New Health Assessment Method Reveals Remarkable Results for Developing Countries

For the first time, a team of researchers at the Johns Hopkins School of Public Health has discovered that the burden of disease in developing countries, such as Pakistan, can be assessed by using a composite indicator that was developed by the researchers themselves. The results of the study can be found in the August 2000 issue of the American Journal of Public Health.

The team, comprised of Adnan A. Hyder, MD, MPH, PhD and Richard H. Morrow, MD, MPH, FACP, both of the Department of International Health at the Johns Hopkins School of Public Health, developed the HeaLY (healthy life-year) method, first published 3 years ago in the American Journal of Public Health. The HeaLY combines the loss of healthy life from premature mortality and disability into a single number. The current study evaluates the application of the HeaLY method for national health assessment in a developing country, in this case Pakistan.

"We were interested in taking the HeaLY method, a tool we personally developed, and applying it, for the first time, to a country that could really benefit from the results. It helped us evaluate the burden of disease from a wide spectrum of conditions and enabled us to pinpoint conditions that need to be targeted for interventions" said Hyder.

Researchers were interested in evaluating the burden of disease from many of the common conditions in Pakistan by using national data from 1990 to test the HeaLY approach. For the first time in Pakistan, data was taken from 180 sources for population and disease parameters, and the HeaLY approach was used to generate an estimate of the loss of healthy life from premature mortality and disability.

Results showed that the HeaLY approach was able to establish the impact of childhood and infectious diseases that were responsible for a two thirds of the burden of disease in Pakistan. However, condition-specific analysis revealed that chronic diseases and injuries have taken a strong foothold in the country and were among the top ten causes of HeaLY loss. Hypertension was the leading cause of disability losses, injuries were the second, while ischemic heart disease was contributing to both mortality and morbidity. When compared, regional estimates demonstrate a consistency of disease trends in both communicable and chronic diseases.

Researchers conclude that the burden of disease in countries such as Pakistan can be assessed by using composite indicators, such as the HeaLY method. The measurement of non-fatal health outcomes on the same dimension as fatal health outcomes creates a new perspective for health assessments. However, researchers are concerned about the obstacles that could be encountered in trying to retrieve good-quality, population-based data. "We've proven that our method works; but the real challenge is in making sure developing countries keep accurate data from which we can draw our conclusions," says Morrow.