For a long time I've marvelled at a mishmash of metrics in the world of HIV and AIDS. Incidence, prevalence, case detections, and deaths. Health professionals who work in the field of HIV are confused by them. So it is no wonder that communities often cannot use these metrics to know what is going on with their own epidemics.
Though I am new to the field, I see similar confusion in the world of measuring noncommunicable diseases or NCDs. I recently saw many retweets of the figure that 38 million or 70% of deaths were due to NCDs. I think tweeting a large number of deaths was meant to impress us. Though deaths may make an impression on government officials (or not) there is a problem with using NCD deaths as a metric to measure progress against them.
1) Most deaths occur in older people, so the suffering caused by NCDs in younger people is not picked up by this metric. Deafness and blindness don't cause death at all so they become even more invisible.
2) As the number of deaths due to infections and maternal child health conditions decreases and global population increases, both the number of deaths and the proportion of deaths due to NCDs will increase. Publicizing a number that indicates *more* deaths will not favourably impress government officials or the public at all.
3) Eventually almost every single one of us will die of an NCD. What else are we going to die of?
Certainly decreasing incidence or decreasing the number of new detections of NCDs is one way to measure progress in our response to the pandemics of NCDs. There is another way to measure progress in the response. We can use Disability Adjusted Life Years or DALYs. One of my friends calls a DALY a measure of the amount of suffering. Progress against NCDs can be measured by fewer DALYs lost and less suffering. Isn't the relief of suffering one of our highest goals?
Want to see the difference between deaths and DALYs? Take a moment to look at the wonderful interractive graphic at https://vizhub.healthdata.org/gbd-compare/. Use the controls on the left to toggle between Deaths and DALYs. See the difference?
Comments, criticisms, and suggestions welcome.
Happy Thingyan to all,
Jamie
