The Unequal Burden of Disease

“Would you rather live 10 years and be blind, or 5 years in near-perfect health?”

“Would you rather live 10 years and be paralyzed, or 3 years in perfect health?”

These are the questions being asked by the Global Burden of Disease Survey 2010—an instrument to help determine the leading causes of death, illness, and disability in the world as well as assess policy responses to these.  As any student of policy knows, measures are powerful things and they often help policy makers decide which interventions are most cost-effective—i.e who dies and who gets a chance to stay alive.

I’m currently working at the UNDP, and we’re always thinking about measures of mortality—child mortality, infant mortality, mortality from HIV/AIDS / malaria, maternal mortality etc.  But we very rarely talk about DALYs—a measure of health that accounts both for years of life lost due to premature death and years of healthy life lost due to illness or disability.  

Years of healthy life lost are of critical importance in countries where your life and the life of your family is entirely dependent on how much money you bring in each day. Illness—not just of the fatal variety—is a major contributor to poverty and a major barrier to moving out of poverty. In a study in Bangladesh’s slums, Morduch et al found that over 50% of residents are affected by non-fatal illness. These illnesses cause major setbacks to their overall financial, emotional and physical health.

So what will the 2010 Global Burden of Disease study do to affect the lives of people living in Bangaldesh’s slums? Some of its affects could be very practical. It will identify several risk factors that lead to death and illness, such as unsafe sex, poor sanitary conditions, and under-nutrition. 

Lucky for us, we have a pretty good handle on how to limit exposure to these risks.

Take poor sanitation for example.  Unlike the problem of climate change or economic growth—this problem has a pretty straightforward answer—build a safe sanitation system! In places like Nairobi and Karachi, slum dwellers have shown that they are willing to pay for this service and cases of diarrheal disease have dramatically reduced.

If the 2010 GHB find s that diarrheal disease is still causing infant and child mortality (which it probably is) and that building safe sanitation systems can prevent these deaths (which it definitely can) then it would follow that a governments’ health intervention for that year will focus on sanitary infrastructure development. 

Well, in theory anyway.   

To me, the most important thing that the Global Burden of Disease points to is how social inequities cause preventable disease and disability. What we often don’t see is the costs associated with these illnesses.

Take the case of Feizal, one of the subjects interviewed in Morduch’s study. His broken leg kept him out of work for eight months. During that time, his wife had to take on another job and his children had to quit school and start working just to make ends meet.

While the Global Burden of Disease Study is not going to tell us those stories, it is going to show us how much fatality, illness, and disability can be prevented with simple and targeted interventions.

The next step of course, is finding the political will to make those interventions happen.

But in the meantime, at least we’ll have some numbers.


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