7 th Task Force on Health Expectancies Meeting Luxembourg, 2 December 2008 Dr. Enrique Loyola Health Intelligence Service Summary measures in public health activities in WHO

Two main types of measures –Health life expectancies (HALE) Initial estimations produced are from 2002 Initially not planned, however, due to high demand, a next iteration update will be done in 2009 –Disability adjusted life expectancy (DALY) Initial estimations produced for Global Burden of Disease are from 2002 A review has just been published a few weeks ago, including 2004 estimated data Summary measures of health WHO work in the recent past

Summary measures of health Global Burden of Disease 2008 (DALY) What is new? In general –The 2008 version does not include a complete review and revision of data inputs and estimates for every cause from the 2002 edition –More recent and higher quality mortality data –Improved estimations of prevalence and incidence of diseases Higher number of participants - publications Large projects – more robust estimates Newer estimations – recent work –African estimates involve different mix of causes –More additional emphasis in some diseases and disorders –Data available on incidence, prevalence, deaths, mortality rates, years of life lost (YLL), years of life expectancy lost (YLD) globally and by WHO and other regional and economic assessments

Summary measures of health Global Burden of Disease 2008 (DALY) What is new? Mortality –Complete update of estimated deaths by age, sex and cause for all Member States Includes revisions in death estimates for AIDS, wars, and natural disasters Latest death registration data from 112 countries Updated country level mortality estimates for all Member States for 17 causes of death Incorporation of cause specific and multiple cause models for causes of death for children under 5 and neonates, resulting in consistent cause specific estimates Revision of cause specific models for countries without usable death registration data and regional patterns for cause specific mortality distributions were updated for Africa

Summary measures of health Global Burden of Disease 2008 (DALY) What is new? Morbidity, disability and years lost to disability (YLD) –Revised for 52 causes where updated information was available, resulting in significant changes in some cases, while for other causes they were only projected from 2002 estimates –Incidence and prevalence of AIDS and mortality estimates based on advances of methodologies, yielding substantial changes HIV infection prevalence down from 38 to 32 million globally, and deaths from 2.7 to 2 million. Impact of retroviral drugs on survival also taken into account. –Updated estimates for vaccine-preventable childhood diseases

Summary measures of health Global Burden of Disease 2008 (DALY) What is new? Morbidity, disability and years lost to disability (YLD) –Revised incidence and mortality estimates for malaria forms and specifically for Plasmodium falciparum based on national reports and transmission-intensity-based models, resulting in 21% increase proportion of such deaths among children under 5 years –Estimates of dengue fever, Japanese encephalitis and other tropical diseases were revised with data on population at risk, levels of endemicity, reported cases, case fatality and treatment coverage. –Site-specific cancer incidence and mortality estimates were updated using revised estimates of site-specific survival probabilities and incidence distributions from IARC

Summary measures of health Global Burden of Disease 2008 (DALY) What is new? Morbidity, disability and years lost to disability (YLD) –Diabetes incidence and prevalence estimates revised to account for recently published population surveys that used oral glucose tolerance tests and WHO criteria –Recent WHO country-level data of underweight, stunting and wasting and anaemia were used to update estimates of protein-energy malnutrition and iron-deficiency anaemia –Incidence and prevalence estimates of alcohol disordes were revised based on a new review of post-1990 studies using high-quality survey instruments. Disability weights downwards from 0.18 to depending on age and based on WHO MICS –Prevalence estimates for low vision and blindness from specific disease and injuries causes were revised to take into account WHO analyses and regional distributions of causes of blindness

Summary measures of health Global Burden of Disease 2008 (DALY) What is new? Morbidity, disability and years lost to disability (YLD) –Calculations for ischaemic heart disease used a revised model used to estimate incidence and prevalence of angina pectoris based on recent national BoD* studies, resulting in an increase of global prevalence from 25 to 54 million and corresponding 78% increase in YLD and 7% in DALYs for IHD –Data from two recent national BoD studies wereused to re- calibrate long-term case fatality from stroke, resulting in a reduction in the prevalence of stroke survivors from 50 to 30 million and a reduction of 30% in YLD –Population estimates are based on the latest revisions by the United Nations Population Division * BoD = Burden of Disease

What is planned for the future? Working with the Health Metrics Institute, Harvard, Johns Hopkins University, University of Queensland and other institutions –reviewing methodologies, –re-assessing estimations –calculating detailed estimates for specific causes –new estimates on comparative risk assessments for various diseases updated and used on estimations of attributable fractions –publication planned for 2010 Summary measures of health Global Burden of Disease 2010 (DALY)

Summary measures of health Data availability at EURO for SMPH European Health for All (HFA) databases On- and off-line versions last updated July 2008 Accessible at WHO/EURO website:

Mortality data availability in EURO