At a plenary session Thursday at the 19th Conference on Retroviruses and Opportunistic Infections, Christopher Murray, MD, PhD, presented preliminary data from the 2010 revision of the Global Burden of Disease. This effort, funded by the Bill & Melinda Gates Foundation, is aimed at analyzing global health trends to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex and geography for specific points in time. The study is a collaboration of the Institute for Health Metrics and Evaluation, the University of Queensland, the World Health Organization and the Harvard and Johns Hopkins Schools of Public Health. The revision looks at 225 health conditions and more than 50 risk factors. The analysis is still under way but will be published later this year and available to the public through a very innovative website.
Murray defined DALYs – disability adjusted life years – as the sum of time lost due to premature mortality and time lived with disease and impairment-years of healthy life lost. According to Murray’s data, in 2010 HIV infection was the number 11 cause of global DALYs. HIV remains the number one cause of disease burden in 12 countries despite the progress of the last decade. HIV is one of the top five causes of disease burden in more than 30 countries. Murray noted that HIV ranks very high in years of life lost because it kills people in the prime of life. For instance, in South Africa among men between the ages of 35 and 39, 70 percent of all deaths are due to HIV infection.
The study has also defined dramatic reductions in mortality from HIV infection since 1990 – as high as 50 to 60 percent in some of the highest burden countries in Africa. Murray attributes this mortality reduction to the scale up of resources for HIV. HIV spending was the major driver of the momentum in global health spending – momentum and funding expansion that appears to have ended as of 2009. Growth rates in global health spending are now looking more similar to the very gradual growth seen in the 1990s. The very marginal growth seen in the last few years is largely attributable to increased investments by the United Kingdom and Australia. Declines in resources for the Global Fund to Fight AIDS, Tuberculosis and Malaria and flat-lined U.S. spending are likely to mean very little growth in global health spending over the next five years, Murray said.
Looking forward, Murray argued that rising needs to fund antiretroviral therapy and the expanding global health agenda to meet the millennium development goal (MDG) 4 and 5 targets, and respond to malaria, tuberculosis and non-communicable diseases, will put tremendous pressure on limited funds. The one nugget of good news he offered was that developing country governments outside of Africa in South America and Asia are spending more money on their own health programs.
The key challenges will exist in some of the poorest countries in Africa and could have significant implications for the reductions in mortality attributable to investments in ART, the prevention of mother-to-child transmission of HIV, and in the case of India, prevention programs. He noted that continued progress will depend on increased funding and/or dramatic improvements in technical efficiencies in ART delivery or scientific breakthroughs.
Countries with large HIV epidemics are also facing new challenges from the shift toward an increasing burden of non-communicable diseases associated with obesity and tobacco. For example, South Africa now has the highest rate of female obesity in the world.