Global Burden of Disease Essay

In this discussion, you will be exploring the impact of the “global burden of disease” by identifying a disease that affects our global population and then describing its political, social, and financial cost. Also discuss how you can plan and develop programs and partnerships to alleviate this burden. (200 words; 2+ References)Global Burden of Disease Essay

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With most societies trying to cope with the increasing demand for health resources, the issue then becomes how to assess the comparative importance of risks to health and their outcomes in different demographic groups of the population. This leads to the development of a principal framework known as the Global Burden of Disease (GBD) which can be used as a guideline for organisations such as the Chan-Zukerberg Initiative.The Chan-Zukerberg initiative plan has set a long term commitment to eliminate, prevent and manage all diseases with a focal point on creating tools and technologies to detect, respond, treat and prevent all diseases before the end of the century through a collaborative research (Hayden,2016). With this initiative’s long-term objective, this report attempts to bring to attention the role the GBD study; as a tool for assessing the performance of the health system and the role of Disability – adjusted life years (DALY). Furthermore, using its findings to advice the initiative on the best possible approach(es) to allocate its funds to combat the global health issue before the end of the century.
 Section One
 1.1 Current Situation; The Global Burden of Disease Study The Global Burden of Disease, Injuries and Risk Factors (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex, and geography for specific points in time (Murray et al, 2012). Global Burden of Disease Essay

An important project spearheaded by some of the World Health Organization (WHO) staff in the 1990s was to measure the global “burden of disease” – that is, the contributions of diseases, injuries, and risk factors such as tobacco smoking to ill health. This international effort continues at several institutions and especially in the work of the Institute for Health Metrics and Evaluation (IHME). At the risk of implying more cohesiveness and unity than is in fact the case, I shall refer to these researchers as “the GBD team.” To measure the global burden of disease, the GBD team has attempted to generate summary measures of overall population health and to measure the health effects of diseases by means of these summary measures. The GBD team hopes that these summary measures will serve other purposes, such as identifying locations where health is particularly bad, assisting research, and guiding the allocation of health-related resources ([1]), but this essay is concerned mainly with the attempt to measure the global burden of diseases, injuries, and risk factors.Global Burden of Disease Essay

In particular, this essay asks whether the global burden of diseases, injuries, and risk factors should be understood in terms of their consequences for health, as maintained by the GBD team, or in terms of their consequences for well-being, as argued by John Broome [2]. I answer that the burden of disease should be understood in terms of the consequences of disease for health, and I defend the wider efforts to measure health by many others who are in other ways skeptical of detailed features of the GBD team’s projects.Global Burden of Disease Essay

The view of the burden of disease shared by the GBD team and by most others who have attempted to measure health starts with conceptualizing a person’s health over a time period in terms of the sequence of their health states. People’s health states are defined in turn by their functional deficiencies (such as cognitive problems, limitations to mobility or agility, sensory deficiencies, or affective disorders), and by aspects of their subjective states, such as pain and depression. Diseases, injuries, and risk factors, like health interventions, change the distribution of health states within a population. This framework abstracts as far as possible from the debates concerning the concept of health. It is compatible with the so-called “biostatistical view” defended by Christopher Boorse ([3–6]) and the related views defended by Jerome Wakefield ([7, 8]). But is also compatible with many more evaluative views of health. (For general discussions of the concept of health see [9] and [10].) The burden of disease understood concretely is the contrast between the distribution of health states due to some disease or risk factor and a state of complete health. Without a scalar measure of the change in health states, there is however no unambiguous way to compare the burdens of different causes of ill health. So what is called the burden of disease is some scalar measure of the departure from full health due to disease.Global Burden of Disease Essay

The GBD team, unlike those who have generated health measurement schemes such as the EQ-5D or the Health Utilities Index (HUI), has hoped literally to measure the quantity of health. For example, Mathers et al. [11], p. 324 write, “The health state valuations . . . represent quantifications of the overall health levels associated with different states.” Salomon et al. [12], p. 307 write, “[W]e consider a health state valuation to provide a scalar cardinal index of the overall level of health associated with a multidimensional health state.” (See also [13], p. 16, and [14], p. 431.) But it is impossible literally to measure the quantity of health, because the relation “healthier than” is incomplete. Health is multidimensional, and the different dimensions are not commensurate. The same is true of commodity bundles, and just as there is no way to say whether one bundle of commodities is larger than another (unless the first contains at least as much of each commodity as the second), there is no way to say whether one health state contains “more health” than another ([15]). Though there is no way to assign a measure to some putative quantity of health itself (just as there is no way to measure the size of a commodity bundle), people can evaluate health states (just as they can evaluate commodity bundles). By treating the values of health states as their measures – that is, by measuring health states by how good they are – health economists can calculate the values of distributions of health states. Health economists can then measure the effect of a disease on population health by subtracting the value of the distribution of health states that results from the disease from an estimate of the value of what the distribution would be without disease.Global Burden of Disease Essay

John Broome argues that this way of determining the global burden of disease is misconceived ([2]). He maintains that those concerned with the burden of disease should attempt to measure the effects of diseases on well-being rather than attempting to measure their health effects. Although he directs his criticisms to the GBD team, they apply broadly to efforts to measure health, both welfarist and “extra-welfarist” ([16]). Broome maintains that purported measurements of health are really defective measures of well-being, and his arguments imply that health cannot be measured at all. Broome’s position is implicitly as critical of those who attack the GBD team’s efforts, such as Alan Williams ([17]), as of the GBD team’s project.

Broome makes two arguments against measuring the burden of disease by its consequences for health. His first argument relies on the premise that the value of health is its contribution to well-being.Global Burden of Disease Essay

“. . . the measure should measure health as a component of well-being . . . . it is to measure how good a person’s health is for the person, or how bad her ill-health. . . . That is to say, it aims to measure the contribution of health to well-being. ([2], p. 94)”

The argument then concludes that the value of health cannot be measured. Here is the argument: Health contributes to well-being both causally and constitutively. But the contribution that health makes to well-being is not separable from the contribution of other factors. Individuals in the same health state but different circumstances will often not be equally well off, and that difference cannot be factored into some common portion contributed by health coupled with the separate contribution of the circumstances. The contribution to well-being of a token health state of a particular kind (that is, the contribution to overall well-being of a specific person being in that health state at a specific place and time) differs depending on a person’s circumstances. A health state of any specific kind makes no uniform contribution to well-being.Global Burden of Disease Essay

“Obviously, the way in which a person’s well-being is affected by the various elements of her health depends a great deal on other features of her life. For example, asthma is less bad if you are well housed, mental handicap less bad in supportive communities, blindness less bad if you have access to the internet. ([2], p. 95)”

So there can be no measure of the well-being produced by a kind of health state.Global Burden of Disease Essay

In fact, Broome’s critique is much more general. Whether or not one focuses on well-being, the effects of health states that determine their values depend on the geographical, economic, technological, and cultural environment. In addition, the values of health states depend on the tastes, values, and objectives of individuals and on prevailing social values. Because health states have different evaluatively relevant consequences in different contexts, token health states will have different values, and health states of a given kind will have no uniform value at all. Since the value of a kind or type of health state is not defined, it cannot be measured. There is no such thing as the value of a kind of health state. So there is no way to measure the burden of disease by measuring the value of the distribution of the kinds of health states it causes. Health cannot be measured either by its quantity or its value. Indeed, it cannot be measured at all!Global Burden of Disease Essay

Although not stating his negative argument this broadly, Broome concludes that the burden of disease should be measured by the change in well-being it causes in the circumstances. If it is impossible to measure health, then one cannot measure the burden of disease by measuring health. If what matters is well-being (which leads to Broome’s second argument), then one should focus on the joint consequences for well-being of health states and nonhealth factors.

Broome’s second argument against measuring the burden of disease by its consequences for health is that “we should be concerned with all of well-being” ([2], p. 98) and hence with “the whole reduction in people’s well-being, which is caused by disease” ([2], p. 97) not with “only the part that consists in a reduction in people’s health” ([2], p. 93). I take the “we” here to include those who make health policy. The implications of this view extend far beyond efforts to carry out summary measures of population health. For example, Broome’s view implies that the National Institute for Health and Clinical Excellence should determine what treatments the National Health Service should provide by examining their effectiveness at promoting well-being, rather than by examining their effectiveness at promoting health.Global Burden of Disease Essay

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Broome maintains that health policy must be guided by considerations of fairness as well as by concerns about well-being. Saving the life of a poor patient or a disabled patient may contribute less to aggregate well-being than saving the life of someone richer or not disabled, but that does not, in Broome’s view, justify treating the rich or nondisabled rather than the poor or disabled, because doing so would be unfair ([2], p. 99). Although Broome believes that fairness ultimately matters because of its contribution to the overall good ([2], p. 100), he maintains that it is useful to separate concerns about fairness from concerns about increasing well-being. In Broome’s view one should measure the burden of disease by the consequences for both well-being and fairness. His focus in this critique is, however, on well-being. So, Broome argues, the burden of disease should be quantified by the impact of disease on well-being, and the value of a token health state lies in its bearing on well-being. Broome writes, for example,Global Burden of Disease Essay

“Disease causes harms of a great many sorts, which are often not themselves specifically changes in health. For example, some diseases prevent their victims from working, and so deprive them of income and the other benefits that accompany work: companionship, self-esteem and so on.”

Africa, is experiencing a double burden of diseases [1]. This is characterised by the increasing prevalence of chronic non-communicable diseases (NCD) and the battle to deal with infectious diseases [2,3]. The burden of NCDs disproportionately affects populations in low and middle income countries (LMIC) where health systems are weak [4]. In LMICs, especially in sub Saharan Africa (SSA), hypertension is increasing rapidly because of rapid population growth, increased life expectancy and lifestyle factors [5–7]. Age specific prevalence rates of hypertension are highest in SSA (46%) and lowest in the America’s (36%) [4].Global Burden of Disease Essay

In Ghana, the prevalence of NCDs such as obesity, hypertension, diabetes and heart diseases have been rising [8–10]. In 2013, NCDs contributed 22.2% of deaths at the Korle-Bu Teaching Hospital [11]. The Ghana Ministry of Health (MoH) 2010 annual report indicated that hypertension is the second leading cause of outpatient morbidity in adults 45 years and above [12].

Research, however, shows that adequate blood pressure treatment and control can significantly reduce the first incidence of heart attack, strokes and recurrent strokes, heart failure, chronic kidney disease and premature death [13,14]. However, limited access to health care is a barrier to preventing the epidemic of hypertension, diabetes and other cardiovascular diseases in the country is experiencing [15,16]. There is a low level of awareness of hypertension and diabetes [17–19]. In Africa, less than 30% of people living with hypertension are on biomedical treatment [20,21]. The majority of people living with hypertension and diabetes are not on treatment because of limited access and cost of biomedical treatment [22]. As a result, people living with NCDs healer shop which increases the risk of complicati Global Burden of Disease Essay.

In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. These disease conditions were selected because they are the leading causes of morbidity and deaths among the Ghanaian population [11,24,25]. This paper focuses on addressing access to health care because social organisations and processes at the macro level generate health inequalities. Understanding the inequalities in health and the policies which might reduce these is essential for addressing the cardiovascular public health challenge Africa faces. Global Burden of Disease Essay.

Materials and methods
Data from the Access, Bottlenecks, Costs and Equity (ABCE) Facility Survey, Ghana was used. The survey was part of a project jointly conducted by the Ministry of Health, Ghana (MoH), Institute for Health Metrics and Evaluation (IHME), Ghana Health Service (GHS), and UNICEF [26]. The Ghana Health Service provided ethical clearance for the project. A nationally representative sample of health facilities in Ghana were selected. The data was collected between June and October 2012. The questionnaire was administered to facility administrators. A two-stage stratified sampling design was used to select rural and urban districts as identified by the 2011 Multiple Indicator Cluster Survey (MICS). In the first sampling stage one rural and one urban district was randomly selected from the ten regions of Ghana (n = 20). In addition, the Accra and Kumasi metropolitan areas were purposively added to the selected districts [26].ons and mortality [23]. Global Burden of Disease Essay.

The second stage of sampling facilities took place across a range of platforms. The ABCE project defined a platform as the channel used to deliver health services. In Ghana 9 platforms were identified. These were: 1) teaching hospitals; 2) regional referral hospitals; 3) hospitals; 4) health centres; 5) Community-Based Health Planning and Services (CHPS), 6) maternity clinics 7) pharmacies and 8) drug stores, as well as District Health Monitoring Teams (DHMT). A facility sampling frame was developed based on 2011 MoH Needs Assessment. In each district 4 hospitals, health centres, CHPS and maternity clinics were sampled. In addition, two pharmacies were sampled. Out of the 240 facilities sampled, 220 responded. The survey response rate was 92%.ons and mortality [23]. Global Burden of Disease Essay.

Measurement of variables
The provision of diagnostic and treatment services for malaria, hypertension and diabetes were the main outcome variables. The dataset has information on the type of services offered by health facilities from 2007 to 2011 [26]. In 2010, Ghana implemented the test-before treatment policy for malaria. As a result of this policy, healthcare providers are expected to have Rapid Diagnostic Test (RDT) [27]. A facility was classified as providing malaria test if they had the RDT available at the time of the survey. Also in 2011, health facilities were expected as part of health procedures to provide blood pressure measurements for all out-patient clients. A health facility was classified as providing hypertension diagnosis if they had blood pressure apparatus. The fasting blood glucose test was the measure used to assess diabetes diagnosis. Facilities that reported providing fasting blood glucose were classified as providers of diabetes diagnosis. Global Burden of Disease Essay.

To pharmacologically treat diabetes among obese individuals with Type 2 diabetes the MoH recommends Metformin and/or Thiazolidinediones [28]. Among patients with ketoacidosis, Type 1 diabetes, in pregnant and breast- feeding women, whether Type 1 or Type 2, and Type 2 patients insulin is recommended. Diabetes treatment at the facility level was measured with the availability of Metformin Tablet, 500 mg and insulin. The pharmacological treatment recommended for hypertension includes Beta-blockers (e.g Atenolol, oral, 50–100 mg daily) and Thiazide diuretics (e.g., Bendroflumethiazide (bendrofluazide) oral, 2.5 mg daily) [28]. In the ABCE survey, facilities were asked to indicate whether they had Atenolol. Therefore, facilities which said yes were classified as providing hypertension treatment. To treat uncomplicated malaria the MoH recommends Artesunate-Amodiaquine, Artesunate-Lumefantrine, or Dihydroartemisinin-Piperaquine oral tablets while quinine is recommended for treatment of severe malaria. Facilities were classified as providers of malaria treatment if they had Artesunate-Amodiaquine and Quinine at the time of survey. Global Burden of Disease Essay.

We used five facility-level variables from the ABCE dataset as independent variables: type of facility, facility years, type of facility management, location of facility, and region of location. The type of facility was measured using the platform created by the GHS as a categorical variable: CHPS, health centre, hospital, maternity home, pharmacy, private clinic and referral hospital. The facility years refer to the number of years the facility has been delivering health services. It was measured as a categorical variable (1–5 years, 6–10 years, 11–15 years, 16–20 years and 21+ years). The type of management of the facility was classified as public or private. Facilities that were owned by the government of Ghana or a mission, but managed by the MoH were listed as public facilities while facilities owned by a mission (but not managed by the MoH) or private enterprise were categorised as private. The geographical location of the facilities was measured by the ten regions of the country and whether the facility is located in an urban or rural area. Global Burden of Disease Essay.

Analysis
All analyses were carried out using the STATA statistical software package version 12 (2017; StataCorp, College Station, TX, USA). The data were used without weighting. In the data release information sheet all the factors needed to generate weight were not provided [26]. Although, the data were not weighted, the sample is representative of the types of health facilities in Ghana due to the facility sampling frame used. In each district, four hospitals, health centre, CHPS, maternity clinics and two pharmacies were selected [26]. Using ABCE data, the proportions of the characteristics of facilities and the services they provided were calculated. The Pearson’s chi-squared test statistic was calculated to test for differences in proportions. A trend analysis was done for the treatment and testing procedures from 2007 to 2011. The association between facility characteristics and service delivery were analysed for the year 2011 only.Global Burden of Disease Essay.