文章基本信息

标题：Is It Time to Reassess the Categorization of Disease Burdens in Low-Income Countries?
本地全文：下载
作者：Philip W. Setel ; Lance Saker ; Nigel C. Unwin 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：3
页码：384-388
语种：English
出版社：American Public Health Association
摘要：The classification of disease burdens is an important topic that receives little attention or debate. One common classification scheme, the broad cause grouping, is based on etiology and health transition theory and is mainly concerned with distinguishing communicable from noncommunicable diseases. This may be of limited utility to policymakers and planners. We propose a broad care needs framework to complement the broad cause grouping. This alternative scheme may be of equal or greater value to planners. We apply these schemes to disability-adjusted life year estimates for 2000 and to mortality data from Tanzania. The results suggest that a broad care needs approach could shift the priorities of health planners and policymakers and deserves further evaluation. HOW DISEASE BURDENS ARE characterized and categorized in terms of broad groupings is an important issue that receives little attention or debate. The application of conventional broad cause groups (i.e., communicable, noncommunicable, and injuries ) to the disease burden determines much of the field on which important debates in international health are conducted. The broad cause view of disease burdens in developing countries has informed both influential policy recommendations that poor countries invest solely in communicable disease reduction to achieve the greatest future health returns, 1 and potent warnings that noncommunicable diseases loom as “tomorrow’s pandemics” in the developing world. 2 The time is ripe for challenging the conventional categories underlying these discussions. A move away from groupings based on causes to ones that stress the effects and care needs of disease burdens would be instructive. Perhaps more importantly, they may be of greater intrinsic use for high-level public health policy and services planning. Our concerns echo recent calls for a reassessment of models of health care delivery that move away from a narrow focus on acute, episodic treatment to ones that more closely reflect the increasing burden of conditions requiring long-term care and management regardless of etiology. 3 To illustrate our point, we present a simple broad care needs scheme for categorizing the burden of disease. We then apply both the conventional broad cause scheme used in the 1990 Global Burden of Disease (GBD) study 4, 5 and the proposed needs-oriented scheme to 2 sets of data: GBD disability-adjusted life year (DALY) estimates for sub-Saharan Africa for 2000, and community-based data on cause-specific mortality from a rural district in the United Republic of Tanzania for 2000.