Research paper, 2011, 14 Pages
The Global Burden of Disease
Part One: Two Epidemiological Scenarios
Steady Progress Scenario
Progress Stymied Scenario
Factors Affecting the Two Scenarios
Part Two: Epidemiological Aspects of Two Population Pyramids and Causes of Death
Comparison Between Two Population Pyramids
Expected Changes in Causes of Death
The Global Burden of Disease was a comprehensive study conducted by the World Health Organization (WHO), and Harvard School of Public Health to assess the health of the world's population. More specifically, the study assessed the impact of mortality and disability due to different disease conditions, injuries and risk factors for all regions of the world, calling attention to the global and regional estimates of premature mortality, disability and loss of health for over 100 causes by age and gender (WHO, 2011a). To measure the overall disease burden, the researchers developed a single measure called Disability Adjusted Life Years (DALYs), which was calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in a population and the Years Lost due to Disability (YLD) (WHO, 2011b). The study culminated in a report, The Global Burden of Disease, which highlights that the world's populations are expected to see dramatic changes in their health needs in the future. It is believed that many developing countries will experience an epidemiological transition, with rapid population ageing and a sharp increase in the incidence of chronic diseases (e.g., depression and coronary heart disease) that are associated with changes in lifestyle and dietary habits (WHO, 2011a; WHO, 1998). As the economies of these countries are growing, the non-communicable diseases (NCDs) are becoming more prevalent, largely because of over-nutrition, the adoption of westernized diets, and other risk factors, such as smoking, and lack of physical activity (Vorster et al., 1999). Moreover, the NCDs are projected to replace infectious diseases as the leading causes of disability and premature death and by the year 2020, the chronic diseases are expected to account for seven out of every ten deaths in the developing regions, while injuries, both unintentional and intentional, are expected to rival infectious diseases worldwide as a source of ill health (Murray & Lopez, 1996; WHO, n.d.).
The present paper is divided into two parts. The first part reviews two epidemiological scenarios that have been discussed by the international health community regarding the global outlook of communicable versus non-communicable diseases. This part focuses on the optimistic scenario, i.e., the Steady Progress, and the pessimistic scenario, i.e., the Progress Stymied. The second part compares two population pyramids to decide which country is farther along in the epidemiologic transition as described in the Global Burden of Disease report. At the same time, this part uses a graph published by Omran (1971) to identify the changes that are expected in the causes of death if the global life expectancy increases to 76 years within the next 10 years. The overall conclusions are then summarized in the final section of the paper.
The two epidemiological scenarios: Steady Progress and Progress Stymied, discussed by Gannon (2000) are reflected in the different approaches to the epidemiology of communicable versus non-communicable diseases (Gannon, 2000).
On the one hand, researchers supporting the Steady Progress scenario and those who have published the WHO Global Burden of Disease report believe that most countries are facing an epidemiologic transition, which can be defined as the shift in morbidity and mortality factors from epidemics (i.e., infectious diseases) to chronic diseases (i.e., the non-communicable diseases such as cardiovascular disease, mental illnesses, diabetes, and cancer) (WHO, n.d.; Murray & Lopez, 1996). The deaths caused primarily by infectious diseases will fall steadily from 34% of the total disease burden in 1990 to 15% in 2020, with HIV/AIDS moving from 28th place to 10th, whereas mortality from non-infectious diseases is likely to climb from 55% of the total disease burden to 73%, with the remainder of deaths due to accidents and other types of injuries (Gannon, 2000). Additionally, according to WHO (2006), the proportion of total number of deaths caused by non-communicable diseases in developing countries, where healthcare services are already limited, is expected to increase from 61% in 2005 to 68% in 2030, while the share of communicable, maternal, perinatal and nutritional diseases is projected to decline from 30% to 22% (WHO, 2006). If such a scenario was to occur or if it makes sense scientifically, it would be reasonable to highlight the urgent need to develop public health interventions, especially to prevent unhealthy lifestyles from gaining a foothold in low and middle income countries.
Nevertheless, it must be stated that although this scenario captures some real patterns, it overestimates the progress achievable, while underestimating the fact that serious diseases, including TB, malaria, and HIV/AIDS, have re-emerged and are spreading into new regions, which means that potential scientific challenges involved in developing new drugs and vaccines for these complex pathogens may result in humans being exposed to even more virulent and drug-resistant strains of dangerous microorganisms. Furthermore, other interrelated factors that emphasize the unlikelihood of this scenario are (i) the projected decline in life expectancy in countries heavily affected by HIV/AIDS; (ii) the slowing of progress in basic social indicators in much of the developing world; (ii) the negative impact of a halting growth in many countries due to structural economic problems and the risk of recurring economic crises; and (iv) the high costs of certain drugs, especially those used to treat serious infectious diseases, such as HIV/AIDS and multidrug resistant TB.
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