The Burden of Disease among the Global Poor

Citation: Gwatkin, Guillot, M., Heuveline (1999) The Burden of Disease among the Global Poor.
Internet Archive Scholar (search for fulltext): The Burden of Disease among the Global Poor
Tagged: uw-madison (RSS), wisconsin (RSS), sociology (RSS), demography (RSS), prelim (RSS), qual (RSS), WisconsinDemographyPrelimAugust2009 (RSS)

Summary

Background

Because of the demographic-epidemiological transition, non-communicable diseases cause a majority of the world's deaths and disabilities. This transition is likely to continue in the coming decades, ever increasing the importance of addressing non-communicable diseases. However, because existing work is based on national or even regional averages, it masks the variation in disease profiles between the rich and poor. To address this problem, Gwatkin et al. estimate the burden of disease among 20 percent of the global population living in countries with the lowest per capita incomes, and then compare it to the 20 percent of the global population living in countries with the highest per capita incomes.

Methods

First, the poorest and richest 20% of the global population were calculated through a country-based approach. Countries were analyzed according to average per capita incomes adjusted for purchasing power. About half of the poorest 20% were in India, and about a quarter lived in sub-Saharan Africa; about three-quarters of the world's richest 20% lived in established market economies. Second, the total number of deaths was estimated for each population via data from the UN, World Bank, and Global Burden of Disease study. Third, the number of deaths due to each cause (i.e., communicable, non-communicable and injuries) was estimated. Fourth, data for the numbers of deaths by cause were converted to DALYs.

Findings

Communicable diseases were much more important for the poor than was suggested by global averages. Among the poorest 20%, communicable diseases caused 59% of deaths, while non-communicable diseases caused 32% of deaths. Conversely, among the richest 20%, communicable diseases accounted for only 8% of deaths but non-communicable diseases accounted for 85% of deaths. The large gap in death and disability rates between rich and poor was overwhelmingly accounted for by differences in communicable diseases (77% for deaths and 79% for DALYs). If communicable diseases were reduced by twice their projected rate of decline between 1990 and 2020, the poor would be the primary beneficiaries (i.e., life expectancy would increase by 4.1 years among the poor versus 0.4 years among the rich). By contrast, if non-communicable diseases were reduced by twice their projected rate of decline over this period, the rich would reap most of the benefit (5.3 vs. 1.4 years of life expectancy improvement).

Conclusions

"Caution is needed before policy-makers embrace the current shift in emphasis from communicable diseases among the young toward non-communicable diseases at older ages. Such a shift is no doubt justifiable from an overall global perspective, but the figures developed here suggest that the shift turns away from the diseases of greatest importance for the world's poor . . ." (p. 589).