Summary international public health
Lecture 1 -- Global burden of disease
What is a disease burden/burden of disease?
→ A concept that describes death and loss of health due to diseases, injuries and
risk factors. It measures the impact of living with illness and injury and dying
prematurely with e.g. mortality and morbidity (indicators).
→ The burden of a disease or a condition is estimated/calculated in terms of disability-
adjusted life years (DALYs) which quantify the number of years of life lost (YLL)
due to disease & premature death and the number of years of life a person lives
with disability caused by the disease (YLD)
DALY = YLL (mortality) + YLD (morbidity)
• YLL = years of life lost to (early) death
• YLD = years of life with disability
1 DALY = the loss of one year of healthy life due to disability or premature death
The Global Burden of Disease Study
A systematic scientific effort to quantify the comparative magnitude of health loss due to
diseases, injuries and risk factors by age, sex and geographies for specific time points
WHO - Main causes of Death
GROUP 1: Communicable, maternal, perinatal and nutritional conditions (CDs)
GROUP 2: Non-communicable conditions (NCDs)
GROUP 3: Injuries, including motor vehicle accidents and homicide; mental health
problems and suicide
Communicable Diseases (CDs)
→A communicable disease is one that can be spread from one person to another through a
variety of ways, including:
- Physical contact with an infected person, such as through touch (staphylococcus),
sex (gonorrhea, HIV, Hepatitis B and C), faecal/oral transmission (Hepatitis A), or
droplets (influenza, TB)
- Contact with a contaminated surface or object, food (salmonella, E. coli, Norwalk
virus), blood (HIV, Hepatitis B and C) or water (cholera)
- Bites from insects or animals capable of transmitting the disease (mosquitos:
malaria, yellow fever, Zika virus; fleas: plague)
- Transmission via the air (tuberculosis, measles)
,WHO classification of CDs
1. diseases with a large-scale impact on mortality, morbidity or disability, such as
human immunodeficiency virus (HIV) infection and acquired immunodeficiency
syndrome (AIDS), tuberculosis (TB) and malaria
2. diseases that can potentially cause epidemics, such as influenza, cholera and the
Ebola virus
3. diseases that can easily be controlled with available cost-effective interventions, such
as diarrhoeal diseases and TB
Non-Communicable Diseases
→ Also known as chronic diseases (tend to be of long duration). Often caused by a
combination of genetic, biological, environmental and behavioral factors
Four main groups:
- Cardiovascular diseases (leading to heart attacks and strokes
- Cancers/Neoplasms
- Chronic respiratory diseases (such as chronic obstructive pulmonary disease [COPD]
and asthma)
- Diabetes
< 1990: no comprehensive assessment of the state of health in the world
GBD 1990: commissioned by the World Bank
◦ 131 diseases and injuries, and 10 risk factors
GBD 2000: commissioned by WHO – Burden of Disease Unit
◦ 159 diseases and injuries; 14 regions
GBD 2010: collaboration between 7 institutions
◦ 301 disease and injuries, and 26 risk factors; 21 regions, 7 super-regions; 20 age-groups/sex
GBD 2019: Latest - Published October 2020 [https://www.thelancet.com/gbd]
◦ Most comprehensive global study—analyzing 286 causes of death, 369 diseases and
injuries, and 87 risk factors in 204 countries and territories—reveals how the world’s
population was prepared in terms of underlying health for the impact of the COVID-19
pandemic.
Shift in causes of years of life lost (YLL) globally
,21 Global leading causes of YLL (2019)
- Orange/peach: Communicable, maternal, perinatal and nutritional conditions (CDs)
- Blue: Non-communicable conditions (NCDs)
- Green: Injuries, including motor vehicle accidents, self-harm and homicide
Leading causes of YLL in High-Income Countries (HICs) (2019)
, Leading causes of YLL in Low and middle-Income Countries (LMICs) (2019)
Leading causes of YLL in HIC & LMICS (2019)
Shift in the global burden of disease: From CDs to NCDs in globally
Double burden of disease: the onset of significant burden from non-communicable diseases
(NCDs), while the burden from communicable diseases (CDs) remains high (in LMICs)
Lecture 1 -- Global burden of disease
What is a disease burden/burden of disease?
→ A concept that describes death and loss of health due to diseases, injuries and
risk factors. It measures the impact of living with illness and injury and dying
prematurely with e.g. mortality and morbidity (indicators).
→ The burden of a disease or a condition is estimated/calculated in terms of disability-
adjusted life years (DALYs) which quantify the number of years of life lost (YLL)
due to disease & premature death and the number of years of life a person lives
with disability caused by the disease (YLD)
DALY = YLL (mortality) + YLD (morbidity)
• YLL = years of life lost to (early) death
• YLD = years of life with disability
1 DALY = the loss of one year of healthy life due to disability or premature death
The Global Burden of Disease Study
A systematic scientific effort to quantify the comparative magnitude of health loss due to
diseases, injuries and risk factors by age, sex and geographies for specific time points
WHO - Main causes of Death
GROUP 1: Communicable, maternal, perinatal and nutritional conditions (CDs)
GROUP 2: Non-communicable conditions (NCDs)
GROUP 3: Injuries, including motor vehicle accidents and homicide; mental health
problems and suicide
Communicable Diseases (CDs)
→A communicable disease is one that can be spread from one person to another through a
variety of ways, including:
- Physical contact with an infected person, such as through touch (staphylococcus),
sex (gonorrhea, HIV, Hepatitis B and C), faecal/oral transmission (Hepatitis A), or
droplets (influenza, TB)
- Contact with a contaminated surface or object, food (salmonella, E. coli, Norwalk
virus), blood (HIV, Hepatitis B and C) or water (cholera)
- Bites from insects or animals capable of transmitting the disease (mosquitos:
malaria, yellow fever, Zika virus; fleas: plague)
- Transmission via the air (tuberculosis, measles)
,WHO classification of CDs
1. diseases with a large-scale impact on mortality, morbidity or disability, such as
human immunodeficiency virus (HIV) infection and acquired immunodeficiency
syndrome (AIDS), tuberculosis (TB) and malaria
2. diseases that can potentially cause epidemics, such as influenza, cholera and the
Ebola virus
3. diseases that can easily be controlled with available cost-effective interventions, such
as diarrhoeal diseases and TB
Non-Communicable Diseases
→ Also known as chronic diseases (tend to be of long duration). Often caused by a
combination of genetic, biological, environmental and behavioral factors
Four main groups:
- Cardiovascular diseases (leading to heart attacks and strokes
- Cancers/Neoplasms
- Chronic respiratory diseases (such as chronic obstructive pulmonary disease [COPD]
and asthma)
- Diabetes
< 1990: no comprehensive assessment of the state of health in the world
GBD 1990: commissioned by the World Bank
◦ 131 diseases and injuries, and 10 risk factors
GBD 2000: commissioned by WHO – Burden of Disease Unit
◦ 159 diseases and injuries; 14 regions
GBD 2010: collaboration between 7 institutions
◦ 301 disease and injuries, and 26 risk factors; 21 regions, 7 super-regions; 20 age-groups/sex
GBD 2019: Latest - Published October 2020 [https://www.thelancet.com/gbd]
◦ Most comprehensive global study—analyzing 286 causes of death, 369 diseases and
injuries, and 87 risk factors in 204 countries and territories—reveals how the world’s
population was prepared in terms of underlying health for the impact of the COVID-19
pandemic.
Shift in causes of years of life lost (YLL) globally
,21 Global leading causes of YLL (2019)
- Orange/peach: Communicable, maternal, perinatal and nutritional conditions (CDs)
- Blue: Non-communicable conditions (NCDs)
- Green: Injuries, including motor vehicle accidents, self-harm and homicide
Leading causes of YLL in High-Income Countries (HICs) (2019)
, Leading causes of YLL in Low and middle-Income Countries (LMICs) (2019)
Leading causes of YLL in HIC & LMICS (2019)
Shift in the global burden of disease: From CDs to NCDs in globally
Double burden of disease: the onset of significant burden from non-communicable diseases
(NCDs), while the burden from communicable diseases (CDs) remains high (in LMICs)
