Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010

BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. METHODS We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. FINDINGS 13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. INTERPRETATION This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results.

Global burden of disease attributable to mental and substance use disorders : findings from the Global Burden of Disease Study 2010

Background We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the burden of disease attributable to mental and substance use disorders in terms of disability-adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs). Methods For each of the 20 mental and substance use disorders included in GBD 2010, we systematically reviewed epidemiological data and used a Bayesian meta-regression tool, DisMod-MR, to model prevalence by age, sex, country, region, and year. We obtained disability weights from representative community surveys and an internet-based survey to calculate YLDs. We calculated premature mortality as YLLs from cause of death estimates for 1980–2010 for 20 age groups, both sexes, and 187 countries. We derived DALYs from the sum of YLDs and YLLs. We adjusted burden estimates for comorbidity and present them with 95% uncertainty intervals. Findings In 2010, mental and substance use disorders accounted for 183·9 million DALYs (95% UI 153·5 million–216·7 million), or 7·4% (6·2–8·6) of all DALYs worldwide. Such disorders accounted for 8·6 million YLLs (6·5 million–12·1 million; 0·5% [0·4–0·7] of all YLLs) and 175·3 million YLDs (144·5 million–207·8 million; 22·9% [18·6–27·2] of all YLDs). Mental and substance use disorders were the leading cause of YLDs worldwide. Depressive disorders accounted for 40·5% (31·7–49·2) of DALYs caused by mental and substance use disorders, with anxiety disorders accounting for 14·6% (11·2–18·4), illicit drug use disorders for 10·9% (8·9–13·2), alcohol use disorders for 9·6% (7·7–11·8), schizophrenia for 7·4% (5·0–9·8), bipolar disorder for 7·0% (4·4–10·3), pervasive developmental disorders for 4·2% (3·2–5·3), childhood behavioural disorders for 3·4% (2·2–4·7), and eating disorders for 1·2% (0·9–1·5). DALYs varied by age and sex, with the highest proportion of total DALYs occurring in people aged 10–29 years. The burden of mental and substance use disorders increased by 37·6% between 1990 and 2010, which for most disorders was driven by population growth and ageing. Interpretation Despite the apparently small contribution of YLLs—with deaths in people with mental disorders coded to the physical cause of death and suicide coded to the category of injuries under self-harm—our findings show the striking and growing challenge that these disorders pose for health systems in developed and developing regions. In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a public health priority.

The arts and Australia's national innovation system 1994 - 2008 arguments, recommendations, challenges

Based on 15 years of arts and innovation literature, this paper explores the central proposition that the arts sector - particularly the performing arts, visual arts and crafts, new media arts and creative writing - should be included in Australian Government innovation policy development and play a significant role in national innovation. After a brief overview of innovation policy and the national innovation systems approach in Australia, we examine the marginal place of the arts in Australia's innovation agenda and various attempts to include them. We identify the principal voices that have argued for arts and innovation development: the humanities, arts and social sciences (HASS) sector, digital content industries, arts education and university research, and new media arts. After three main periods of arts and innovation policy activity from the mid.1990s (when the importance of innovation as a key driver of Australia's prosperity was recognised) to early 2008, a fourth period has opened up as part of the Australian Government's Review of the National Innovation System in 2008.

The Why, What, and How of Global Biodiversity Indicators Beyond the 2010 Target

The 2010 biodiversity target agreed by signatories to the Convention on Biological Diversity directed the attention of conservation professionals toward the development of indicators with which to measure changes in biological diversity at the global scale. We considered why global biodiversity indicators are needed, what characteristics successful global indicators have, and how existing indicators perform. Because monitoring could absorb a large proportion of funds available for conservation, we believe indicators should be linked explicitly to monitoring objectives and decisions about which monitoring schemes deserve funding should be informed by predictions of the value of such schemes to decision making. We suggest that raising awareness among the public and policy makers, auditing management actions, and informing policy choices are the most important global monitoring objectives. Using four well-developed indicators of biological diversity (extent of forests, coverage of protected areas, Living Planet Index, Red List Index) as examples, we analyzed the characteristics needed for indicators to meet these objectives. We recommend that conservation professionals improve on existing indicators by eliminating spatial biases in data availability, fill gaps in information about ecosystems other than forests, and improve understanding of the way indicators respond to policy changes. Monitoring is not an end in itself, and we believe it is vital that the ultimate objectives of global monitoring of biological diversity inform development of new indicators. ©2010 Society for Conservation Biology.

Literacy, place, and pedagogies of possibility: Working against residualization effects and deficit discourses in poor school communities

Australia has a long history of policy attention to the education of poor and working-class youth (Connell, 1994), yet currently on standardized educational outcomes measures the gaps are widening in ways that relate to social background, including race, location and class. An economic analysis of school choice in Australia reveals that a high proportion of government school students now come from lower Socio-Economic Status (SES) backgrounds (Ryan & Watson, 2004), indicating a trend towards a gradual residualisation of the poor in government schools, with increased private school enrolments as a confirmed national trend. The spatial distribution of poverty and the effects on school populations are not unique to Australia (Lupton, 2003; Lipman, 2011; Ryan, 2010). Raffo and colleagues (2010) recently provided a synthesis of socially critical approaches towards schooling and poverty arguing that what is needed are shifts in the balances of power to reposition those within the educational system as having some say in the ways schooling is organized. ‘Disadvantaged’ primary schools are not a marginal concern for education systems, but now account for a large and growing number of schools that serve an ever increasing population being made redundant, in part-time precarious work, under-employed or unemployed (Thomson 2002; Smyth, Down et al 2010). In Australia, the notion of the ‘disadvantaged’ school now refers to those, mostly public schools, being residualised by a politics of parental choice that drives neoliberalising policy logic (Bonner & Caro 2007; Hattam & Comber, forthcoming 2014; Thomson & Reid, 2003)...

Changing citizen confidence: Orientations towards political and social institutions in Australia, 1983-2010 [Review]

Since the early 1980s, when confidence in institutions was first measured in an Australian academic social survey, Australia - And the world - has faced many political, social and economic changes. From corporate scandals and company collapses, to unprecedented terrorist attacks, to major ongoing international conflicts, to changes in government and all manner of political machinations, to the global financial crisis and its aftermath. One consequence of such developments has been that many major political, social and economic institutions have come under intense pressure. Using survey research data, this paper investigates how public confidence in various Australian institutions and organisations has changed over time. The results are variable and in some instances surprising. Confidence in some institutions has remained high, and in some low, over an extended period of time. In other cases, confidence has varied quite markedly at different time points. As well as looking at trends in the level of public confidence in institutions, the paper examines different dimensions of confidence together with underpinning socio-political factors. It also discusses theoretical and practical implications of the data.

Deriving information systems innovation execution mechanisms

Despite a wealth of studies focusing on innovation, types of innovations and their outcomes, the process of innovation has largely been under studied. In 2010, Swanson calls for researchers to address the ‘innovation process black box’, to better understand how IT innovation potential can be exploited upon. This study derives and instantiates three unique and mutually exclusive innovation execution mechanisms: Continual, Progressive and Plug and Play. The innovation execution mechanisms of this study are developed with reference to Swanson (1994) Information Systems innovation types.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Wastewater pollution abatement in China: A comparative study of fifteen industrial sectors from 1998 to 2010

This study analyzes the management of wastewater pollutants in a number of Chinese industrial sectors from 1998 to 2010. We use decomposition analysis to calculate changes in wastewater pollutant emissions that result from cleaner production processes, end-of-pipe treatment, structural changes in industry, and changes in the scale of production. We focus on one indicator of water quality and three pollutants: chemical oxygen demand (COD), petroleum, cyanide, and volatile phenols. We find that until 2002, COD emissions were mainly reduced through end-of-pipe treatments. Cleaner production processes didn’t begin contributing to COD emissions reductions until the introduction of a 2003 law that enforced their implementation. Petroleum emissions were primarily lowered through cleaner production mechanisms, which have the added benefit of reducing the input cost of intermediate petroleum. Diverse and effective pollution abatement strategies for cyanide and volatile phenols are emerging among industries in China. It will be important for the government to consider differences between industries should they choose to regulate the emissions of specific chemical substances.

Australia's Biodiversity Conservation Strategy 2010-2020 Submission to the National Biodiversity Strategy Review Taskforce

This submission focuses on “Priority for Change 3: Knowledge for all” and “Priority for Change 5: Involving Indigenous Australians”. Our particular interest lies with ensuring that Indigenous knowledge holders are engaged with in a manner that recognises their prior rights over their own knowledge and intellectual property. As the Preamble of the recently endorsed United Nations Declaration on the Rights of Indigenous Peoples states, we need to; “Recognis[e] that respect for Indigenous Knowledge, cultures and traditional practises contributes to sustainable and equitable development and proper management of the environment”.