Julio Frenk

GBD 2.0: a continuously updated global resource

www.thelancet.com Vol 382 July 6, 2013 9 The Global Burden of Disease Study 2010 (GBD 2010) provides a comprehensive and coherent assessment of the state of the world’s health from 1990 to 2010. With consistent defi nitions, standardised approaches to data quality, and consistent modelling strategies, GBD 2010 assesses mortality, premature mortality, and disability caused by a detailed list of diseases, injuries, and risk factors. The analysis is undertaken in great detail, covering 187 countries, two decades, both sexes, and 20 age groups. The fi ndings point to rapid changes in patterns of health outside sub-Saharan Africa, with large shifts in many regions towards non-communicable diseases, chronic disability, and risk factors related to behaviours. In sub-Saharan Africa, mortality of children younger than 5 years decreased substantially and maternal mortality also fell; since 2005, major progress has been made for HIV, and for malaria since 2004. Despite this progress, GBD 2010 also shines a spotlight on the challenges that many of the poorest countries continue to face, where several infectious diseases, such as diarrhoea, pneumonia, and neonatal conditions, con tinue to dominate as major causes of premature child death. Substantial investments by developing countries and US

Non-Communicable Diseases in the Global Health Agenda

28·1 billion in 2012 in development assistance for health, focusing on the Millennium Development Goals, are contributing to accelerated transitions. Countries are experiencing a complex set of changes in health problems and their underlying causes, which need more and more contextualised policy responses. For several reasons, national, regional, and global actors need to have access to the best available evidence for patterns of health and how they are changing. Although it is an enormous resource, GBD 2010 needs to be regularly and systematically revised and improved to refl ect new evidence and new methods as they accumulate for at least fi ve reasons. First, new data sources for a country—eg, a Demographic and Health Survey, a census, a local survey, or national vital registration data—can substantially change understanding of health trends. Demographic and Health Surveys in several sub-Saharan African countries have shown accelerated decreases in child mortality in the past decade. Trends in mortality can change abruptly: from 2008 to 2010, adult male mortality in Ukraine dropped about 22%; and scale-up of antiretroviral therapy (ART) has radically reduced adult mortality since 2005 in several countries (eg, Botswana). Second, multicentre studies, such as the Global Enterics Multi-Center Study or Pneumonia Etiology Research for Child Health Study, will provide much-needed highquality information about the aetiology of diarrhoea and pneumonia. Additionally, proposed studies of the risks of death associated with malaria parasitaemia in adults would potentially change understanding of malaria mortality when completed. Multicentre investigations will probably change detailed understanding of disease patterns. Burden estimates should be quickly revised to refl ect this type of new knowledge. New studies will also aff ect understanding of the hazards associated with diff erent risk factors. Third, expanded use of the GBD 2010 results will probably lead local analysts to identify data sources that have not been used and could strengthen the analysis for a specifi c country. For example, collaborative work with the University of Zambia and the Ministry of Health of Zambia on district-level health outcomes was able to make use of many data sources not used in international assessments of child health. Fourth, careful refl ection on the GBD 2010 results and future iterations of GBD will probably suggest alternative interpretations of the biases and necessary corrections in many data sources. This type of assessment is iterative and benefi ts from repeated assessments. The development of the UNAIDS esti mation methods and datasets for HIV prevalence over more than 15 years is GBD 2.0: a continuously updated global resource 8 WHO. NCD country profi les: Brazil, 2011. http://www.who.int/nmh/ countries/bra_en.pdf (accessed May 6, 2012). 9 Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev 2012; 33: 48–70. 10 Alleyne G, Binagwaho A, Haines A, et al. Embedding non-communicable diseases in the post-2015 development agenda. Lancet 2013; 381: 566–74. 11 Fernald LC, Gertler PJ, Hou X. Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults. J Nutr 2008; 138: 2250–57. 12 de Bem Lignani J, Sichieri R, Burlandy L, Salles-Costa R. Changes in food consumption among the Programa Bolsa Familia participant families in Brazil. Public Health Nutr 2011; 14: 785–92. 13 Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010; 121: 1356–64.

An Individual-Level Approach to Health Inequality: Child Survival in 50 Countries

For a long time non-communicable diseases (NCDs) have been a major cause of death and disability worldwide. However, the profile of this health challenge is changing: Having dominated the epidemiologic contour of high-income countries in the 20th century, it is now increasingly affecting the developing regions of our planet. Unless we start implementing measures to reduce the burden of NCDs in lowand middle-income countries, the pressure on their health systems will be unbearable and will limit the prospects for economic development.1