The Global Burden of Disease Study: a useful projection of future global health?

One major conclusion of the Global Burden of Disease Study (GBDS) is that the global burden of disease will not change significantly from 1990 to 2020, in developed regions, developing regions or as a whole. Using the disability-adjusted life year (DALY), the Study estimates the burden as a result of 107 diseases, accidents and their disabling sequelae, disaggregated with respect to cause, sex, age and geographical region. The basic data used to construct estimates are sparse, and the DALY as a tool has received many criticisms. It obscures the distribution of disease and its impact in terms of handicap, and includes several social and economic value judgements. This weakens its power as a guide for the rational allocation of health resources at any point in time. Does it have use in guiding future planning and preventive action? At a global level, exceeding ecological capacity primarily through relative overpopulation is likely to be the greatest threat to overall health, yet overpopulation is not considered as a risk factor in itself. This reflects the understanding of health as an issue of the individual rather than the community. Together with the productivity-orientated weighting of DALYs, the Study appears to be more concerned with cost-effectiveness of health interventions rather than their equity. This underlies the reservations of the World Health Organization regarding the Study's use as a rational tool in health policy.