics South Africa, 2002

  30. Percentage of Female Deaths Due to the Eight Leading Underlying Causes of Death, 1997-2001

  31. Leading Causes of Death From a Multi-Center Study of Adult Mortality in Tanzania, Ghana, and Ethiopia PERCENT Quigley et al. Int J Epidemiol 1999 Dec;28:1081-7; Quigley et al. Trop Med Int Hlth 2000

  32. Source: R. Bonita, World Health Organization

  33. Sub-Saharan Africa Moderate increase in some countries Impending Pandemic of CVD in Sub-Saharan Africa Modified from Ruth Bonita, WHO

  34. Evidence of the Epidemiologic Transition In Sub-Saharan Africa • Among town dwellers, intakes of food, especially fat, have risen and intakes of fibre-containing foods have fallen. • Mean serum cholesterol level is almost double that of rural populations living traditionally. • Level of physical activity has decreased. • Obesity in females has risen enormously. Walker & Sareli J R Soc Med 1997 Jan;90(1):23-7

  35. Hypertension by Body Mass Index Among Populations of West African Origin: ICSHIB, 1995 35 Chicago, IL 30 Barbados St. Lucia 25 Jamaica Percent Hypertensives 20 Cameroon Urban Nigeria 15 Cameroon Rural 10 22 24 26 28 30 32 Body Mass Index

  36. Influence of Urbanization on Some CVD Risk Factors in Black South African Men, THUSA Study Vorster. Pub Hlth Nutr 2002;5:239-243

  37. Influence of Urbanization on Sme CVD Risk Factors in Black South African Women, THUSA Study Vorster. Pub Hlth Nutr 2002;5:239-243

  38. Inflammatory 8% Stroke 47% Other 17% Ischemic 26% Rheumatic 2% Proportion of Deaths Due to Specific Heart Diseases and Stroke, Sub-Saharan Africa, 1990 Murray & Lopez, 1996

  39. Stages of Epidemiologic Evolution in CVD Patterns in Blacks Sat-Fat Intake Acculturation Urbanization CVD (CAD) CVD (HTN) Salt Intake Description of Stage Affluence STAGE Smoking RF Gillum. NEJM 1996;335:1597-8

  40. Lessons Learned • CVD already contributes to a “double burden of disease” in sub-Saharan Africa • Adverse trends in risk factors will lead to significant increases in CVD burden

  41. Lessons Learned • The need for accurate surveillance data and trends is urgent • Aggressive efforts must be introduced to prevent and control the major risk factors • Health promotion and primary prevention strategies are crucial

  42. The Singapore Declaration:Forging the Will for Heart Health in the Next Millennium A Decade of International Declarations on Heart Health

  43. www.who.int/hpr/globalforum/regional.networks.shtml

  44. Capacity Equals Infrastructure Plus The Will to Act - 1 • Appropriate infrastructure • Skilled public health workforce • Surveillance capability • Effective health communication and social marketing • Community organizing & coalition building • Strategic partnerships & networking • Adequate resources

  45. Capacity Equals Infrastructure Plus The Will to Act - 2 • The Will to take Action • Individual and societal will to act • Political will to commit resources • Political will to develop or change policy and sustain action • Adopt best practices • Effective use of evidence • Act in all key settings: schools, communities, healthcare, worksites

  46. Mensah. Ethn Dis. 2003;13[suppl2]:4-12)

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