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Vol. LXV, No. 9
April 26, 2013
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A Plea for Collaboration
Murray Presents Global Burden of Disease Study 2010

On the front page...

Dr. Chris Murray

Dr. Chris Murray

That sound you hear is the mind stretching to grasp a report on a heroic scale: the Global Burden of Disease Study 2010. A collaboration of 486 authors, 302 institutions and 50 countries, GBD 2010 is the largest single study ever published by The Lancet.

It turns out that the largest systematic scientific effort in history to quantify the world’s health challenges is about you.

It includes you. If you—or someone you love, work with, play basketball with—has ever susfeatures tained injury, disease, death or risk, then you’re in this report.

Along with 7 billion other folks.

Continued...

The study’s co-author, Dr. Chris Murray of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, recently visited NIH to present the results: “The Global Burden of Disease 2010 Study: What Does It Mean for the NIH and Global Health Research?”

His lecture and discussion in Natcher Auditorium, hosted by the Fogarty International Center, drew an engaged audience from NIH and beyond.

“A report of this sort represents a remarkable achievement,” said NIH director Dr. Francis Collins in opening remarks.

“We spent a lot of time on methods,” Murray said. And on tools: supple interactive graphs and cool maps depict shifts and trends over time.

For folks in global health, this is catnip.

Here’s the gist. When deciding which health programs to offer, develop or continue, we need evidence. Using the construct of health loss, not income or productivity loss, GBD 2010 shows three massive shifts, Murray said. Since 1990, the starting point for the first study:

  • The world has grown considerably older.

  • Where infectious disease and childhood illnesses related to malnutrition were once the primary causes of death, now more people are dying from chronic, non-communicable diseases (NCDs) such as heart disease and cancer.

  • Disease burden is increasingly defined not by premature death, but by disability: musculoskeletal disorders, mental health conditions, back and neck pain and injuries.

Obesity and high blood sugar are replacing a lack of food as leading risks, he added.

And in a study this large, “There were lots of limitations,” as in separating comorbidities (co-occurring diseases) in depression and in the risk of intimate partner violence in HIV.

So how do we think about these trends? Take measles, for example. As an overall disease burden, it has dropped from number 16 to 56.

“This is a global health success story,” Murray said.

But some U.S. results were surprising: “[There’s been] lower progress in women’s deaths here than in other high-income countries,” he said. “The U.S. did rather well for stroke, colorectal cancer, brain cancer, prostate cancer and falls. Then everything else is below average. We were worst in diabetes, heart disease and COPD [chronic obstructive pulmonary disease].

NIH director Dr. Francis Collins (l) and FIC director Dr. Roger Glass (r) were on hand for Murray’s lecture on the global burden of disease.

NIH director Dr. Francis Collins (l) and FIC director Dr. Roger Glass (r) were on hand for Murray’s lecture on the global burden of disease.

Photos: Ernie Branson

“So this is a plea for collaboration and research from NIH,” Murray continued. “GBD is a global public good. This should be a continuing process: Our goal is to shift to continuous updates as new studies are published and quickly incorporated.”

This might mean partnering with NIH in creating new methods, expanding the study scope to include adverse events and forecasts and tracking funding at the national level by disease and injury.

“Ultimately, GBD 2010 offers a bigger vision on cost effectiveness,” Murray said. “It becomes a vehicle for thinking about public health, primary care and integrated frameworks.”

In an extended Q&A, Murray described what had surprised him most about the GBD: “The pace of change in 2 decades in the dramatic shift to chronic disability. It’s so fast that people in the health ministries are still thinking [in] the way they were trained.”

Dr. Charlotte Pratt of NHLBI focused on Africa: “The data is very depressing,” she said, “especially when you look at the life expectancy from 25 to 40…”

“I think that the results from sub-Saharan Africa are not as depressing as they came across,” Murray said. “If you look at life expectancy outside of southern Africa, there’s been substantial improvement despite HIV in east Africa…And with ARV [anti-retroviral therapy] scale-up in the HIV-affected belt, from Kenya down to South Africa, in at least half those countries, there are marked drops, we think, in adult mortality.

“It’s a story of real tangible progress,” he continued, “for malaria, for HIV, for child mortality…It’s a reasonable prediction to say that as long as resources keep flowing, Africa will soon be joining the rest of the developing world in having to deal with the challenges of NCDs and disability.”

Fogarty director Dr. Roger Glass queried Murray on a graph showing the U.S. on the bottom, as the worst in many areas, and Sweden at the top.

“Sweden’s a very homogeneous population,” said Glass. “Are those differences issues of health equity? Population homogeneity? Lifestyles?”

“Have a look at a place like Denmark,” Murray suggested. “It’s doing just about as badly as the U.S. and it’s a very homogeneous place…

“I must say I always struggle to understand why we do so badly on most of these metrics,” he continued. “It’s something that I find difficult to fathom. Part of it is the legacy of tobacco…But as time goes on, that’s increasingly hard to explain. Part of it is we have a worse obesity epidemic. And we’ve done much worse, maybe related to that, on managing blood pressure.

“The type of analysis to answer what you’re describing, which is now becoming feasible,” said Murray, “would be to strip off, from these 19 [richest] countries, the effects of the top 10 risks—take away tobacco, take away alcohol, take away blood pressure—and then progressively see if the U.S. and these other countries converge, or how much is unexplained by that. Certainly it’s something that should be done.”

That sound you hear is NIH’ers crunching, and meta-crunching, those numbers. Murray invited everyone to explore IHME’s interactive tools, available to the public at www.healthmetricsandevaluation.org/gbd.

The videocast is archived at http://videocast.nih.gov/pastEvents.asp.


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