Global Burden of Diseases

Winslow defined Public Health ‘as the science and art of prevention of disease, prolongation of life and promotion of health and well-being through organized community effort for the sanitation of the environment, the control of communicable diseases, the organization of medical and nursing services for the early diagnosis and prevention of disease, the education of the individual in personal health and the development of the social machinery to ensure for everyone a standard of living adequate for the maintenance or improvement of health’.¹

Public health is striving to create an atmosphere in which people can live healthy. Benjamin Disraeli has said, ‘the health of people is really the foundation upon which all their happiness and all their power as a state depend’. Public health deals with the health of the population as a whole rather than the treatment of individuals. Public health works by promoting physical and mental health, and by preventing disease, injury and disability, thus creating healthy people in healthy communities.² This is also reflected in the statement made by William Mayo: ‘Of all cooperative enterprises, public health is the most important and gives the greatest returns’.

Public health deals with threats to the overall health of the community. The main aim is the prevention of disease; while doing so it monitors the health of the community through surveillance of cases of different diseases. It tries to promote health by making the people adopt healthy lifestyle. The treatment of diseases, especially communicable diseases, plays a vital role in preventing their spread to others. Charles Mayo has said, ‘good health is essential to happiness and happiness is essential to good citizenship’. John F. Kennedy stressed, good health is a prerequisite to the enjoyment of ‘pursuit of happiness’.

Since health of people is affected by numerous factors from genetics to socioeconomic conditions, the focus of public health in the last quarter century has broadened to include physical, mental, social, spiritual and intellectual wellbeing. These features have pervaded the fabric of every society. Public health strives to correct these inequalities to improve the health of population. Arnold Toynbee has said, ‘the twentieth century will be remembered chiefly as an age in which human society dared to think of the health of the whole human race as a practical objective’.

The strategy of immunization program, mother and child care, improvement of nutritional status have helped to reduce the incidence of communicable diseases, and life expectancy of people has increased resulting in increased number of ageing population. In India, life expectancy has gone up from 20 years at the beginning of the 20th century to 70 years at present. This has brought an increased prevalence of many non-communicable chronic disorders such as cardiovascular diseases, neurological diseases, joint disease, malignancy, and degenerative disorders. Public health attempts to provide an acceptable quality of life for such people suffering from the sequelae of many chronic diseases.

The Health Services of Government has recognized the importance of public health in reducing the disease and disability. Since many communicable diseases have shown their decline, the focus is on chronic diseases. Health statistics deal primarily with quantifying the health status of population. However, the information is partial and fragmented and it fails to provide most basic data. Information on relative burden of different health problems, conditions and risks to health play an important role in strategic health planning. Looking at the limitations of the data, World Health Organization (WHO), the World Bank, and the Harvard School of Public Health undertook a large collaborative international project called ‘Global Burden of Disease (GBD)’ study. The objectives of the study are, i) to incorporate non-fatal conditions in the assessment of health status, ii) to disentangle epidemiology from advocacy and produce objective, independent and demographically plausible assessment, and projects of the burden of health conditions and diseases, and iii) to measure disease and injury burden by developing a novel method that can also be used to assess the costeffectiveness of interventions.³ GBS study has been accepted as a single measurement index of the disabilityadjusted life year (DALY).

Health promotion and disease prevention are intimately related. Answering the question, What is health promotion? Tannahill defined the condition as a process of enabling people to increase control over their health and improve it.⁴ Success can be achieved with coordinated efforts from Governments, health sector and other social and economic sectors, non-governmental and voluntary organizations, local authorities, industry and the media.⁴

The focus of public health interventions for disease prevention could be primary prevention, secondary prevention or tertiary prevention.⁵ Prevention of the disease or stopping individuals from becoming high risk is referred as primary prevention. It involves universal and selective prevention. The former targets the entire population group and the latter targets the individuals or subgroups of the population exhibiting a higher risk for developing disease. Secondary prevention attempts to decrease the severity of disease or reduce risk or progress of disease through early detection and treatment. Tertiary prevention attempts at interventions that reduce premature death and disability, rehabilitation and prevention of relapses and recurrences of the disease.

GBD provides information on disease burden for diagnostic categories of the International Classification of Diseases (ICD) and the major risk factors that cause those health conditions. The estimates of incidence, prevalence, duration, sequelae, and mortality are provided on a mathematical model, DisMod.⁶

The overall health of the population measures the survival and health status on the basis of the sum of measurement of premature mortality (years of life lost because of premature mortality, or YLL) and disability (years of healthy life lost as a result of disability or YLD). The resultant DALY gives a measure of the future healthy life (years expected to be lived in full health) that is lost due to incidence of specific diseases and injuries.⁷

GBD study has shown that non-communicable diseases and injuries are responsible for considerable health burden all over the world. It is considered a major advance in the quantification of the impact of diseases, injuries and risk factors on population health. Franklin D. Roosevelt has said, ‘nothing can be more important to a state than its public health. The state’s paramount concern should be the health of its people’.

The GBD framework provides a common denominator that can be used to determine progress over time within a single country or region or relative performance across countries or regions. It provides projections of mortality and burden of disease by region and gives updated projections of future trends for mortality and burden of disease. Since the projections of the future are highly uncertain, they have to be interpreted with caution. The limitation of the GBD framework includes uncertainties in the baseline data on levels of trends in cause specific mortality, the ‘baseline as usual’ assumption, and the use of relatively simple to model-based largely on projections of economic and social development.⁷ However, GBD framework projects future trends of mortality and burden of disease which help in planning the strategy to control and prevent diseases. Based on the information, action has to be initiated globally to contain the diseases.

From the beginning of the third millennium, India is witnessing fast growth in elderly population and increasing incidence of non-communicable diseases. The GBD study is the ongoing international collaborative project and it has shown evidence indicating neurological disorders as one of the greatest threats to public health. An immediate action is warranted before the problem becomes more serious and unmanageable. Karl Marx considered the best country as the one which has the fewest diseases. The words of John F. Kennedy should be remembered: ‘Good health for all our people is a continuing goal. In a democratic society where every human life is precious, we can aspire to no less. Healthy people build a stronger nation, and make a maximum contribution to its growth and development’.

Everyone desires to live a long healthy life. But in real life this does not happen. GBD has provided a tool by which we can quantify loss of health from a variety of diseases, injuries and risk factors. The 2019 GBD report has given a call to Global health community that it is time for radical change. It has stressed that health can be created from improved quality of education, economic growth, gender equality and migration policy.⁸

World Health Statistical Report 2021 has given data for more than 50 health-related indicators for the sustainable Development Goals and WHO’s ‘Triple Billion’ targets.⁹ There is an increase in global life expectancy and healthy life expectancy at birth. WHO constitution has declared health as a fundamental human right and it has committed to ensure highest attainable level of health for all through Universal Health Coverage (UHC).

WHO triple billion targets is trying to improve the health of billions of people by 2023 where a billion people enjoy better health and wellbeing, another billion get benefit from UHC and the third billion get better protected from health emergencies. We are eagerly looking forward for a long, healthy life for the mankind. The GBD study results have given a clear picture of health challenges faced by people across the globe in the 21st century and it has shown the way to overcome the obstacles and reach the goal of long life in full health.

Conflict of Interest

None