Research Article: The Global Burden of Disease Assessments—WHO Is Responsible?

Date Published: December 26, 2007

Publisher: Public Library of Science

Author(s): Claudia Stein, Tanja Kuchenmüller, Saskia Hendrickx, Annette Prüss-Űstün, Lara Wolfson, Dirk Engels, Jørgen Schlundt, Juerg Utzinger

Abstract: The Global Burden of Disease (GBD) concept has been used by the World Health Organization (WHO) for its reporting on health information for nearly 10 years. The GBD approach results in a single summary measure of morbidity, disability, and mortality, the so-called disability-adjusted life year (DALY). To ensure transparency and objectivity in the derivation of health information, WHO has been urged to use reference groups of external experts to estimate burden of disease.Under the leadership and coordination of WHO, expert groups have been appraising and abstracting burden of disease information. Examples include the Child Health Epidemiology Reference Group (CHERG), the Malaria Monitoring and Evaluation Reference Group (MERG), and the recently established Foodborne Disease Burden Epidemiology Reference Group (FERG). The structure and functioning of and lessons learnt by these groups are described in this paper.External WHO expert groups have provided independent scientific health information while operating under considerable differences in structure and functioning. Although it is not appropriate to devise a single “best practice” model, the common thread described by all groups is the necessity of WHO’s leadership and coordination to ensure the provision and dissemination of health information that is to be globally accepted and valued.

Partial Text: Borrowing the words of the New Testament Apostle Paul, Samuel H. Preston stated that “before 1990, the global disease landscape…was perceived through a glass darkly” [1]. Indeed, the Global Burden of Disease (GBD) 1990 series [2] was a landmark publication that constructed an internally consistent global overview of morbidity, disability, and mortality burden for some 130 diseases and conditions. Frustrated by fragmented, incomplete, incomparable, and often advocacy-driven health information, the authors of the GBD 1990 synthesized a plethora of data and health measures into a single health metric, the so-called disability-adjusted life year (DALY), thus permitting policy makers to directly compare the burden of different diseases, set priorities, and evaluate the cost-effectiveness of their interventions.

The GBD approach was developed in the 1980s with the commissioning of cost-effectiveness analyses by the World Bank. The results of this effort were first published in the World Development Report 1993[8] and the Disease Control Priorities in Developing Countries project [9]. Since adopting the GBD approach in its health reporting, WHO has not only undertaken a major review of the GBD 1990 with its GBD 2000 publications [10], but also provided annual updates in the annex tables of the World Health Report[11]. Moreover, in collaboration with external scientists, WHO developed creative new methodologies for the assessment of disease burden resulting from risk factors [12]. The latter included a widely publicized contribution estimating the GBD from environmental factors such as unsafe water and sanitation, climate change, unsafe sex, and lead exposure, among others. The DALY approach brought new knowledge to the public health community, which was particularly evident in the World Health Report 2001—Mental Health: New Understanding, New Hope[13]. This publication quantified for the first time the “silent burden” of mental disorders by identifying depressive disorders as the leading cause of disability among men and women world-wide. A succinct summary of the GBD study and its evolution is given by Mathers et al. [7].

The burden of disease initiatives described in this paper vary considerably in their structure and procedures, but they are linked by a common thread of strong internal and external collaborations. Given the different nature of the diseases described and the often multiple purposes of the groups established, it would not be prudent to prescribe a blueprint or “best practice” model for external WHO reference groups. For this reason, we have refrained from providing a detailed tabulated summary contrasting specific tactics and approaches that worked well and should be replicated with those that did not work well and should be avoided. The lessons learnt by these groups, however, are helpful in providing focus for the establishment and management of reference groups at WHO. It is apparent that WHO should aim for clarity of the purpose, roles, and procedures applied to the reference groups it convenes. This should include transparent selection procedures for experts, involvement of all stakeholders and partners in the process, and clear communication with constituents.



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