Editorial
GBD 2015: from big data to meaningful change
The Global Burden of Diseases, Injuries, and Risk Factors
Study 2015 (GBD 2015) brings together the most recent
epidemiological data according to year, age, and sex
from 195 countries and territories. In a continuation of
the partnership between The Lancet and the Institute
for Health Metrics and Evaluation (IHME), this year
marks the rst of an annual commitment to publish
the four capstone GBD paperson global mortality,
years lived with disability, disability-adjusted life-years,
and risk factorsin a single issue. 2015 also represents
a key milestone in the global health and development
community, with the end of the Millennium Development
Goals (MDGs) era and the launch of the 17 Sustainable
Development Goals (SDGs). Two health-related MDGs
maternal and child mortalityare subjected to systematic
analysis in this issue, and a third companion study aims to
dene baseline measurements for health-related SDGs.
The GBD provides a window into the most pressing
challenges and commendable achievements of the
collective endeavour to transform human health
and wellbeing. Although globally life expectancy
has increased since 1980, conict and interpersonal
violence has driven its stagnation or decrease in many
regions, with male life expectancy in Syria decreasing by
113 years between 2005 and 2015. The combination of
socioeconomic development and an ageing population
is contributing to declines in some risk exposures, such
as childhood undernutrition, but increases in others,
such as low physical activity and high body-mass
index. Fundamentally, the GBD is about systematising
everything we know about descriptive epidemiology to
produce the most reliable global health statistics to date.
This is the science of making data meaningful. As such,
each iteration produces not only a worldwide update on
disease burden, but, just as importantly, drives advances
in the methods used to produce robust measurements
and comparisons. Publication of the GBD in an academic
journal is part of a deliberate eort to build a scientic
discipline of estimation that is subjected to peer-review
and public scrutiny. It is this scientic rigour that makes
the GBD an essential basis for achieving quantiable
progress in global health.
At a national level, the GBD estimates support
countries by enabling them to measure successes,
identify important gaps, make comparisons with other
www.thelancet.com Vol 388 October 8, 2016
countries, and set new priorities. These estimates are an
important tool for policy makers, non-governmental
organisations, practitioners, and other stakeholders.
Recent methodological renements have increased the
granularity of estimates available for individual countries,
increasing the ability to target resources to where they are
Majcot/Shutterstock
needed most. China, Mexico, and the UK included the rst
subnational level analyses in GBD 2013, with GBD 2015
expanding these analyses to also include several other
countries such as Brazil, South Africa, Japan, and India.
See Comment pages 1448,
At the global level, the GBD functions as an accountability 1450, and 1453
tool. Too often, high-level targets, commitments, and See Special Report page 1455
goals pay scant attention to approaches for measuring See Articles pages 1459, 1545,
1603, 1659, 1725, 1775,
their real-world impact. Indeed, approaches for and 1813
collecting and analysing data are scattered across the
17 SDGs and their individual targets and indicators,
and are often found at the bottom of the priority list.
The Socio-demographic Index (SDI) is among the most
important technological developments of GDB 2015. As
a new indicator derived from measures of educational
attainment, fertility rate, and per capita income, this
index is critical to measuring the impact of public health
interventions by separating secular trends that are driven
by socioeconomic development from overall progress. In
the baseline analysis for the SDGs, GBD 2015 produced a
health-related SDG index for each country and examined
its relationship with the SDI, nding that some countries,
including several in western Europe and Latin America, had
SDG indices that were higher than expected on the basis
of SDI alone, whereas others, such as the USA and India,
performed poorer than expected. These ndings indicate
that progress in health is achievable beyond the ow-on
eects of development status.
Despite the gains made by 2015, considerable
challenges remain. Crucially, the global health community
needs to move beyond assessing individual health-related
SDGs to investigating the links between dierent goals.
There can be little doubt that factors such as education,
access to clean water and sanitation, gender equality,
and peace, justice, and strong civil institutions all have a For more on the IHME see
http://www.healthdata.org/
profound impact on health. What is less clear, however,
For more on the SDGs see
is how to analyse and measure these relationships. But https://sustainabledevelopment.
measure them we must. Because what you dont measure un.org/sdgs
For the infographic and more on
you dont know, and what you dont know you cant act GBD see http://www.thelancet.
on. Good science is the start. The Lancet com/gbd
1447