USING GBD TO ASSESS COUNTRIES’ HEALTH PROGRESS
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Benchmarking is particularly useful in EU and EFTA countries to show regional comparisons as seen in Figure 11, where the columns across the top are ordered by YLLs in EU and EFTA countries relative to the regional average in 2010. With respect to DALYs, ischemic heart disease and low back pain were the first- or secondleading causes in Denmark, Finland, Iceland, Norway, and Sweden. The number of years of healthy life lost from low back pain increased in all of these countries while it declined in all of the countries for ischemic heart disease. For injuries – falls, road injury, and self-harm – only DALYs due to falls increased in these countries. The increase ranged from slight, 8% in Denmark; to moderate, between 24% and 31% in Norway, Sweden, and Finland; to significant, 56% in Iceland. Between 1990 and 2010, Denmark experienced some of the biggest declines in health loss from road injury, at 32%, and self-harm, at 51%. However, Denmark posted the smallest decline in lower respiratory infections, the only communicable, maternal, neonatal, or nutritional condition in the top 25 causes of disease burden in the Nordic subregion. Its 7% decrease was well below the range of 44% to 63% in the other four countries. To further illustrate how benchmarking can be implemented at the country level, IHME launched a unique collaboration with public health experts in the UK to explore changes in population health over time and to compare its health performance to other countries with similar and higher levels of health spending. In December 2012, GBD researchers presented their initial findings for disease burden in the UK to a group of policymakers and researchers from government agencies and universities. This presentation sparked an ongoing collaboration between GBD and UK researchers that has revealed new insights into the data. Working with decision-makers at the National Health Service and Public Health England, the UK benchmarking study examined the context in which health progress has occurred, such as the UK’s provision of universal health coverage and its implementation of numerous public health interventions. The results of the study were published in March 2013 in The Lancet. For the UK, GBD estimates of life expectancy and healthy life expectancy, years lost due to premature mortality (YLLs), years lived with disability (YLDs), and healthy life lost (DALYs) provided a detailed and comprehensive picture of changes in health outcomes over time. Comparing GBD estimates across countries elucidated areas of health where the UK performs both better and worse than its peers. In addition, analysis of potentially modifiable risk factors can shed light on ways that public health policy could address major causes of ill health and premature death. The IHME-UK benchmarking study aims to identify key opportunities to speed up the pace of health improvements in the nation. Researchers found that, although overall health in the UK improved significantly between 1990 and 2010, the UK performed worse than the 15 original members of the European Union, Australia, Canada, Norway, and the United States (EU15+) on certain key measures. Looking just at age-specific mortality for nearly every age group, as shown in Figures 12a, 12b, and 12c, the UK’s performance relative to its peer countries was worse in 2010 than in 1990. For example, in female 25- to 29-year-olds, the UK ranked fourth for mortality rates in 1990 and in 2010 ranked 16th. In male 25- to 29-year-olds, the UK ranked third for mortality rates in 1990, and in 2010 ranked 10th.