Beyond disease burden: towards solution-oriented population health

摘要: The Global Burden of Disease Study (GBD) 2010 made a major contribution to population health by igniting debate about how best reduce human suff ering and premature death. timing was impeccable. As governments, agencies, civil society go into conclave elect successor framework the Mil lennium Development Goals (MDGs), GBD put high on policy agenda. We live in world horrendous inequalities despite vast array eff ective interventions. In 2010, healthy life expectancy men 30 years Haiti but 70 Japan. corresponding fi gures for women were 37 72 years, respectively. Never before has our obligation been accompanied such potential do so. challenge makers is maximise with resources at their disposal, taking account equity social values. From this perspective, taxonomies solutions are more useful than disease burden. important problems ones that we can something about, those which have Because budget limits, decision invest particular set interventions means implicitly deciding not others. By prioritising cost-eff inter ventions make most available resources. However, budgets only constraint. ecosystem disruption threat survival, ecological limits must also be considered. Maximisation gain requires focus cost carbon ectiveness. information need allocation decisions less burden costs, benefi ts, environmental ect solutions. Priority setting should informed marginal improvement resource intensity Methods allocate within between programmes optimise constraints avail able. They allow explicit inclusion concerns, although vague easier explicit. Although authors acknowledge priority guided costs ts intervention, point largely lost given “The challenges us rigorous clear arguments criteria guide programming investment decisions” writes President World Bank. “Accurate assessment global, regional, country situation trends critical evidence-based making public health” WHO Director-General. These views challenged. Accurate data essential priorities it necessary accurately count many people died prematurely prevent A preoccupation dis ease could move from highly costeff ones, reducing gain. way improve think problem, burden, solution— carbon-eff solution-oriented approach taken research investment. what fund, funding bodies consider relation expected value will provide. increase size whose choice intervention additional evidence, traditional measures as incidence prevalence (in case chronic diseases) needed rather summary estimates Often there tenuous link questions faced aiming health. Starting comprehensive model examining extent reduction uncertainty parameters would aff appropriate simple Investment without monitoring return holding recipients accountable foolish. repeated comparisons populations over time, because mortality morbidity multicausal, any changes diffi cult attribute actions sector. system might achieve possible its budget, other causes (eg, changing food supply or climatic conditions). Similarly, provide substandard care while falls. Even high-income countries correlation qual ity low. accountability advantages. For example, early administration tranexamic acid bleeding trauma patients reduces risk death third. treatment all irrespective income level. causal established, monitor whether receive drug. Such case-fatality, case-mix Lancet 2013; 381: 2219–21