ADB HEALTH TALKS

SEMINAR
John Wong, MD MSc

5 June 2017
ADB
Measuring health

What is GBD?

GBD in the
Philippines

GBD Worldwide

Conclusion
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS CONCLUSION
ANALYSIS
HEALTH GBD? THE PH WORLDWIDE

MORTALITY oldest and simplest

summarizing mortality experience in the

LIFE EXPECTANCY pop.

MORBIDITY condition-specific
(incidence/prevalence)

HRQoL standardized weighting systems

(QALYs and DALYs) anchored by 0 (dead) and 1 (full health)
National Research Council (US) Panel to Advance a Research Program on the Design of National Health Accounts. Accounting for Health and Health Care: Approaches to Measuring the Sources and Costs of Their Improvement.
Washington (DC): National Academies Press (US); 2010)

MEASURING POPULATION HEALTH

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

MORTALITY not age standardized, difficult to use for comparison

standardized death rates,

LIFE EXPECTANCY but age-specific mortality rate change

condition-specific, several instruments are needed;

MORBIDITY instrument for multiple diseases cant yet be combined
(incidence/prevalence) into single summary score

morbidity + mortality in a single number

HRQoL - capture the cumulative effects of multiple conditions
(QALYs and DALYs) - reflect both psychological and physiological dimensions

National Research Council (US) Panel to Advance a Research Program on the Design of National Health Accounts. Accounting for Health and Health Care: Approaches to Measuring the Sources and Costs of Their Improvement.
Washington (DC): National Academies Press (US); 2010)

MEASURING POPULATION HEALTH

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

Magnitude of the Problem

Life
Disease/ Incidence/
Mortality Expectancy DALY
Measure Prevalence
(national)
Ischemic Heart 292,825.85 /
92,204.32 68.27 years 2,274,882.15
DIsease 1,270,420.74

Skin diseases 1,793.88 68.27 years 121,315,679.472/ 774,393.30

34,444,693.35
Lower
respiratory 54,915.42 4,696,785.27 / 1,793,879.34
68.27 years
147,885.35
infection

SIGNIFICANCE OF MEASURING HEALTH

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

Prioritization in health care

What are people getting for their health care peso?
Life Expectancy
Mortality Incidence/ Prevalence DALYs/QALYs
(national)
simplest, data often age standardized easily measured with summary number,
readily available modern registries accounts for
cumulative effect of
multiple diseases
may be too simple based on mortality captures particular point accounts for
in time non-death effects
(multidimensional)
information only at end of may not be since disease-specific, represent
life disaggregated difficult to combine into community
when needed comprehensive measure preferences useful
of health for a person in CEA
Global Burden of Disease Study 2015. Global Burden of Disease Study 2015 (GBD 2015) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2016.
Available from http://ghdx.healthdata.org/gbd-results-tool.

SIGNIFICANCE OF MEASURING HEALTH

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

a systematic, scientific effort to quantify

the comparative magnitude of health loss
due to diseases, injuries, and risk factors.
Now an ongoing enterprise with annual
updates, GBD is an international,
collaborative effort with more than 1,400
researchers in over 100 countries,
led by IHME.
WHAT IS THE
GLOBAL
BURDEN OF
DISEASE
source: http://www.healthdata.org STUDY?
WHAT IS GBD?
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

THE ANNUAL GBD

Institute of Health Metrics and Evaluation (IHME)
University of Washington

disseminating comprehensive epidemiological data

79 risk factors
315 diseases and injuries
195 countries, including the Philippines

See: http://thelancet.com/gbd for more info

The data for the latest GBD for 2015 is available free from http://ghdx.healthdata.org/gbd-results-tool.

source: http://www.healthdata.org

WHAT IS GBD?
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

DALY (Disability-adjusted Life Years)

A summary measure of population health
Years or time lost due to illness or early death

BURDEN OF DISEASE: What is a DALY?

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

Accounts Only For Does Not Account For

Socio-demographic
Fertility Rate Expected Status
Demographic
Transition of the Advances in Medical
Mortality Rate
Technology
Country
Changes in Life
Ageing of Population
Expectancy

LIMITATIONS OF GBD STUDY

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

Leading causes of DALYs worldwide in 2015

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

THE PROCESS
Data from Global PARETO PRINCIPLE TOP 48
Burden of Disease applied to identify the DISEASES
2013 & Philippine top causes of death
Census 2010 was and disability in the 1.
used to determine the Philippines [DALYs] 2.
Philippine burden of for 2015. 3.
disease profile for 4.
2015 - 2035. 5.
80% .
20% DISEASES
BURDEN .
.
48.

APPLICATIONS IN THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

UPDATED TOP 48 FOR THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

Ten (10) diseases account for

40% of the disease burden

PARETO PRINCIPLE
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

2015 (GBD 2013) 2017 (GBD 2015) 2040 (GBD 2015)

1 IHD
1 Ischemic heart disease (IHD) 1 IHD
2 Lower respiratory tract inf. 2 LRI 2 LRI
(LRI)
3 3 HS 3 HS
Tuberculosis (TB)
4 4 DM 4 DM
Preterm birth complications
(PBC)
5 Hemorrhagic stroke (HS) 5 PBC 5 TB
6 Diabetes mellitus (DM) 6 TB 6 COPD
7 Lower back pain (LBP) 7 LBP 7 LBP
8 Chronic obstr. pulm. dis. 8 A 8 A
(COPD)
9
9 COPD 9 ARHL
Iron deficiency anemia (IDA)
10
10 NS 10 IS
Ischemic stroke (IS)

11 IDA
12 Asthma (A)
19
13 Age-related and other 15 PBC
Neonatal sepsis & other
neonatal infections (NS) hearing loss (ARHL) 21 NS
21 IS

UPDATED TOP 48 FOR THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

A1: THE VITAL FEW: 48 Diseases and Conditions that

Cause 80% of the Philippine Burden

APPLICATIONS IN THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

A2: Priority Setting Process for PHIC Benefit Package Design

APPLICATIONS IN THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

A3: Intervention Scoping for the

Guaranteed Health Benefits Package

APPLICATIONS IN THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

A4: Intervention Costing for the

Guaranteed Health Benefits Package

General Objective: To estimate the cost of

facility-based interventions of the 48 most
burdensome diseases under the GHPB to support
strategic purchasing and shift in provider payment.

Proper costing of the resource requirements will:

guide hospitals in strategic purchasing
guide policy makers set-up the appropriate provider
payment schemes
identify cost-sharing schemes to decrease patient
out-of-pocket expenditures for financial risk protection.

APPLICATIONS IN THE PHILIPPINES

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

The Work to Come

A6
EVALUATION OF A5
BUDGET
BENEFIT
PACKAGES IMPACT
ANALYSIS

A4
A3
A2
A1
APPLICATIONS IN THE PHILIPPINES
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

APPLICATIONS ABROAD
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

APPLICATIONS ABROAD
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

APPLICATIONS ABROAD
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

data for benefit package

development and guidance for
reimbursement intervention scoping
decisions
framework for
priority-setting for costing
resource allocation

0.773
774 85
9
6
C
*
1 2 3 +
0 ! - =

WHAT GBD DATA CAN CONTRIBUTE TO

 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

Lancet volume on the GBD Study

Excel-based viewer of ASEAN GBD

Results

TOOLS
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

TOOLS
 MEASURING WHAT IS GBD IN GBD
INTRODUCTION DEFINITIONS RRL METHODS ANALYSIS
CONCLUSION
HEALTH GBD? THE PH WORLDWIDE

THANK YOU