Placing Coronavirus In Public Health Perspective

Posted on | January 29, 2020 | 2 Comments

Source: The Institute for Health Metrics and Evaluation (IHME).

Mike Magee

The big news this week is the new coronavirus spreading across the globe compliments of China. Prevention efforts are challenging and depend on limiting human contact with and transmission of the virus in a globally connected world. Even in the US, fear and panic spread faster than a wildfire.

In response to a single student at Arizona State University testing positive this week, a student written online petition stating, “The students of ASU do not feel comfortable attending classes due to the outbreak of the Novel Coronavirus. Until proper precautions have been taken to ensure the wellbeing of the students, such as disinfecting areas the student with Novel Coronavirus was present, ASU students want their classes canceled.”, garnered over 20,000 signatures.

Such communicable threats have always received outsized coverage compared to chronic preventable disease. Public health experts have struggled to accumulate the language and tools to provide a balanced view of the various health risks and threats to our human population.

As Starbucks and McDonald’s reactively close half their stores in China in response to China residents and visitors locking themselves indoors; and as US stock markets reel in response, let’s review some nomenclature that speaks to health and disease worldwide.

Two decades ago I keyed in on the work of Alan Lopez at the WHO and a young Harvard epidemiologist named Christopher Murray and their landmark work on the Global Burden of Disease. Murray is now at the University of Washington and heads up an independent global health research center called The Institute for Health Metrics and Evaluation (IHME).

When was the Global Burden of Disease report first published?

The Global Burden of Disease study was published in Science in 1996.

What did it examine?

It looked at the effect of disease not only on “lifespan” but also on “health span” for the first time. Investigators did so by moving beyond mortality rates and creating a new measure called DALY.

What is a DALY?

DALY stands for “disability adjusted life year” and is a measure that expresses one year of life lost (YLL) to poor health.

What is the difference between “lifespan” and “healthspan”?

Lifespan equals the number of years living, while health span equals the number of years of healthy living. These are two enormously different measures. We increasingly appreciate that disease and disability can significantly limit an individual’s productivity and happiness and radically alter individual, family and community well being.

Who was involved in the study?

The Global Burden of Disease study, begun in 1992, involved 100 collaborators in more than 20 countries. It attempted to quantify disease and injury burden of over 100 conditions and make projections out 30 years for 500 consequences or results of these conditions. In the analysis, over 50,000 estimates were made.

What is “dual burden of disease”?

Dual burden of disease refers to two different causative paths for disease and disability. One path is communicable disease, believed to be more prevalent in developing nations. A second path is chronic, debilitating non-communicable diseases felt in the past to be restricted largely to developed nations.

Did the study project forward?

Yes. The study predicted that by 2020 heart disease worldwide would achieve top billing, followed by depression, auto accidents, cerebrovascular disease and chronic obstructive pulmonary disease or emphysema.

Have there been any follow-up studies?

Yes. The Global Burden of Disease 2017 Project was reported out in Lancet, and continues to report targeted findings affecting the 195 participating nations on a regular basis.

What have been the study’s take-away observations?

1. Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability.

2. This family of diseases is associated with metabolic inflammation, that is a low-grade chronic inflammatory state which adversely effects gene-environment interaction. A focus on basic science research and personalized health behavioral solutions will be required to modulate this burden as world populations age.

3. In stressed developing nations, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden.

4. The rising burden from mental and behavioral disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems.

5. The US Opioid Epidemic has resulted in increased mortality and declining lifespans over the past 3 years, especially of white males, from suicide and homicides. This year’s results have flattened, but they remain below pre-epidemic levels. In addition, maternal and infant mortality in the US remains an outlier to comparator developed nations.

6. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets.

There will always be emerging threats like the current coronavirus that demand our attention. But, as Dr. Murray’s remarkable interactive online maps based on GBD data well illustrate, these pale in comparison to the modifiable threats contributing to chronic disease in our human population.

Comments

2 Responses to “Placing Coronavirus In Public Health Perspective”

Charles Fahey
January 30th, 2020 @ 9:00 am

Mike,

Thanks again for well stated, timely , helpful information.

Peace and all good things, chuck
Mike Magee
January 30th, 2020 @ 10:49 am

Thanks, Chuck, for your support and mentorship! Mike