Cross-national compartability of burden of disease estimates:the European disability weights project

Objective: To investigate the sources of cross-national variation in disability-adjusted life-years (DALYs) in the European Disability
Weights Project.

Methods: Disability weights for 15 disease stages were derived empirically in five countries by means of a standardized procedure and the cross-national differences in visual analogue scale (VAS) scores were analysed. For each country the burden of dementia in women, used as an illustrative example, was estimated in DALYs. An analysis was performed of the relative effects of cross-national variations in demography, epidemiology and disability weights on DALY estimates.

Findings: Cross-national comparison of VAS scores showed almost identical ranking orders. After standardization for population size and age structure of the populations, the DALY rates per 100 000 women ranged from 1050 in France to 1404 in the Netherlands. Because of uncertainties in the epidemiological data, the extent to which these differences reflected true variation between countries was difficult to estimate. The use of European rather than country-specific disability weights did not lead to a significant change in the burden of disease estimates for dementia.

Conclusions: Sound epidemiological data are the first requirement for burden of disease estimation and relevant between-countries comparisons. DALY estimates for dementia were relatively insensitive to differences in disability weights between European countries.

The burden of smoking related ill health in the UK

Background: Smoking is one of the biggest avoidable causes of morbidity and mortality in the United Kingdom. This paper quantifies the current health and economic burden of smoking in the UK. It provides comparisons with previous studies of the burden of smoking in the UK and with the costs for other chronic disease risk factors.

Methods: A systematic literature review to identify previous estimates of National Health Service costs attributable to smoking was undertaken. Information from the World Health Organization’s Global Burden of Disease Project and routinely collected mortality data were used to calculate mortality due to smoking in the UK. Population-attributable fractions for smoking-related diseases from the Global Burden of Disease Project were applied to NHS cost data to estimate direct financial costs.

Results: Previous studies estimated that smoking costs the NHS about £1.4 billion to £1.7 billion in 1991 and has been responsible for about 100 000 deaths per annum over the past 10 years. This paper estimates that the number of deaths attributable to smoking in 2005 was 109 164 (19% of all deaths, 27% deaths in men and 11% of deaths in women). Smoking was directly responsible for 12% of disability adjusted life years lost in 2002 (15.4% in men; 8.5% in women) and the direct cost to the NHS was £5.2 billion in 2005–6.

Conclusion: Smoking is still a considerable public health burden in the UK. Accurately establishing the burden in terms of death, disability and financial costs is important for informing national public health policy.

The burden of physical activity-related ill health in the UK

Background: Despite evidence that physical inactivity is a risk factor for a number of diseases, only a third of men and a quarter of women are meeting government targets for physical activity. This paper provides an estimate of the economic and health burden of disease related to physical inactivity in the UK. These estimates are examined in relation to current UK government policy on physical activity.

Methods: Information from the World Health Organisation global burden of disease project was used to calculate the mortality and morbidity costs of physical inactivity in the UK. Diseases attributable to physical inactivity included ischaemic heart disease, ischaemic stroke, breast cancer, colon/rectum cancer and diabetes mellitus. Population attributable fractions for physical inactivity for each disease were applied to the UK Health Service cost data to estimate the financial cost.

Results: Physical inactivity was directly responsible for 3% of disability adjusted life years lost in the UK in 2002. The estimated direct cost to the National Health Service is £1.06 billion.

Conclusion: There is a considerable public health burden due to physical inactivity in the UK. Accurately establishing the financial cost of physical inactivity and other risk factors should be the first step in a developing national public health strategy.

The burden of alcohol-related ill health in the United Kingdom

Background Although moderate alcohol consumption has been shown to confer a protective effect for specific diseases, current societal patterns of alcohol use impose a huge health and economic burden on modern society. This study presents a method for estimating the health and economic burden of alcohol consumption to the UK National Health Service (NHS).

Methods Previous estimates of NHS costs attributable to alcohol consumption were identified by systematic literature review. The mortality and morbidity due to alcohol consumption was calculated using information from the World Health Organization Global Burden of Disease Project and routinely collected mortality data. Direct health-care costs were derived using information on population attributable fractions for conditions related to alcohol consumption and NHS cost data.

Results We estimate that alcohol consumption was responsible for 31 000 deaths in the UK in 2005 and that alcohol consumption cost the UK NHS £3.0 billion in 2005–06. Alcohol consumption was responsible for 10% of all disability adjusted life years in 2002 (male: 15%; female: 4%) in the UK.

Conclusions Alcohol consumption is a considerable public health burden in the UK. The comparison of the health and economic burden of various lifestyle factors is essential in prioritizing and resourcing public health action.

The burden of disease and injury in Australia 2003

The report measures mortality, disability, illness and injury arising from over 170 diseases and injuries. Burden of disease analysis gives a unique perspective on health

The DALY, context and the determinants of the severity of disease: an exploratory comparison of paraplegia in Australia and Cameroon

This paper summarises the findings of an empirical investigation of some of the technical and social assumptions on which the disability adjusted life year (DALY) is based. The objectives of the study were to examine the notion that the burden of disease is broadly similar without regard to country, environment, gender or socio-economic status and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors. The study was a multi-factorial exploratory study employing qualitative and quantitative techniques to obtain data on the effects of country (development), environment (urban versus rural), gender and socio-economic status on people with paraplegia. The data provided an extensive and detailed compilation of context rich descriptions of living with paraplegia. Striking features of the data were the differences between countries with respect to the impact of the health conditions on functioning and highlight a context in which paraplegia of like clinical severity can be fatal in one environment and not in another. While there has been some focus on the control of social determinants of disease, there has been little work on the social determinants of the severity of disease. The underlying assumptions of the DALY, which ignore context in the assessment of the burden of disease, risk exacerbating inequalities by undervaluing the burden of disease in less-developed countries. There is a need to continue to subject the development of indicators to rigorous debate to determine a balance between the assumption of a global “average social milieu” and the treatment of each individual as belonging to their own context in the assessment of population health in order for indicators to be meaningful cross-culturally.

Estimating the disease burden of alcohol : the problems arising when data and policy interact

While the risk of many disease or injury conditions is raised by the presence of health risk factors, it is usually impossible to identify individual risk-factor caused cases. However, the overall burden of disease and injury attributable to various health risks can be estimated if we know the prevalence of exposure to the risk factor in the community and the relative risk of each causally associated disease or injury for those exposed to the risk factor. This paper describes the estimation of the total number of deaths and hospital episodes attributable to alcohol consumption. It also describes how some methodologically trivial variations to the estimation methods raised some major issues in interpreting the results for the development of public policy.

Perioperative Mortality Rate (POMR): a global indicator of access to safe surgery and anaesthesia

The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery.

The breast cancer related burden of morbidity and mortality in six European coutries

Background: The burden of breast cancer expressed in Disability Adjusted Life Years (DALYs) was compared for six European countries and its sensitivity to different sources of variation examined. Methods: DALYs were calculated using country-specific epidemiological data and European Disability Weights. Epidemiological data for 1996 were obtained for Denmark, England and Wales, France, the Netherlands, Spain and Sweden. Disability weights were empirically derived. Results:  Denmark and the Netherlands lost the largest number of DALYs (approximately 1100 DALYs per 100,000 women). They were followed by England (87% of the Danish burden), France (72%), Sweden (68%) and Spain (67%). 70 to 80% of the burden was caused by mortality. Cross-national variation in disease epidemiology was the largest source of variation in the burden of breast cancer. Variation in disability weights and uncertainty in epidemiological data had smaller effects. Conclusion: To compare the burden of breast cancer and most other types of cancer mortality rates provide sufficient information.

The burden of overweight and obesity-related ill health in the UK

This paper reviews previous cost studies of overweight and obesity in the UK. It proposes a method for estimating the economic and health costs of overweight and obesity in the UK which could also be used in other countries. Costs of obesity studies were identified via a systematic search of electronic databases. Information from the WHO Burden of Disease Project was used to calculate the mortality and morbidity cost of overweight and obesity. Population attributable fractions for diseases attributable to overweight and obesity were applied to National Health Service (NHS) cost data to estimate direct financial costs. We estimate the direct cost of overweight and obesity to the NHS at £3.2 billion. Other estimates of the cost of obesity range between £480 million in 1998 and £1.1 billion in 2004 [Correction added after online publication 11 June 2007: 'of the cost of obesity' added after 'Other estimates']. There is wide variation in methods and estimates for the cost of overweight and obesity to the health systems of developed countries. The method presented here could be used to calculate the costs of overweight and obesity in other countries. Public health initiatives are required to address the increasing prevalence of overweight and obesity and reduce associated healthcare costs.

Assessing the burden of overweight and obesity : an example from the United Kingdom

Introduction: In this paper I review previous cost studies for overweight and obesity in the UK. I propose a method for estimating the economic and health costs of overweight and obesity in the UK which could also be used in other countries.

Methods: Costs of obesity studies were identified via a systematic search of electronic databases. Information from the WHO Burden of Disease Project was used to calculate the mortality and morbidity cost of overweight and obesity.
Population attributable fractions for diseases attributable
to overweight and obesity were applied to National Health Service (NHS) cost data to estimate direct financial costs.

Results: We estimate the direct cost of overweight and obesity to the NHS at £3.2 billion. Other estimates range between £480 million in 1998 and £1.1 billion in 2004. There is wide variation in methods and estimates for the cost of overweight and obesity to the health systems of developed countries.

Conclusion: The method presented here could be used to calculate the costs of overweight and obesity in other countries. Public health initiatives are required to address the increasing prevalence of overweight and obesity and reduce associated healthcare costs.

Regular exercise participation mediates the affective response to acute bouts of vigorous exercise

Physical inactivity is a leading factor associated with cardiovascular disease and a major contributor to the global burden of disease in developed countries. Subjective mood states associated with acute exercise are likely to influence future exercise adherence and warrant further investigation. The present study examined the effects of a single bout of vigorous exercise on mood and anxiety between individuals with substantially different exercise participation histories. Mood and anxiety were assessed one day before an exercise test (baseline), 5 minutes before (pre-test) and again 10 and 25 minutes post-exercise. Participants were 31 university students (16 males, 15 females; Age M = 20), with 16 participants reporting a history of regular exercise with the remaining 15 reporting to not exercise regularly. Each participant completed an incremental exercise test on a Monark cycle ergometer to volitional exhaustion. Regular exercisers reported significant post-exercise improvements in mood and reductions in state anxiety. By contrast, non-regular exercisers reported an initial decline in post-exercise mood and increased anxiety, followed by an improvement in mood and reduction in anxiety back to pre-exercise levels. Our findings suggest that previous exercise participation mediates affective responses to acute bouts of vigorous exercise. We suggest that to maximise positive mood changes following exercise, practitioners should carefully consider the individual's exercise participation history before prescribing new regimes.

Mind the gap! : A discussion on the disparity between low and high income countries in the provision of mental health care and the implications for capacity building in Kenya’s nursing workforce.

About fourteen per cent of the global burden of disease has been attributed to mental, neurological and substance use disorders. A number of initiatives have been launched in recent years to respond to this, the World Health Organisation (WHO) introduced the Mental Health Gap Action Programme (mhGAP) to address the widening gap between what is needed to provide adequate mental health services and what is currently available, especially in low and middle income countries where the gap is widest.
This discussion paper will focus on mental health nursing in Kenya, a country in East Africa with a population of 42 million people. Mental illness is common in Kenya with up to twenty five per cent prevalence rates, yet mental health services are sparse at the tertiary and primary care level and mental health remains a low budget and policy priority for the government. The aim of this paper is to raise participants’ awareness of the challenges of delivering mental health nursing care in low-income countries such as Kenya, and to explore possible solutions to the problem.