Global Burden of Disease and Risk Factors

This book emerges from two separate, but intersecting, strands of work that began in the late 1980s, when the World Bank initiated a review of priorities for the control of specific diseases. The review generated findings about the comparative cost-effectiveness of interventions for most diseases important in developing countries. The purpose of the cost-effectiveness analysis (CEA) was to inform decision making within the health sectors of highly resource-constrained countries. This process resulted in the publication of the first edition of Disease Control Priorities in Developing Countries (DCP1).

Also important for informing policy is a consistent, quantitative assessment of the relative magnitudes of diseases, injuries, and their risk factors. DCP1 included an initial assessment of health status for low- and middle-income countries as measured by deaths from specific causes; importantly, the numbers of cause-specific deaths for each age-sex group were constrained by the total number of deaths as estimated by demographers. This consistency constraint led to downward revision of the estimates of deaths from many diseases.

These two strands of work—CEA and burden of disease—were further developed during preparation of the World Development Report 1993: Investing in Health. This report drew on both the CEA work in DCP1 and on a growing academic literature on CEA. In addition, the World Bank invested in generating improved estimates of deaths and the disease burden by age, cause, and region for 1990.

Over the past six years, the World Health Organization has undertaken a new assessment of the global burden of disease for 2000-2. The World Health Organization has also invested in improving the conceptual, methodological, and empirical basis of burden of disease assessments and the assessment of the disease and injury burden from major risk factors. During 1999-2004, the authors of this volume and many collaborators from around the world worked intensively to assemble an updated, comprehensive assessment of the global burden of disease and its causes.

The Global Burden of Disease and Risk Factors is the definitive, scientific account of these efforts and of the health conditions of the world's population at the beginning of the 21st century. This book includes a full account of methods, the complete results of recent work, and an assessment of trends for total mortality and for major causes of death among children under five. In addition, two chapters cover sensitivity and uncertainty analyses in relation to a broad range of potentially important parameters.