The document discusses global burden of diseases metrics and methodologies. It provides historical context on global burden of disease studies, which began in the 1990s and are now conducted annually by an international consortium involving thousands of researchers. The document outlines various metrics used to measure burden of disease, including years of life lost, years lived with disability, and disability-adjusted life years. It also discusses methodologies for calculating disease incidence and prevalence, and risk factors.

1. Global Burden of Diseases
Metrics and Methodologies
A.Vijay Kumar MPH
Sri Ramachandra Univ

2. Data Driven - World

3. • The reliable information on the incidence and prevalence of diseases, injuries and
risk factors is rarely available in developing countries.
• The data are collected, particularly hospital records, are unlikely to reflect the true
pattern of disease and injury in the community due to biases and uncertainties.
• Scientific evidence is key to improving global public health, because national and
international health policies to be based on accurate , meaningful health information.
• Setting health priority information that is comparable, reliable and comprehensive
across a wide range of conditions that cause death or ill-health in a population.
• This GBD study served as the most comprehensive effort up to that point to
systematically measure the world’s health problems.
Historical Perspective

4. • World Bank commissioned the original study in the 1990 and featured in World
Development Report 1993.GBD is an effort of researchers from all over the world.
• By Institute of Health Metric Evaluation (IHME) at University of Washington (UW)
funded by Gates Foundation.
• GBD later institutionalized at the world health organization along with the
researchers from Harvard University continued to update GBD findings.
• It has grown over the past two decades into an international consortium of nearly
5500 researchers, and its estimates are being updated annually.
• The Alma-Ata Declaration of 1978 Intl Conf on PHC identified primary health care as
the key to the attainment of the goal of “Health for All” by WHO countries.
Contd..

5. • The systematic and scientific effort to quantify the magnitude of health loss due to
diseases , injuries, and risk factors by age , sex and geographies. The sum of
mortality and morbidity is referred to as the burden of disease.
• Assessing health outcomes by both mortality and morbidity (the prevalent
diseases) provides a more encompassing view on health outcomes.
• Morbidity - The number of people in a population who are unwell or disabled, and
the severity of their illness or disability.
• Mortality - The number of people in a population who die as a result of a specific
disease or disability.
• Risk attribution - It comments on links between illness, disability or death outcomes
to recognized risk factors.
Burden of Diseases

6. Years of Life Lost - YLL
It is the years of life lost due to premature mortality from a specific cause of death.
reference to specific exposures or risk factors.
YLL = N * L
N Total deaths from the specific cause and L Standard life expectancy
Years of Life lived with Disability - YLD
It is the years of life lived with disability due to disease incidence.
YLD = I * DW * L
I number of incident cases, DW disability weight, L mean duration of disease.
Disability Adjusted Life Years - DALY
It is the burden of disease parameter that includes both morbidity and mortality
and that can be compared across different diseases.
DALY = YLL + YLD
Metrics

7. Disability Weights
DW represents the magnitude of health loss associated with specific health
outcomes. It seeks to weight the disability of living with different diseases
Quality Adjusted Life Year
QALY is commonly used in health economic evaluations as a means of quantifying
the health effect of a medical intervention, utility value measure between 0 (death)
and 1 (perfect health) 1 Year of Life × 1 Utility Value = 1 QALY
Disease Weights
All cancers 0.81
Alzheimer 0.64
AIDS 0.50
Tuberculosis 0.27
Deafness 0.22
Contd..

8. Health Adjusted Life Expectancy
HALE is a measure of population health that takes into account mortality and morbidity.
It adjusts overall life expectancy by the amount of time lived in less than perfect health
A = years lived healthily
B = years lived with disability
A+(f)B = healthy life expectancy, where f is a weighting to reflect disability level
Potential Years of Life Lost
PYLL is a measure attempts to quantify the potential years of life lost by looking at
average age of death from conditions compared to average life expectancy.
The calculation involves adding up deaths due to a cause at each age and multiplying this
with the number of remaining years to live up to a selected age limit.
Contd..

9. Population Attributable Risk
• Attributable risk is the portion of
disease incidence in the exposed that
is due to the exposure , which also
provides the risk difference.
• PAR is the proportion of the disease
incidence in the population that is due
to the exposure.
• This is a similar measure to AR except
it is concerned with the excess rate of
disease in the population
• It compares with the rate of disease in
the exposed group

10. GBD TOOL

11. GBD - Risk Characterization - Target Group

12. Determinants - Health Geography

13. According to “world bank reports 1996” women's overall underutilization of health
services has been well documented. For instance, even though women in India report
more illness than men, hospital records show that men receive more access to health.
(a)biological differences - immune relevant genes - xx chromosome
(b) women longer life expectancy - less exposures - household
(c) labor force participation - agri - historically - set
(d) women access to social protection mechanisms - health insurance
(e) cultural norms, religious beliefs, and customs - religions
(f) gender differences in educational attainment - marital status
GBD - Gender Perspective

14. DALY India n World

15. Contd.. YLD

16. MMR n U5MR

17. • Globally, under-five mortality rate has decreased by 59%, from an estimated rate of
93 deaths per 1000 live births in 1990 to 39 deaths per 1000 live births in 2018.
• This is equivalent to 1 in 11 children dying before reaching age 5 in 1990,
compared to 1 in 26 in 2018.
• Globally, the infant mortality rate has decreased from an estimated rate of 65
deaths per 1000 live births in 1990 to 29 deaths per 1000 live births in 2017.
Annual infant deaths have declined from 8.8 million in 1990 to 4.1 million in 2017.
• Maternal mortality is unacceptably high. About 295000 women died during and
following pregnancy and childbirth in 2017.
• 94% of all maternal deaths occur in low and lower middle-income countries.
Especially in the Sub Saharan Countries
Contd..

18. Life Expectancy

19. Mortality Data

20. • The policy aims to raise public healthcare expenditure to 2.5 percent of GDP from the
current 1.4 percent, with more than two-thirds of the resources
• Reduce mortality rate of children under 5 years of age to 23 (per 1000) by 2025 and
maternal mortality rate (MMR) from current levels to 100 by 2020.
• Reduce infant mortality rate to 28 by 2019. Reduce neo-natal mortality to 16 and still
birth rate to 'single digit' by 2025.
• Reduction of total fertility rate to 2.1 at national and sub-national level by 2025.
Establish regular tracking of disability adjusted life years (DALY) Index as a measure of
burden of disease and its trends by major categories by 2022.
• It also has plans for substantial reduction of AIDS, tuberculosis, vector borne diseases
and neglected tropical diseases and combat hepatitis, water-borne and ncds.
National Health Policy 2017

21. Health Schemes
• Integrated Child Development Service was launched to improve the nutrition and health
status of children in the age group of 0-6 years, through proper nutrition and health
education.
• Rastriya Swasthya Bima Yojana is a government-run health insurance programme aims to
provide health insurance coverage to the unrecognized sector workers n BPL families
• Mission Indradhanush with the aim of improving coverage of immunization in the country
which will cover unvaccinated and in rural and urban areas of India.
• Shishu Suraksha Karyakaram to motivate those who still choose to deliver at their homes to
opt for institutional deliveries and would reach every needy pregnant woman
• Rashtriya Bal Swasthya Karyakram aiming at early identification and early intervention for
from birth to 18 years to cover 4ds Defects at birth, Deficiencies, Diseases, Development

22. • Reproductive, Maternal, Newborn, Child and Adolescent Health
(RMNCH+A) programme essentially looks to address the major causes of mortality
among women and children, introduces initiatives like the use of score card to track
health performance, National Iron + Initiative to address the issue of anemia Screening
and Early interventions for defects at birth, diseases, and deficiencies among children
and adolescents
• National Health Protection Scheme: aka Ayushman Bharat with the sum assured now a
raised to Rs 5 lakhs. The coverage has enabled expansion to include tertiary care
making provision for purchasing it from the private sector where the such services are
not available in public sector.
• Pradhan Mantri Bhartiya Jan Aushadhi Pari Yojana. The scheme envisaged to make
available the basic essential medicine and to provide generic drugs, at lesser prices but
are equivalent in quality and efficacy as expensive branded drugs.
Contd..

23. IHD - Global - CV risks

24. • Angiotensin-converting enzyme 2 ACE2 is an enzyme attached to the cell membranes of
cells in the lungs, arteries, heart, kidney, and intestines.
• This “decreased braking” when the SARS-CoV-2 virus binds to ACE2 likely contributes
to injury, especially to the lungs and heart, in COVID-19 patients.
• ACE2 helps modulate the many activities of a protein called angiotensin II (ANG II) that
increases blood pressure by vasoconstriction, increasing damage to blood vessel
linings.
• According to a study by the University Medical Center Groningen, this ACE2 receptor is
found in higher concentrations in men.
• Researchers discovered this gender difference while investigating a positive correlation
between the ACE2 receptor and chronic heart failure.
COVID19 - CV risks

25. Contd.. CV risks

26. GBD - ICD Nomenclature
• The International Classification of Disease (ICD) is a standard diagnostic tool
created by the World Health Organization (WHO), for monitoring the incidence and
prevalence of diseases and related conditions.
• The ICD has diverse clinical applications, and is used not just by doctors but also by
paramedic staff, insurance companies, researchers and policy makers.
• The significance of the ICD-10 code system can be assessed from its application in
various realms of quality management, healthcare, information technology and
public health.
• ICD-10-CM adopted internationally to facilitate implementation of quality health
care on global scale and to identify patients in need of immediate disease
management and to tailor effective disease management programs.

27. Contd..

28. Early 18th Century - AP
• Industrial Revolution, in modern history, change
from an agrarian and to one dominated
by industry and machine manufacturing.
• This process began in Britain in the 18th
century and from there spread to other parts of
the world (movement of goods n services).
• The use of new energy sources, fuels and motive
power, such as coal, engine , steam, electricity
petroleum, and the internal-combustion engine,
• The increasing application of science to
industry and the changes made a tremendous
exploit of natural resources and the mass
productions.

29. Air pollution is now the third-highest cause
of death among all health risks, ranking just
above smoking, in India.
Centre for Science and Environment said
that Life expectancy in India has gone
down by 2.6 years due to deadly diseases
caused by air pollution.
Also reports that air pollution kills an
average 8.5 out of every 10,000 children in
India before they turn 5
99% of children born under 5 are exposed
to dangerous levels of PM2.5.
Public Health Emergency

30. Health Effects - Vulnerable group

31. Pollutants

32. • Particulate Matter is a suspended mixture of, smoke, metals, nitrates, sulfates, dust,
and water. It can be directly emitted and forms oxides in reaction with atmosphere
e.g. nitrogen oxides.
• Small particles PM 2.5 a fine particulate matter pose the greatest problems because
they bypass the body’s natural defenses and can get deep into your lungs and
potentially your bloodstream.
• Lung Cancer
• Irritation of the airways.
• Asthma
• COPD
• Emphysema
• Bronchitis
• Premature death
• Heart or lung disorders.
Particulate Matter

33. Delhi - Case Study
Stubble Burning in Punjab, Rajasthan
and Haryana causes a thick blanket of
smog in Delhi during winters.
Dust Storm from Gulf countries: The
dust storm from Gulf countries was also
the reason enhances.
Topography: Delhi lies in landlocked
Indo-Gangetic region which does not
have a geographical advantage.
Lack of winds coupled with weather
conditions in winter trap the pollutants
in the plains

34. Alipur, Delhi - DPCC 238.00
Anand Vihar, Delhi - DPCC 238.00
Ashok Vihar, Delhi - DPCC 243.00
Aya Nagar, Delhi - IMD 166.00
Bawana, Delhi - DPCC 298.00
Burari Crossing, Delhi - IMD 224.00
CRRI Mathura Road, Delhi - IMD 193.00
DTU, Delhi - CPCB 267.00
Dr. Karni Singh Shooting Range, Delhi - DPCC 175.00
Dwarka-Sector 8, Delhi - DPCC 281.00
IGI Airport (T3), Delhi - IMD 194.00
IHBAS, Dilshad Garden, Delhi - CPCB 208.00
ITO, Delhi - CPCB 208.00
Jahangirpuri, Delhi - DPCC 270.00
0-50 Good Minimal impact
51-100 Satisfactory Minor breathing
discomfort to sensitive
people
101-200 Moderate Breathing discomfort to
the people with lungs,
asthma and heart
diseases
201-300 Poor Breathing discomfort to
most people on
prolonged exposure
301-400 Very Poor Respiratory illness on
prolonged exposure
401-500 Severe Affects healthy people
and seriously impacts
those with existing
diseases
CPCB - Delhi AQI

35. Air (Prevention and Control of Pollution) Act, 1981
The important functions are to improve the quality of air and to prevent, abate air
pollution in the country, to advise the government on any matter concerning the
improvement of the quality of air and the prevention, control or abatement of air
pollution, to plan and executed a program
Air (Prevention and Control of Pollution) Rules,1982
Defined the procedures for conducting meetings of the boards administrative guidance to
the various bodies , e.g. CPCB functions.
Air (Prevention and Control of Pollution) Amendment Act 1987
Amendment to the original Air Act 1981 , The boards were authorized to take immediate
measures to tackle such emergencies and recover the expenses incurred from the
offenders.
Indian Legislations

36. Environment Protection Act 1986 Central Government shall have power to take all such
steps it thinks necessary for the preserving and improving the quality of the
environment and preventing and controlling environmental pollution, to prohibit and
restrict on the location of industries and the carrying on of the process and operations in
different areas.
National Clean Air Programme NCAP one of the initiatives recently by launched Ministry
of Environment, Forest & Climate Change (MoEFCC) to combat and abate air pollution
across the country. To reduce 20-30% of PM 2.5 and PM 10 concentration in 102 cities
in the most hazardous cities
CPCB National Ambient Air Quality Standards NAAQ for major pollutants were notified
by the CPCB.These are deemed to be levels of air quality necessary with an adequate
margin of safety, to protect public health, vegetation and property. The NAAQ prescribes
specific standards for industrial, residential, rural and other sensitive areas.
Contd..

37. Global Environment Monitoring System (GEMS )
It is the UN Environment Programme mechanism on air quality monitoring that builds
and maintains collaboration amongst global stakeholders to enhance and keep the state
of the quality of the world’s air quality.
It builds capacity and generates services in partnership with multiple stakeholders
using low cost sensors to support the development of evidence-based air quality
management policies and to support actions for mitigating air pollution.
Urban Air Action Platform (UAAP)
The World’s largest Real-Time Crowd-Sourced Air Data Platform United Nations
Environment Programme (UNEP) to develop the largest real-time air quality databank,
bundling real-time air quality data for particulate matter (PM2.5)
Global
Measures

38. GM Contd..

39. • London was an early starter in discouraging car use and is world leader among big
cities in putting up roadblocks to automobiles.
• From April, London will charge drivers of older petrol and diesel cars a Euro 12.50
fee on top of the existing Euro 11.50 congestion charge to drive into the central
Ultra-Low-Emission-Zone.
• Spain recently imposed stringent new rules banning older petrol and diesel vehicles
from a two-square-mile zone in Central Madrid.
• The city reports the ban has already cut the number of vehicles plying the roads by
20% and public transport speeds have risen by 14%.
• China, on its part, is rolling out extensive EV infrastructure and offering automakers
numerous incentives to produce clean cars.
GM Contd..

40. • Determine priority pollutants. The pollutants of concern for a specific location will be
based on the nature determined. Identify measures to control sources of pollution.
• Develop a control strategy and plan that incorporates the control measures. The
written plan should include implementation dates.
• The plan will need to reference the requirements that owners or operators of
emission sources will need to undertake to reduce pollution contributing to the air
quality problems.
• Involve the public. Invite input from the regulated community and others, including
the general public when developing the control strategy.
• Include compliance and enforcement programs. These programs are very important
to include and help owners or operators of sources understand the requirements.
USEPA - Guidelines

41. AQMS - Analytics n Modelling

42. SDG’s 2015-2030

43. • https://vizhub.healthdata.org/gbd-compare/
• https://www.ncbi.nlm.nih.gov/books/NBK11729/
• https://www.healthline.com/health-news/men-more-susceptible-to-serious-
covid-19-illnesses
• https://www.shape.com/lifestyle/mind-and-body/why-life-expectancy-
longer-women-worldwide
• https://www.britannica.com/event/Industrial-Revolution
• https://data.worldbank.org/indicator/SH.DYN.MORT
References

44. References
• https://www.verywellhealth.com/understanding-healthy-life-expectancy-
2223919
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397034/#:~:text=In%20th
e%20GBD%20study%2C%20a,disease%20or%20experiencing%20an%20inju
ry.
• http://www.healthdata.org/sites/default/files/files/Projects/GBD/GBD_Proto
col.pdf
• https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=
1&contentid=3066
• https://www.honeywellsmarthomes.com/blog/causes-of-air-pollution-in-
delhi/

45. THE END