1. Metrics for Health, Development and the Environment Christopher JL Murray Institute Director

2. 2 Outline Context from the GBD 2010 Desirable Attributes of Metrics Some Ideas

3. 3 Global Burden of Disease 2010 1) Continuation of work initiated by the World Bank, World Health Organization and Harvard University in 1991. 2) 2010 Revision systematically assesses all the available evidence on mortality, morbidity and disability from 291 diseases and injuries, 1,160 sequelae of the diseases and injuries and 67 risk factors. 3) Results for 187 countries, three years 1990, 2005 and 2010. 4) Summary results will be published in the Lancet December 14 th in a dedicated triple issue.

4. 4 Three Shifts in Global DALYs 1990 to 2010 1) Demographic transition – growth and aging. 2) Cause of death transition – progressive increase in share of deaths from NCDs 3) Disability transition

5. Percent DALYs by age and sex, 1990 and 2010 5

6. Share of DALYS Due to YLLs and YLDs by Region, 1990 and 2010 6 19902010

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8. MDG 4, 5, and 6 DALYs as Percent of Total DALYs by Region, 1990 to 2010 8

9. Percent of DALYs, 2010, Both Sexes 9

10. Estimated PM 2.5 2005 from Ambient Sources 10 PM 2.5 (µg per m 3 )

11. Percent of DALYs, 2010, Both Sexes, cont. 11

12. 12 Outline Context from the GBD 2010 Desirable Attributes of Metrics Some Ideas

13. 13 Five Key Aspects of Indicators for Post 2015 1) Focus on topics with big impacts – on health, development or the environment. 2) Choose indicators that measure the real quantity of interest not a distant proxy. 3) Indicators should be readily interpretable – monotonicity is desirable. 4) A practical measurement strategy should be developed before proposing any new indicator. This can several years to implement but there should be a route to good measurement. 5) Indicator should be relevant to a broad set of countries.

14. 14 Outline Context from the GBD 2010 Desirable Attributes of Metrics Some Ideas

15. 15 Particulate Exposure 1) Household air pollution and ambient air pollution increase PM2.5 exposure. PM2.5 accounts for approximately 6-7% of the burden of disease. 2) Strategies to reduce PM2.5 have environmental benefits as well. Policy strategies to reduce indoor and outdoor PM2.5 could be designed to reduce carbon emissions as well. 3) Some measurement challenges but these are probably surmountable – need to shift from proxy measures like cooking with biomass.

16. 16 Clean and Safe Transport 1) Road traffic injuries, ambient air pollution from vehicles, and lead from vehicles account for substantial burden of disease in all regions of the world. 2) An indicator of the fraction of miles travelled using clean and safe transport could capture both all these dimensions that relate to health and the environment. 3) Maybe ways to incorporate physical activity metrics into a clean and safe transport indicator.

17. 17 Burden Due to Poor Diet 1) All components of diet combined account for more than 10% of disease burden. 2) Promoting healthy diets focused on fruit, nuts/seeds, whole grains, fiber, vegetables can be linked to agricultural policies that have environmental impacts. 3) Lost years of healthy life from poor diet is now available at the country level and can be tracked overtime.

18. 18 Healthy Life Expectancy 1) A good summary measure of a communities overall health is healthy life expectancy (HALE). 2) HALE reflects the contribution of all sectors to health not just public health and medical care: economic, education, environment are key drivers. 3) HALE is available by country and now overtime. 4) Some resistance in the health sector to such a measure because other sectors have so much impact on HALE.

19. Health adjusted life expectancy: Males 2010 19