This slide set is about the Global Burden of Disease Study. You can learn more here: https://publichealthmatters.blog.gov.uk/2015/09/15/the-burden-of-disease-and-what-it-means-in-england/

1. Global Burden of Disease
Changes in health in England
Analysis by region and areas of deprivation
1990-2013
Professor John Newton
Chief Knowledge Officer, Public Health England
14 September 2015

2. Contents
• Global Burden of Disease: why it matters
• Headline findings of GBD 2013 for England
• Improvements in life expectancy
• The challenges of morbidity – and multi-morbidity
• Persistent inequalities
• Risk factors – and attributable ill-health
• Concluding remarks and next steps
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3. GBD: Why it matters
• GBD helps us understand and track the scale of the
health challenge: quantifies relative burden
• Integrates data on disparate diseases (eg: cancer,
heart disease, back pain, depression) into a common
framework
• Integrates multiple sources on length of time, severity,
and assessment of impact of burden into this
framework
An important guide for policy, resource allocation,
future planning of health services, public health and
research

4. 4
GBD: What is a DisabilityAdjusted Life Year (DALY)?
It is a measure of the overall
burden of disease – It adds
the years of life lost with the
years lived with disability or
in ill health together

5. GBD: Changes in health in England
• GBD: an ongoing project with programme of papers
around the world (by country, by disease)
• This paper: Changes in health in England, with analysis
by English regions and areas of deprivation, 1990-2013
• A landmark collaboration between IHME, PHE and
leading academics around the country
• What’s new? Results for England. Regional analysis
allows focus on health inequalities
• Refined analysis of risk factors; updated data sources
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6. GBD: Changes in health in England
headline findings
• England performs above average vs other high income
countries on key health outcomes
• Life expectancy from birth +5.4 years 1990-2013 from
75.9 years to 81.3 years: one of the biggest increases
compared with other countries
• Gains greater for men than for women
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7. 7
GBD: Life Expectancy at birth, 1990-2013
ranking of EU15+

8. GBD: Changes in health in England
headline findings
• We’ve seen big improvements in rates of premature
mortality but not in morbidity: we’re living longer but
spending more years in ill-health
• Morbidity and especially multiple morbidity: a major
challenge for our health services
• Our paper finds persistent health inequalities – largely
driven by deprivation; important within regions as well as
between regions
• Finally, we rank risk factors and attributable DALYs (diet
No: 1 with tobacco) and the scope for prevention
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9. GBD: Changes in health in England
Morbidity
• We’ve seen big improvements in premature mortality,
down by 41%. Of note: heart disease, COPD, road
injuries, colorectal cancer, breast cancer
• But virtually no improvement in morbidity (-1.4%): people
are living longer with several illnesses
• Low back and neck pain is now leading cause of DALYs
in England for both sexes combined.
• Depression, hearing and vision loss, falls, migraine in top
15 alongside diseases with high mortality (IHD, stroke,
COPD, lung cancer)
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10. GBD: Changes in health in England
Persistent health inequalities
• Little, if any, improvement in health inequalities overall
• By 2013, people living in most deprived areas: not yet
reached levels of life expectancy that less deprived
groups had in 1990
• In 2013, range in life expectancy between deprivation
areas: 8.2 years for men and 6.9 years for women
• Primary driver of these inequalities is deprivation, not
geography
• For disability, harder to assess inequality
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11. GBD: Changes in health in England
Risk factors
• Major contribution of GBD: estimate contribution of
different causal factors to burden of morbidity and
mortality – complex methodology
• Behavioural, metabolic, environmental risk factors (have
individual and overlapping effects)
• Risk factors jointly explain 40% of DALYs. But higher for
CVD (84%) and chronic respiratory disease (62%)
• An opportunity for preventive public health
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12. GBD: Changes in health in England
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13. Concluding thoughts – next steps
For GBD
• Enhanced data sources (eg: on distribution of causes of
morbidity) – routine data and surveys
• Break-down of data at local level – regions to districts
• GBD data to model future projections and resource
planning
• Incorporate analysis of socio-economic determinants
• We’d encourage users to explore the wealth of data in
GBD on the web site and the interactive tool
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14. Thank you
Professor John Newton
Chief Knowledge Officer