Applications of Burden of Disease Analysis
Burden of disease analyses are useful for informing health policy in at least five major ways as outlined in this section. Estimates of deaths by cause or years of life lost serve these same purposes, but for some uses, less well.
Assessing Performance
The burden of disease provides an indicator that can be used to judge progress over time within a single country or region or relative performance across countries and regions. In this application, burden of disease may be considered analogous to national income and product accounts, developed by Simon Kuznets and others in the 1930s and culminating in 1939 with a complete national income and product account for the United Kingdom prepared at the request of the treasury. In subsequent decades, national income and product accounts have transformed the empirical underpinnings of economic policy analysis. As one leading scholar put it,"The national income and product accounts for the United States , and kindred accounts in other nations, have been among the major contributions to economic knowledge over the past half century Several generations of economists and practitioners have now been able to tie theoretical constructs of income, output, investment, consumption, and savings to the actual numbers of these remarkable accounts with all their fine detail and soundly meshed interrelations" ( Eisner 1989 , p. 1).
Generating Forums for Informed Debate of Values and Priorities
In practice, assessing the disease burden involves participation by a broad range of disease specialists, epidemiologists, and often, policy makers. Debating the appropriate values for, say, disability weights or for years of life lost at different ages helps clarify values and objectives for national health policy. Discussing the relationships between diseases and their risk factors in the light of local conditions sharpens consideration of priorities and of programs to address them.
Identifying National Control Priorities
Many countries now identify a relatively short list of interventions whose full implementation becomes an explicit priority for national political and administrative attention. Examples include interventions to control tuberculosis, poliomyelitis, HIV/AIDS, smoking, and specific micronutrient deficiencies. Because political attention and high-level administrative capacity are in relatively fixed and short supply, the benefits from using those resources will be maximized if they are directed toward interventions that are both cost-effective and aimed at problems associated with a high disease burden. National assessments of disease burden are one input into the process of establishing a shortlist of disease control priorities.
Creating Knowledge
Medical schools offer a fixed number of instructional hours, and training programs for other levels and types of health workers are similarly limited. A major instrument for implementing health policy priorities is to allocate this fixed time resource well. This implies allocating time to training for interventions where the disease burden is high and cost-effective interventions exist.
Information on the disease or risk factor burden is also a vital input for informing resource allocation for research and development. In particular, whenever a fixed effort will have a benefit proportional not only to the size of that effort, but also to the size of the problem being addressed, estimates of the disease burden become essential for formulating and implementing research and development priorities. For example, developing a vaccine for a broad range of viral pneumonias would have perhaps hundreds of times the impact of a vaccine against hantavirus infection.
Allocating Resources across Health Interventions
A key task for priority-setting analyses in health is to create the evidence base to stimulate the reallocation of resources to interventions that, at the margin, will generate the greatest reduction in health loss. When there are major fixed costs in mounting an intervention, as is the case with political and managerial attention for national control priorities, burden estimates are required to improve resource allocation. Similarly, major fixed costs may be associated with the universalization (or major expansion) of an intervention and, if so, the cost-effectiveness of the expansion will depend in part on the size of the burden.
