The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: Developing the evidence base for national, regional and global public health action

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.

A process for the systematic review of community-based rehabilitation evaluation reports: formulating evidence for policy and practice

A methodological framework for conducting a systematic, mostly qualitative, meta-synthesis of community-based rehabilitation (CBR) project evaluation reports is described. Developed in the course of an international pilot study, the framework proposes a systematic review process in phases which are strongly collaborative, methodologically rigorous and detailed. Through this suggested process, valuable descriptive data about CBR practice, strategies and outcomes may be synthesized. It is anticipated that future application of this methodology will contribute to an improved evidence base for CBR, which will facilitate the development of more appropriate policy and practice guidelines for disability service delivery in developing countries. The methodology will also have potential applications in areas beyond CBR, which are similarly. evidence poor' (lacking empirical research) but 'data rich' (with plentiful descriptive and evaluative reports).

Managing knowledge in tourism planning: How to assess your capability

This paper explores the theme of strategic planning in a State Tourism Organization (STO) from a knowledge management perspective. It highlights the value of knowledge in strategy making and the importance of an organisation's knowledge management agenda in facilitating a strategic planning process. In particular, it considers the capability of an STO to implement knowledge management as the key to a successful strategic planning exercise. In order to develop greater insight into the factors that impact on planning competence, the key aim of this paper is to develop a framework on which the capability of a STO to implement a knowledge-based agenda in strategic planning can be assessed. Research on knowledge management in the field of tourism is limited and there is little practical account of the application of knowledge management principles in tourism planning. Further, there is no apparent tool or instrument that allows for the assessment of an STO's capability to implement knowledge management in planning initiatives. Based on a literature review, a three-point framework of assessment is developed. The three elements of the framework are identified as: 1. Integration of knowledge management objectives with strategic imperatives; 2. A planning approach that balances top-down (outcome focused) with bottom-up (process focused) planning processes; and 3. Organisational capacity, including leadership, people and culture, process, technology, content and continuous improvement. The framework is tested through application to a practical case study - a planning initiative undertaken by a leading tourism STO in Australia. The results demonstrate that the framework is a useful means to evaluate organisational capability in knowledge-led strategic planning exercises and would be of practical value as a point of reference for future knowledge- based strategic planning projects. Copyright © by The Haworth Press, Inc. All rights reserved.

Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use

Alcohol, tobacco and illicit drug use together pose a formidable challenge to international public health. Building on earlier estimates of the demonstrated burden of alcohol, tobacco and illicit drug use at the global level, this review aims to consider the comparative cost-effectiveness of evidence-based interventions for reducing the global burden of disease from these three risk factors. Although the number of published cost-effectiveness studies in the addictions field is now extensive ( reviewed briefly here) there are a series of practical problems in using them for sector-wide decision making, including methodological heterogeneity, differences in analytical reference point and the specificity of findings to a particular context. In response to these limitations, a more generalised form of cost-effectiveness analysis (CEA) is proposed, which enables like-with-like comparisons of the relative efficiency of preventive or individual-based strategies to be made, not only within but also across diseases or their risk factors. The application of generalised CEA to a range of personal and non-personal interventions for reducing the burden of addictive substances is described. While such a development avoids many of the obstacles that have plagued earlier attempts and in so doing opens up new opportunities to address important policy questions, there remain a number of caveats to population-level analysis of this kind, particularly when conducted at the global level. These issues are the subject of the final section of this review.

Repurchase of renewal rights: A policy option for the National Water Initiative

Management of the Murray-Darling river system involves a large number of users with imprecisely defined rights, and an aggregate rate of resource use that is environmentally unsustainable. One possible policy response is to make formal or informal contracts with users, under which users receive current benefits in return for a commitment to forgo usage rights in future. In this paper, this issue is explored with specific reference to the possibility of repurchasing the renewal rights for irrigation licenses.