14 research outputs found
Pengawasan Pendistribusian Bahan Bakar Minyak Bersubdi Kepada Nelayan Kecil Oleh Dinas Perikanan Kabupaten Merauke Berdasarkan Undang-Undang Nomor 7 Tahun 2016
No full textThis research aims to find out how subsidized fuel oil is distributed to small fishermen by the Merauke Regency Fisheries Service based on Law Number 7 of 2016 concerning the Protection and Empowerment of Fishermen, Fish Farmers, and Salt Farmers and find out how Merauke District Fisheries Service monitors the distribution of subsidized fuel oil to small fishermen in Merauke district.This research is empirical juridical research. This research was conducted in the Merauke City Area at the Arafura Buti Street Oil Fuel Station and the Merauke Regency Fisheries Service.The research results in this thesis show that the Fisheries Service regulates the distribution of subsidized fuel oil by distributing fuel using a distribution strategy that is right on target by providing recommendations for purchasing subsidized fuel oil to fishermen. At the supervision stage, the government uses two instruments: control through recommendations given to small fishermen and supervision by assigning employees from the department to carry out supervision.Penelitian ini bertujuan untuk untuk mengetahui bagaimana pendistribusian Bahan Bakar Minyak Bersubdi Kepada Nelayan Kecil Oleh Dinas Perikanan Kabupaten Merauke Berdasarkan Undang-Undang Nomor 7 Tahun 2016 Tentang Perlindungan Dan Pemberdayaan Nelayan, Pembudi Daya Ikan Dan Petambak Garam dan mengetahui bagaimana pengawasan Pendistribusian Bahan Bakar Minyak Bersubdi Oleh Dinas Perikanan Kabupaten Merauke kepada nelayan Kecil di kabupaten Merauke.Penelitian ini merupakan Penelitian Yuridis Empiris. Penelitian ini dilaksanakan di Wilayah Kota Merauke yaitu pada Stasiun Bahan Bakar Minyak jalan Arafura Buti, dan Dinas Perikanan Kabupaten Merauke. Hasil penelitian dalam skripsi ini menunjukkan bahwa pengaturan dari pendistribusian bahan bakar minyak bersubdi oleh Dinas Perikanan dalam menyalurkan BBM menggunakan strategi pendistribusian yang tepat sasaran dengan cara pemberian rekomendasi pembelian bahan bakar minyak bersubsidi kepada para nelayan. Pada tahapan pengawasan, pemerintah menggunakan dua instrument yaitu pengendalian lewat rekomendasi yang diberikan kepada nelayan kecil dan pengawasan dengan menugaskan pegawai dari dinas untuk melakukan pengawasan
The invisible artist: Arrangers in popular music (1950-2000): Their contribution and techniques
No full textThis thesis was submitted for the degree of Doctor of Philosophy and was awarded by Brunel University.This thesis is based on the research conducted by the author for the series,
Richard Niles' History of Pop Arranging, seven thirty-minute documentary
programmes for BBC Radio 2, researched, written and presented by the author and
broadcast in 2003. It also draws on interviews conducted by the author (and other
research) between 2002 and 2007 both for the radio series and for this thesis and on
the author's experience as a professional arranger in popular music working with
many of the genre's significant recording artists including Paul McCartney, Ray
Charles, Cher, Tina Turner, Westlife, Tears For Fears, Dusty Springfield, James
Brown, Pet Shop Boys, Kylie Minogue and producers including Trevor Hom, Steve
Lipson, Steve Mac and Steve Anderson.
It will be argued that the role of the arranger in popular music has often been
undervalued and that during a critical period of popular music history (1950-2000)
arrangers played a significant part in the evolution of musical content. This thesis is,
to the best of the author's knowledge, the first time (apart from the above mentioned
documentary) the subject has ever been examined. The arranger is "invisible" because musical arrangers are often un-credited on
record liner notes or in books or articles concerning popular music. A considerable
amount of research has been necessary to determine who wrote many of the
arrangements considered herein. Motown's Berry Gordy purposely kept the names of
musicians and arrangers off the records because he feared others might 'poach' the
trademark 'Motown Sound'. Other record labels considered the job of the arranger to
be reminiscent of an earlier era, diluting the Rock 'n' Roll image of emotion and
spontanaeity they wished to promote. Some producers and recording artists disliked
sharing credit for their work. Motown arranger David Van dePitte told the author that
arranging was "thankless and anonymous - a very service-oriented profession where
others often take credit for what you've done." Arranging has therefore remained an
intrinsically unseen art created by 'invisible' artists. By analyzing many recordings,
revealing the techniques and concepts they have used in their work to create popular
records, arrangers and their art will be made more 'visible'
Fintech founders: inspiring tales from the entrepreneurs that are changing finance/ Agustín Rubini.
No full textIncludes index.In English."Over 70 in-depth interviews of Fintech Founders provide lessons from some of the most successful fintech entrepreneurs that will help you understand the challenges and opportunities of applying technology and collaboration to solve some key problems of the financial services industry. This book is for entrepreneurs, for people working inside of large organizations and everyone in between who is interested to learn the secrets of successful entrepreneurs. In this advice-filled resource, Rubini gathers advice that comes from a diverse range of financial services niches including financing, banking, payments, wealth management, insurance, and cryptocurrencies, to help you harness the insights of thought leaders. Those working inside the financial services industry and those interested in working in or starting up businesses in financial services will learn valuable lessons on how to take an idea forward, how to find the right business founders, how to seek funding, how to learn from initial mistakes, and how to define and reposition your business model. Rubini also inquires into the future of fintech and uncovers provoking and insightful predictions."--Frontmatter -- About the Author -- Foreword -- Contents -- Preface -- Part 1: Financing Fintechs -- Introduction -- Chapter 1. Henrique Dubugras -- Chapter 2. Renaud Laplanche -- Chapter 3. Levi King -- Chapter 4. Sam Graziano -- Chapter 5. Michael Garrity, Paul Sehr, Casper Wong -- Chapter 6. Sergio Furio -- Chapter 7. Alejandro Cosentino -- Chapter 8. Christoph Rieche -- Chapter 9. Conrad Ford -- Chapter 10. Gamal Moukabary -- Chapter 11. Geetansh Bamania -- Chapter 12. Kelvin Teo -- Chapter 13. Harshvardhan Lunia -- Chapter 14. Simon Loong -- Part 2: Banking and Savings Fintechs -- Introduction -- Chapter 15. Anthony Thomson -- Chapter 16. Nick Ogden -- Chapter 17. Norris Koppel -- Chapter 18. Ricky Knox -- Chapter 19. Mutaz Qubbaj -- Chapter 20. Matthias Kröner -- Chapter 21. Tamaz Georgadze -- Chapter 22. Dr. Yassin Hankir -- Chapter 23. Brett King -- Chapter 24. Pierpaolo Barbieri -- Part 3: Payments Fintechs -- Introduction -- Chapter 25. Mike Massaro -- Chapter 26. Patrick Postrehovsky -- Chapter 27. Sami Louali -- Chapter 28. Elizabeth Rossiello -- Chapter 29. Brett Meyers -- Chapter 30. Christo Georgiev -- Chapter 31. Jacob de Geer -- Chapter 32. Arpit Gupta -- Chapter 33. Wong Joo Seng -- Chapter 34. Prajit Nanu -- Part 4: SME-Specific Fintechs -- Introduction -- Chapter 35. Gert Sylvest -- Chapter 36. Gordon Trouncer Downes -- Chapter 37. Sebastián Cadenas -- Chapter 38. Joel Perlman -- Chapter 39. Tim Fouracre -- Chapter 40. Nicolas Reboud, Raphaël Simon -- Chapter 41. Johan Lorenzen -- Chapter 42. Sean Yu -- Part 5: Investment Fintechs -- Introduction -- Chapter 43. Aaron Klein -- Chapter 44. Mazy Dar -- Chapter 45. John Fawcett -- Chapter 46. Facundo Garreton -- Chapter 47. Gonçalo de Vasconcelos -- Chapter 48. Yoni Assia -- Chapter 49. Adam Leonard -- Chapter 50. Barry Freeman -- Chapter 51. Mike Kayamori -- Part 6: Insurance Fintechs -- Introduction -- Chapter 52. Karn Saroya -- Chapter 53. Tim Attia -- Chapter 54. Michael Serbinis -- Chapter 55. Barry McCarthy -- Chapter 56. Dr. Christopher Oster -- Chapter 57. Talal Bayaa -- Chapter 58. Gustaf Agartson -- Part 7: Data and Analytics Fintechs -- Introduction -- Chapter 59. Stephane Dubois -- Chapter 60. Zor Gorelov -- Chapter 61. Gunnar Carlsson and Gurjeet Singh -- Chapter 62. Walter Alini, Daniel Moisset, Javier Mansilla, Juan Chacon -- Chapter 63. Steve Kirsch and Marten Nelson -- Chapter 64 .Matthew Hodgson -- Chapter 65. Jonathan Epstein -- Part 8: Support Fintechs -- Introduction -- Chapter 66. Steve Polsky -- Chapter 67. Stephen Ufford -- Chapter 68. Sebastian Stranieri -- Chapter 69. Niall Twomey -- Chapter 70. Owen Hall and Vikas Tripathi -- Chapter 71. Bill Safran -- Chapter 72. Raz Abramov -- Chapter 73. William Wei -- Join our newsletter -- Index1 online resource (XVIII, 579 pages)
Behind the medical mask : medical technology and medical power
No full textThis thesis explores the role of technology as a resource in the
structure of medical domination of birth and death, stressing
technology's pivotal position at the intersection of control and
uncertainty.
Based in Intensive Care and Obstetrics (between which the health status
of patients diverges sharply), it notes the convergence of technology
used and examines the contest for control within the labour process.
This includes using technology to facilitate a 'standardized' birth or
death; a more retrospectively defensible event. In general, the
'burden of proof' is concluded to lie with those wishing not to
intervene rather than the reverse.
Given the (cognitively male) biomedical model, mind-body dualism is an
assumption embedded in medical technology: this is especially
significant in childbirth, where it fractures the woman's ontological
experience of giving birth. Its positivistic and pathological
emphasis is associated with a reification of processes and a
commodification of their 'solution': which becomes located in
technology. It is argued that commodification in health provision will
increase with the further application of market principles to the NHS.
It is concluded that 'uncertainty', endemic to medicine and a possible
challenge to control, is proactively manipulated and pressed into the
service of medical domination. Technology is used to mask uncertainty
and aid the medical profession's control of patients/relatives, and
subordinate work groups.
A technological fix may be viewed as the opposite to re-discovering
societal dreams and myths, however, more paradoxically, it is concluded
that dreams and myths have become attached to technology. Thus, the
symbolic role of technology is: to provide hope of continued survival
(or cure), the veiling of existential uncertainty and the offer of
'absolution' - should all efforts fail (a freedom from guilt in the
assurance that "everything possible was tried"). Its 'heroic' project
is viewed as an existentially 'masculine' health provision and
'feminized' health care is posited as an alternative
Correction to: Solving patients with rare diseases through programmatic reanalysis of genome-phenome data
No full textIn the original publication of the article, consortium author lists were missing in the articl
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015.
No full textBACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.Funding: We thank the countless individuals who have contributed to the Global Burden of Disease (GBD) Study 2015 in various capacities. We specifically thank Jeffrey Eaton and John Stover. HW and CJLM received funding for this study from the Bill & Melinda Gates Foundation; the National Institute of Mental Health, National Institutes of Health (NIH; R01MH110163); and the National Institute on Aging, NIH (P30AG047845). LJAR acknowledges the support of Qatar National Research Fund (NPRP 04-924-3-251) who provided the main funding for generating the data provided to the GBD-Institute for Health Metrics and Evaluation effort. BPAQ acknowledges institutional support from PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian government. DB is supported by the Bill & Melinda Gates Foundation (grant number OPP1068048). JDN was supported in his contribution to this work by a Fellowship from Fundacao para a Ciencia e a Tecnologia, Portugal (SFRH/BPD/92934/2013). KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). TF received financial support from the Swiss National Science Foundation (SNSF; project number P300P3-154634). AG acknowledges funding from Sistema Nacional de Investigadores de Panama-SNI. PJ is supported by Wellcome Trust-DBT India Alliance Clinical and Public Health Intermediate Fellowship. MK receives research support from the Academy of Finland, the Swedish Research Council, Alzheimerfonden, Alzheimer's Research & Prevention Foundation, Center for Innovative Medicine (CIMED) at Karolinska Institutet South Campus, AXA Research Fund, Wallenberg Clinical Scholars Award from the Knut och Alice Wallenbergs Foundation, and the Sheika Salama Bint Hamdan Al Nahyan Foundation. AK's work was supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R&D&I and funded by the ISCIII (General Branch Evaluation and Promotion of Health Research), and the European Regional Development Fund (ERDF-FEDER). SML is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship (grant number NIHR/CS/010/014). HJL reports grants from the NIHR, EU Innovative Medicines Initiative, Centre for Strategic & International Studies, and WHO. WM is Program analyst, Population and Development, in the Peru Country Office of the United Nations Population Fund, which does not necessarily endorse this study. For UOM, funding from the German National Cohort Consortium (O1ER1511D) is gratefully acknowledged. KR reports grants from NIHR Oxford Biomedical Research Centre, NIHR Career Development Fellowship, and Oxford Martin School during the conduct of the study. GR acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). ISS reports grants from FAPESP (Brazilian public agency). RSS receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogota Colombia. SS receives postdoctoral funding from the Fonds de la recherche en sante du Quebec (FRSQ), including its renewal. RTS was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI14/00894 from ISCIII-FEDER. PY acknowledges support from Strategic Public Policy Research (HKU7003-SPPR-12).</p
Global, regional, and national disability‐adjusted life years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990‐2015 : a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 Study
No full textBackground
Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.
Methods
We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.
Findings
Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs
Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016
No full textBackground Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.Methods We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0.5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Sociodemographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone.Findings Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86.9 years (95% UI 86.7-87.2), and for men in Singapore, at 81.3 years (78.8-83.7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016.Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
No full textBackground Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under‐5 mortality during 1980‐2015 : a systematic analysis for the Global Burden of Disease Study 2015
No full textBackground
Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.
Methods
Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980–2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
Findings
Globally, 5·8 million (95% uncertainty interval [UI] 5·7–6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7–53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3–43·6) to 2·6 million (2·6–2·7) neonatal deaths and 47·0% (35·1–57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6–3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone
