GLOBAL BURDEN OF DISEASE:

INTRODUCTION:

The Global Burden of Disease Study began in 1990 as a single World Bank-commissioned
study, now called GBD project quantified the health effects of more than 100 diseases and
injuries for eight regions of the world, giving estimates of morbidity and mortality by age, sex,
and region. It also introduced the disability-adjusted life year (DALY) as a new metric to
quantify the burden of diseases, injuries, and risk factors, to aid comparisons. GBD 1990 was
"institutionalized" at the World Health Organization (WHO) and the research was "conducted
mainly by researchers at Harvard and WHO".

MODIFIABLE RISK FACTORS:

In 2006, the WHO released a report which addressed the amount of global disease that could be
prevented by reducing environmental risk factors. The report found that approximately one
fourth of the global disease burden and more than one third of the burden among children was
due to modifiable environmental factors. The "environmentally-mediated" disease burden is
much higher in developing countries, with the exception of certain non-communicable diseases,
such as cardiovascular diseases and cancers, where the per capita disease burden is larger
in developed countries. Children have the highest death toll, with more than 4 million
environmentally-caused deaths yearly, mostly in developing countries. The infant death
rate attributed to environmental causes is also 12 times higher in developing countries. 85 out of
the 102 major diseases and injuries classified by WHO were due to environmental factors.
To measure the environmental health impact, environment was defined as "all the physical,
chemical and biological factors external to a person and all the related behaviors’". The
definition of modifiable environment included:
 Air, soil, and water pollution with chemicals or biological agents
 Ultraviolet and ionizing radiation
 Noise and electromagnetic fields
 Built environment
 Agricultural methods and irrigation schemes
 Man-made climate change and ecosystem degradation
 Occupational risks
 Individual behaviors, such as hand-washing and food contamination due to unsafe water
or dirty hands.

Certain environmental factors were excluded from this definition:

 Indoor smoke from solid fuel use

 Lead

 Mercury
 Natural climate change (as opposed to human-caused climate change)
 Occupational airborne particulates or carcinogens
 Outdoor air pollution

 Sanitation and hygiene problems

 Second-hand smoke
 Solar ultraviolet radiation

The burden of disease can be viewed as the gap between current health status and an ideal
situation in which everyone lives into old age free of disease and disability. Causes of the gap are
premature mortality, disability and exposure to certain risk factors that contribute to illness.

GLOBAL HEALTH PRIORITIES:

Global health priorities have in recent years been defined through several processes and by
several actors and at various forums. In 2000 and 2001, HIV/AIDS, tuberculosis and malaria
came to be discussed in a variety of forums at the UN as well as outside the UN, and
commitments to address the three diseases were made, for example, by theG8, the World Bank,
the World Economic Forum and the European Commission.

Millennium Development Goals (MDGs) are a product of consultations between international

agencies, but were also adopted by the United Nations (UN) General Assembly in September
2001 as part of the road map for implementing the substantially broader Millennium Declaration,
which it had adopted in September 2000.

The MDGs have eight goals, three of which are health-focused, namely those on child mortality,
maternal health, and HIV/AIDS, malaria and other diseases. The UN-led Millennium Project,
directed by the economist Jeffrey Sachs, has the objective of ensuring that all developing
countries meet the MDGs. Development aid for health is also largely steered towards tackling
communicable infectious. USAID has financed population Programmes, including family
planning, for three decades, while its emphasis on health issues is more recent. In 2002, the
USAID population, health, and nutrition funding covered HIV/AIDS, family
planning/reproductive health, child survival/maternal health, and infectious diseases.

APPROACHES FOR IMPROVED GLOBAL HEALTH:

1. Health policy-making has become increasingly fragmented and verticalized, with

the increasing emphases on selected interventions, the increasing number of
partnerships and especially because of the founding of new entities for various
health issues.
2. Little emphasis has been put on comprehensive infrastructure building. These
trends are in contrast to the stated aims of integrating health policy making with
the broader development agenda or with comprehensive health sector planning.
3. An emphasis on innovations and innovative approaches encourages the use of
new technologies and the building of new structures. Problems of unsustainability and
inequity have arisen with the high levels of funding required, an emphasis on fast
results, and the construction of new structures both at global and national levels.
4. In the initial faces of GAVI serious concerns were raised that those children that
had been without basic vaccine coverage before GAVI funding would remain so
and also be out of the reach of the new vaccines.
5. The GAVIemphasis on new and more expensive vaccines have raised the costs of
the immunizations Programmes at country level making the future financing of
the programme highly vulnerable National priorities often differ from the global
priorities, and the thinking around global public goods recognizes this as a
starting point.

THE GLOBAL HEALTH PRIORITES ARE:

In one of the world's largest public-health collaborations, 155 experts from 50 countries have a
plan to tackle the world's deadliest diseases. The result is a list, published this week in the journal
Nature, of the top 20 research and policy priorities in chronic non-communicable diseases —
things like heart disease, stroke, diabetes, and most cancers — which account for 60% of all
deaths worldwide.

RAISE PUBLIC AWARENESS

1. Raise the political priority of non-communicable disease

2. Promote healthy lifestyle and consumption choices through effective education and public
engagement

3 . Package compelling and valid information to foster widespread, sustained and accurate media
coverage and thereby improve awareness of economic, social and public health impacts

ENCHANCE ECONOMIC, LEGAL AND ENVIRONMENTAL POLICIES

4. Study and address the impact of government spending and taxation on health

5. Develop and implement local, national and international policies and trade agreements,
including regulatory restraints, to discourage the consumption of alcohol, tobacco and unhealthy
foods

6 .Study and address the impacts of poor health on economic output and productivity

MODIFY RISK FACTORS

7. Deploy universally measures proven to reduce tobacco use and boost resources to implement
the WHO Framework Convention on Tobacco Control

8 .Increase the availability and consumption of healthy food

9. Promote lifelong physical activity

10 .Better understand environmental and cultural factors that change behavior

ENGAGE BUSINESS AND COMMUNITY

11. Make business a key partner in promoting health and preventing disease

12. Develop and monitor codes of responsible conduct with the food, beverage and restaurant
industries

13. Empower community resources such as voluntary and faith-based organizations

MITIGATE HEALTH IMPACTS OF POVERTY AND URBANIZATION

14. Study and address how poverty increases risk factors

15. Study and address the links between the built environment, urbanization and chronic non-
communicable disease

REORIENTATE HEALTH SYSTEMS

16 .Allocate resources within health systems based on burden of disease

17. Move health professional training and practice towards prevention

18. Increase number and skills of professionals who prevent, treat and manage chronic non-
communicable diseases, especially in developing countries

19. Build health systems that integrate screening and prevention within health delivery

20. Increase access to medications to prevent complications of chronic non-communicable

disease.
Approaches for improved
global health
Health policy-making has
become increasingly frag-
mented and verticalized, with
the increasing emphases on
selected interventions, the
increasing number of partner-
ships and especially because of
the founding of new enti-
ties for various health issues.
Little emphasis has been put
on comprehensive
infrastructure building. These
trends
are in contrast to the stated
aims of integrating health pol-
icy making with the broader
development agenda or with
comprehensive health sector
planning.
An emphasis on innovations
and innovative approaches
encourages the use of new
technologies and the building
of new structures. Problems of
unsustainability and ineq-
uity have arisen with the high
levels of funding required,
an emphasis on fast results,
and the construction of new
structures both at global and
national levels [2,33-35]. In
the initial faces of GAVI serious
concerns were raised that
those children that had been
without basic vaccine cover-
age before GAVI funding would
remain so and also be out
of the reach of the new
vaccines [33,36]. The GAVI
emphasis on new and more
expensive vaccines have
raised the costs of the
immunizations programmes at
country level making the future
financing of the pro-
grammes highly vulnerable
[37].
National priorities often differ
from the global priorities,
and the thinking around global
public goods recognizes
this as a starting point. Yamey
[34] has argued that the
increased emphasis on global
programmes and global pri-
ority setting is problematic
from the point of view of
national sovereignty and
empowerment. He furthermore
states that partnerships rarely
synchronise their activities
with emerging processes within
countries aimed at devel-
oping their national health
systems. This observation has
also been made in relation to
GAVI country level action
[38].
Partnerships are commonly
defined as voluntary and col-
laborative relationships
between state and non-state
par-
ticipants who agree to work
together to achieve a common
purpose or undertake a specific
task, and to share risks,
responsibilities, resources,
competencies and benefits
[39]. According to Richter [7]
one of the most substantive
losses resulting from the shift
towards the partnership par-
adigm is the loss of distinction
between different actors in
the global health arena. UN
agencies, governments, tran-
snational corporations, their
business associations and
public interest NGOs are all
called 'partner'. The realisa-
tion that these actors have
different and possibly conflict-
ing mandates, goals and roles
has been lost.

GLOBAL HEALTH PROGRAME:

Global Health:

Global Health is an area of study, research, and practice that places a priority on improving
health and achieving equity in health for all people worldwide. It emphasizes transnational health
issues, determinants, and solutions; involves many disciplines within and beyond the health
sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based
prevention with individual-level clinical care.

The Global Health Program (GHP) is designed to be intellectually comprehensive, integrating

the social sciences, biological sciences, and humanities. Students will combine academic and
experiential learning, striking a balance between acquisition of hard skills, critical thinking, and
real world knowledge.

GOAL:

Increase global health equity by accelerating the development, deployment, and sustainability of
tools and technologies that will save lives and dramatically reduce the disease burden in the
developing world.

PRINCIPLES:

 Concentrate on the largest, most inequitable global health problems facing

developing countries

 Focus on improving public health through prevention and development and

deployment of 21st-century, affordable, and high impact health tools and
technology

 Invest in efforts that are likely to be sustained over time

– Catalyze new/incremental dollars

– Demonstrate high-impact interventions and ensure their widespread

deployment

– Do not displace governments, industry, and/or other donors

 Build global awareness of public health inequities in the developing word

 Support leadership training for public health leaders in developing countries

NATIONAL AIDS CONTROL PROGRAMME:

INTRODUCTION:

 Human Immunodeficiency Virus (HIV) is a virus that belongs to the retroviruses group
may cause HIV infection/AIDS. Acquired Immunodeficiency Syndrome (AIDS) has
emerged as one of the most serious public health problem in the country after reporting of
the first case in 1986. The initial cases of HIV/AIDS were reported among commercial
sex workers in Mumbai and Chennai and injecting drug users in the north-eastern State of
Manipur. The disease spread rapidly in the areas adjoining these epicenters and by 1996
Maharashtra, Tamil Nadu and Manipur together accounted for 77 percent of the total
AIDS cases. Out of these, Tamil Nadu reporting almost half the number of cases in the
country. However, the overall prevalence in the country is very low, as compared to
many other countries in the Asia-Pacific region.

India

 The trends of HIV infection in India are alarming. Following characteristics of the AIDS
epidemic have been observed:

 In the recent years it has spread from urban to rural areas and from individuals practicing
risk behaviour to the general population.

 More and more women attending antenatal clinics are being found testing HIV-positive
thereby increasing the risk of perinatal transmission. One in every 4 cases of HIV
positive reported is a woman.

 About 84% of the infections occur through the sexual route (both heterosexual and
homosexual).

 Other roots of transmission are blood transmission, injectable drug use and perinatal
transmission.

 Another 4% through injecting drug use.

 About 80% of the reported cases are occurring in sexually active and economically
productive age group of 15-44 years.

 HIV positive in antenatal clinic varied from 0% in Assam to 1.71% in Maharashtra. The
average prevalence work out as a low 0.7% but with more than 500 million adult in the
country. NACO calculates that 4.8 million people are infected.

Attributable factors of the HIV spread are:

1. Labour migration and mobility in search of employment from economically backward to more
advanced regions;

2. Low literacy levels leading to low awareness among the potential high risk groups;
3. Gender disparity;

4. High prevalence of Sexually Transmitted Infections and Reproductive Tract Infections both
among men and women;

5. The social stigma attached to sexually transmitted infections also hold good for HIV/AIDS,
even in a much more serious manner. This coupled with lack of awareness results in reporting of
full-blown AIDS cases in cities like Mumbai and Chennai;

6. There have been cases of refusal of AIDS patients in hospitals and nursing homes both in
Government and private sectors. This has compounded the misery of the AIDS patients;

7. Isolation of AIDS cases in the wards creates a scare among the general patients;

8. At some occasions, discrimination at workplace leads to loss of employment;

9. The treatment options are still in the trial stage and too expensive;

10. Still no effective vaccine is available;

11. Multi-drug protease inhibitor therapy, popularly known as 'cocktail therapy', helps only in
prolonging the life of the patient. There are fears of patients developing drug resistance and side
effects if the therapy is not administered under proper medical supervision;

12. There were instances of quacks taking advantage of the situation and promising cure through
so-called herbal treatment providing only false assurances;

13. Existence of a large number of unlicensed small and medium blood banks in the private
sector has also compounded the problem;

14. The twin problem of drug addiction and HIV transmission raise a serious ethical and moral
issues in the Needle exchange programmes and condom distribution as legally no person should
take drug or should go to prostitutes;

15. Although transmission of HIV through use of needles, razors and other cutting instruments in
the thousands of beauty parlors, hair-cutting saloons is insignificant, lack of hygiene practices in
majority of these establishments also poses a health risk to the unsuspecting general population
who visit these places every day;

16. There is also a twin challenge of HIV/TB infection. Nearly 60% of the AIDS cases are
reported to be opportunistic TB infection cases. Treatment of TB among the HIV-infected
persons is a new challenge to the National TB Control Programme. Some of the anti-tubercular
drugs recommended for TB treatment pose complications in cases of HIV-infected persons, e.g.
thiacetazone can cause skin eruptions. There is no risk of HIV from any TB patient unless he or
she practices high risk behaviour or gets infected from transfusion of HIV-infected blood;
17. Inadequate understanding of the serious implications of the disease among the legislators,
political and social leaders, bureaucracy, media, leaders of trade and industry and even among
medical and paramedical personnel engaged in provision of health care;

18. Difficulty in identifying, reaching, and covering risk groups for interventions;

19. Poor involvement of NGOs due to Borrower's and recipients' non-familiarity with guidelines
and project processing requirements;

20. Vacant posts frequent transfers, holding of dual charges, and changes in staffing patterns is
again major hurdle in implementation of preventive programme strategies;

21. Lack of uniformity in the processes of disbursement of funds in various states; and

22. Large segment of civil society did not acknowledge HIV as a priority in the early 1990s and
were critical of the Central Government and the World Bank for drawing attention towards
HIV/AIDS.

National AIDS Control Programme Phase - I (1992-99)

During this phase, the National AIDS Control Project was developed for prevention and control
of AIDS in the country.

Project Objectives

The ultimate objective of the project was to slow the spread of HIV to reduce future morbidity,
mortality, and the impact of AIDS by initiating a major effort in the prevention of HIV
transmission. The specific objectives were:

(a) Involve all States and Union Territories in developing HIV/AIDS preventive activities with a
special focus on the major epicenters of the epidemic;

(b) Attain a satisfactory level of public awareness on HIV transmission and prevention;

(c) Develop health promotion interventions among risk behaviour groups;

(d) Screen all blood units collected for blood transfusions;

(e) Decrease the practice of professional blood donations;

(f) Develop skills in clinical management, health education and counseling, and psychosocial
support to HIV seropositive persons, AIDS patients and their associates;

(g) Strengthen and control of Sexually Transmitted Diseases (STD); and

(h) Monitor the development of the HIV/AIDS epidemic in the country.

Achievement of Phase I

1. Awareness levels that were almost insignificant have increased to about 70-80% in urban
areas even though the level of awareness in rural areas remains low at about 30%;

2. Modernisation and strengthening of blood banks;

3. Introduction of licensing system of blood banks and gradual phasing out of professional blood
donors; and

4. Availability of good quality condoms through social marketing has made a significant increase
in its use.

National AIDS Prevention and Control Policy (NAPCP) 2002

The NAPCP 2002 has been announced with the aim of bringing AIDS transmission at zero
level by 2007.

1. Prevention of further spread of the disease by making the people at large and specially the
high-risk groups aware of its implications and provide them with necessary tools for protecting
themselves from getting infected. Control of Sexually Transmitted Diseases among sexually
active and economically productive groups together with promotion of condom use a measure of
prevention from HIV infection will be the most important component of the prevention strategy;
2. To provide an enabling socioeconomic environment so that individuals and families affected
with HIV / AIDS can manage the problem; and 3. Improve services for the care of People Living
with AIDS (PLWA) in times of sickness both in hospitals and at homes through community
health care. For this purpose the policy addresses the following components of the national AIDS
control programme for bringing in a paradigm shift in the response to HIV / AIDS at all levels
both within and outside the Government:

National AIDS Control Programme Phase II (1999-2004)

The Phase II of the National AIDS Control Programme has become effective in 1999. It is a
100% centrally sponsored scheme implemented in 32 States/UTs and 3 Municipal Corporations
namely Ahmedabad, Chennai and Mumbai through AIDS Control Societies.

Aims of Phase II

1. To shift the focus from raising awareness to changing behaviour through interventions,
particularly for groups at high risk of contracting and spreading HIV;

2. To support decentralization of service delivery to the State and Municipalities and a new
facilitating role for National AIDS Control Organization. Program delivery would be flexible,
evidence-based, and participatory and to rely on local programme implementation plans;

3. To protect human rights by encouraging voluntary counseling and testing and discouraging
mandatory testing;
4. To support structured and evidence-based annual reviews and ongoing operational research;
and

5. To encourage management reforms, such as better managed State level AIDS Control
Societies and improved drug and equipment procurement practices. These reforms are proposed
with a view to bring about a sense of 'ownership' of the programme among the States, Municipal
Corporations, NGOs and other implementing agencies.

Key Objectives

A. To reduce the spread of HIV infection in India; and

B. Strengthen India's capacity to respond to HIV/AIDS on a long-term basis.

Project Strategies

1. Delivery of cost-effective Interventions against HIV/AIDS.

 A. Priority targeted intervention for groups at high risk

2. Preventive Intervention for the general community

a). IEC and awareness campaigns.

b). Providing voluntary testing and counseling.

c). Reduce transmission by blood transfusion and occupational exposure.

3. Low cost AIDS care.

REPRODUCTIVE AND CHILD HEALTH PROGRAMME

Introduction

The International Conference of Population and Development (ICPD) 1994 established an

International consensus on a new approach to policies to achieve population stabilisation.
Fertility reduction should be addressed at the level of broad social policy, including reduction of
gender discrimination in education, health care and income generation. Reproductive health
Programmes should focus the needs of actual and potential clients, not only for limiting births
but also for healthy sexuality and child bearing. In India, the implications of the reproductive
health approach would be to shift the focus from the use of family planning as a tool intended
essentially for population stabilization, to use family planning as one among a constellation of
interventions that would enable women and men to achieve their personal reproductive goals
without being subjected to additional burdens of disease and death associated with their
reproduction.
Essential Components of RCH Programme

1. Prevention and management of unwanted pregnancy.

2. Maternal care that includes antenatal, delivery and postpartum services.

3. Child survival services for newborns and infants.

4. Management of Reproductive Tract Infection (TRIs) and Sexually Transmitted Infections

(STIs).

The Government have power to restrict any unit, and to take samples of effluents and to get them
analyzed in Central or State laboratories. Whoever fails to comply with any provision of this Act
is punishable with the imprisonment or with fine or with both. Second or third time breaking of
the law is further punishable. Under the provision of this Act Central Pollution Control Board
was established to fulfill its object.

Major Elements of RCH Programme

A. Reproductive Health Elements

 Responsible and healthy sexual behaviour

 Interventions to Promote Safe Motherhood
 Essential Obstetric Care for All
 Prevention of Unwanted Pregnancies: Increase Access to Contraceptives
 Emergency Contraceptives
 Safe Abortion
 Pregnancy and Delivery Services
 First Referral Units (FRUs) for Emergency Obstetric Care
 Management of RTIs/STDs
 Infertility & Gynecological Disorders
 Referral facilities by Government /Private Sector for Pregnant Woman at Risk
 Reproductive Health Services for Adolescent Health
 Global Reproductive Health Strategy

B. Child Survival Element

 Essential New Born Care

 Prevention and Management of Vaccine Preventable Disease
 Urban Measles Campaign
 Elimination of Neonatal Tetanus
 Cold Chain System
 Polio Eradication: Pulse Polio Programmes
 Hepatitis B Vaccine
 MMR Vaccine
  Global Alliance for Vaccine and Immunisation (GAVI)
 Diarrhea Control Programme and ORS Programme
 Prevention and Control of Vitamin A deficiency among children

Strategy

1. Bottom-up Planning

2. Decentralized Participatory Planning & Implementation

3. Strengthening Infrastructure

4. Integrated Training Package

5. Improved Management

SUMMARY:

Disease burden estimations based on sound epidemiological research provide the foundation for
public policy. Which diseases and what interventions does public policy needs to focus upon are
normally derived from such evidence. Well researched, longitudinal data can enable judicious
targeting and help decide what needs to be done where, for whom, and when. Conversely, the
absence of such good quality empirical data can affect programme designing and consequently
outcomes. India has ample evidence of such impacts, often due to the mismatch between disease
burden and its causal factors, and the interventions adopted and priorities in resource allocation.

Besides the need to avert disease for enhancing the quality of life, neglect can have adverse
consequences on the well-being of affected families—social, psychological as well as economic.
Diseases that are heavily concentrated among working age adults or the poor, as is the case with
HIV/ AIDS, cardiovascular disease (CVD), tuberculosis (TB), etc., can have a ruinous impact as
such diseases are extremely expensive to treat, especially due to lack of insurance mechanism.

CONCLUSION:

In 2000–2002, the 1990 study was updated by WHO to include a more extensive analysis using a
framework known as comparative risk factor assessment.

The WHO estimates were again updated for 2004 in the global burden of disease: 2004 update
(published in 2008) and in Global health risks (published in 2009).

The Global Burden of Disease Study 2013 (GBD 2013) was published in 2014.The first
installment, "Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980–2012",
was published in the Journal of the American Medical Association in January, and further
installments were published throughout the year.
BIBLIOGRAPHY:

1.www. global burden of disease

2. www .global health priorities

3.www. Global health programme

4. www. Slide share.com