Lecture 24

Question 1

Global health metrics

Answer 1

• shape narratives around health priorities
• influence resource administration
• reinforce asymmetric power dynamics

Question 2

Era 1: unilateral quarantine/ no cooperation

Answer 2

• 1300-1850s
• limited understanding of disease etiology
• protection of health within borders
• bills of mortality

Question 3

Era 2: nascent sanitary approaches

Answer 3

• 1851-1892
• colonial otherism
• nascent international collaboration
• vital registration system in Europe

Question 4

Era 3: institutionalized sanitary approaches

Answer 4

• 1892-1946
• broad acceptance of germ theory
• emergence of international treaties
• international system for classifying disease (standardized)

Question 5

Era 4: hegemonic health cooperation

Answer 5

• 1946- ?
• international engagement for health
• “health for all”
• global health agenda
• global health metrics/agenda created through global agencies/treaties

Question 6

Global Burden of Disease study

Answer 6

• DALYs introduced
• drove donor priorities, infringed on country autonomy

Question 7

IHME controversy

Answer 7

• IHME results contradicted WHO results
• led to confusion for policymakers
• WHO and IHME then refined, converged methods

Question 8

Health metrics matter to

Answer 8

• guide health policy formulation and resource allocation
• insights into health status where data are lacking
• track progress toward local, regional, and global targets
• identify under-recognized health issues and inequities

Question 9

Why model burden for pneumococcus

Answer 9

• challenges for direct measurements
• inform policy, interventions
• updated estimates

Question 10

Empirical data

Answer 10

use data from studies, records, surveys, etc

Question 11

Mathematical modeling

Answer 11

use models to estimate burden where empirical data is incomplete/inconsistent

Question 12

Risk factor attribution

Answer 12

• use prevalence and relative risk of risk factors to attribute cases/deaths to specific causes

Question 13

Multinomial and ensemble

Answer 13

use a combination of statistical techniques to estimate morbidity and mortality

Question 14

Pneumococcus - civil registration/vital statistics system

Answer 14

• pneumococcus hard to grow in lab -> missing a lot of cases
• little/poor data for highest burdened areas

Question 15

Pneumococcus modeling

Answer 15

1. estimate all cause data - empirical sources + modeled
2. estimate syndromic causes of death
3. Counterfactual/probe approach

Question 16

CFR Challenges

Answer 16

• represent hospital cases usually, excludes underreported cases
• variation across settings
• time lag/bias

Question 17

Global burden of pneumococcal disease

Answer 17

• reduced mortality globally
• reduced across income groups, inequities
• highest in africa, south asia

Question 18

Preparing/publishing global estimates

Answer 18

• look beyond pubmed
• year, geographic scale
• sensitivity analyses and secondary sources
• update methods frequently
• WHO country consultation and IVIRAC review

Question 19

Considerations

Answer 19

• several groups involved in burden estimates
• understand motivation/influence
• be skeptical
• beware of false precision