Preface

This book emerges from two separate, but intersecting, strands of work that began in the late 1980s, when the World Bank initiated a review of priorities for the control of specific diseases. The review generated findings about the comparative cost-effectiveness of interventions for most diseases important in developing countries. The purpose of the cost-effectiveness analysis (CEA) was to inform decision making within the health sectors of highly resource-constrained countries. This process resulted in the publication of the first edition of Disease Control Priorities in Developing Countries (Jamison and others 1993). Also important for informing policy is a consistent, quantitative assessment of the relative magnitudes of diseases, injuries, and their risk factors. The first edition of Disease Control Priorities in Developing Countries included an initial assessment of health status for low- and middle-income countries as measured by deaths from specific causes; importantly, the numbers of cause-specific deaths for each age-sex group were constrained by the total number of deaths as estimated by demographers. This consistency constraint led to downward revision of the estimates of deaths from many diseases.

These two strands of work—CEA and burden of disease—were further developed during preparation of the World Development Report 1993: Investing in Health (World Bank 1993). This report drew on both the CEA work in the first edition of Disease Control Priorities in Developing Countries and on a growing academic literature on CEA. In addition, the World Bank invested in generating improved estimates of deaths and the disease burden by age, cause, and region for 1990. Results of this initial assessment of the global burden of disease appeared both in the World Development Report 1993 and widely in the academic literature (see, for example, Murray and Lopez 1996a, 1996b; Murray, Lopez, and Jamison 1994). Over the past six years, the World Health Organization has undertaken a new assessment of the global burden of disease for 2000–2, with consecutive revisions and updates published annually in its World Health Reports. The World Health Organization has also invested in improving the conceptual, methodological, and empirical basis of burden of disease assessments and the assessment of the disease and injury burden from major risk factors (Ezzati and others 2004; Murray and others 2002; World Health Organization 2002).

In 2002, a number of organizations—the Fogarty International Center of the U.S. National Institutes of Health, the World Bank, the World Health Organization, and the Bill & Melinda Gates Foundation—initiated the Disease Control Priorities Project (DCPP), located at the Fogarty International Center. The DCPP's purpose has been to review, generate, and disseminate information that contributes to the scientific evidence base for improving population health in developing countries. A major product is the second edition of Disease Control Priorities in Developing Countries (DCP2) (Jamison and others 2006), which updates and extends available CEA relevant to developing countries and explores the institutional, organizational, financial, and research capabilities essential for health systems to be able to select and deliver the appropriate interventions.

DCP2 was to have included two major chapters on burden, one dealing with deaths and the disease burden by cause and the other with the burden from major risk factors. Two points quickly became clear. First, even though DCP2 had allocated substantial space for these chapters, much valuable background, methodology, and results still had to be relegated to a separate document on the Web. Second, this material would generate substantial interest independently of its tie to DCP2, because health system activities, including the choice of interventions, depend partly on the magnitude of health problems, and because assessment of the burden of diseases, injuries, and risk factors includes important methodological and empirical dimensions. The sponsors of the DCPP therefore decided to publish this volume, which includes a full account of methods, the complete results of recent work, and an assessment of trends for total mortality and for major causes of death among children under five along with two chapters that cover sensitivity and uncertainty analyses in relation to a broad range of potentially important parameters.

During 1999–2004, the authors of this volume and many collaborators from around the world worked intensively to assemble an updated, comprehensive assessment of the global burden of disease and its causes. This book provides the definitive, scientific account of that effort and of the health conditions of the world's population at the beginning of the 21st century.

Both DCP2 and this book are available on the DCPP Web site (http://www.dcp2.org), as well as through the National Library of Medicine's PubMedCentral. From the DCPP Web site, users can download individual chapters or create an ad hoc group of chapters formatted for printing booklets or course packets. We encourage users to construct variants of the book most suited to their work or their teaching. The DCPP Web site also allows access to Excel versions of all global burden of disease tables so that users can freely reanalyze the data to meet their own needs.