บทคัดย่อ
The Global burden of disease This report consists of three parts. The first part summarizes the document prepared by Murray CJL & Lopez AD 1996. The second part links their findings with a report from Smutharaks et al. 1997. The third part consists of criticisms and suggestions made by the reviewer. Murray & Lopez analyzed global disease burden by using DALY (Disability-Adjusted Life Year) method. They suggested that the world has already been burdened by non-communivable diseases and injuries more than most people have thought. Psychiatric illnesses and smoking-related diseases contribute a large proportion of burden in 1990 and will be more in 2020. Communicable diseases and other ~old-world~ diseases are declining continuously. Analysis by Smutharaks et al. gave similar conclusions. In 1987 and 1993, Thailand had been already overwhelmed by non-communicable diseases and injuries. Burden in term of living in disability is more than that of premature death. Mental diseases, however, were not mentioned in the report. The results from these two studies should be used with cautions. Underlined assumptions that give rather high weight to working age group and higher importance for current than futer problem (concept of discount rate) bias the conclusion toward importance of diseases of the working age group, and less so on preventable diseases among the children. More equidemiological research to verify the magnitude of ischemic heart disease and mental diseases are necessary as the former might be over-reported whereas the latter might be under-reported. In priority setting, cost-effectiveness of control for each group of diseases has to be taken into account. Smoking and alcohol consumption are confirmed to cause high burden currently and in the future. Control of these behaviors should be enhanced.
