MUCH of the money spent on research into infectious diseases should be
used instead to look at mental illness and accident prevention, according to a
major report to be released by the WHO next week. It claims that research into
less publicised causes of death and disability might bring greater improvements
in public health.
The aim of the report, written by an independent committee of experts, is to
ensure that research is carried out in areas where it will have most impact.
Much of the WHO鈥檚 high profile work has focused on battling against infectious
diseases, which kill most people worldwide. But the report predicts that by 2020
mental illness will be the most debilitating affliction in the developing world,
with death and disability resulting from road traffic accidents in second place
(see 鈥淭rafficking in death鈥�, p 34). It also warns of an epidemic of
noncommunicable disease, such as tobacco related illnesses, especially in the
developing world.
The committee was set up to look at 鈥渂est buys鈥� for those who fund research,
after a 1993 World Bank report suggested that relatively small investments could
bring major improvements in public health. Dean Jamison, professor of public
health at the University of California at Los Angeles and chairman of the
committee, hopes the report might persuade agencies to fund research in areas
that have been neglected. 鈥淭hese figures are a wake-up call,鈥� he says. 鈥淚f we
see serious changes of allocation of funds then we鈥檒l know that our analysis has
made a difference.鈥�
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Claude Romer, head of safety promotion and injury control at the WHO, says
that too much attention has been focused on emerging diseases, while major
causes of illness and death have been missed out. 鈥淭his report is really a
breakthrough in terms of reshaping the priority order of health issues,鈥� he
says.
Some researchers will not be so happy. For example, those looking into less
common but high profile diseases such as Ebola could lose funding. The committee
is also highly critical of the amount spent on what is sees as less urgent
research. This includes attempts to improve on something that already
exists鈥攍ooking for a better polio vaccine, for instance, at the expense of
more pressing research into a vaccine for, say, pneumonia, which is one of the
world鈥檚 biggest killers. It also argues that the case for developing some
vaccines is weak if, as in the case of leprosy, an effective multi-drug
treatment already exists.
There is also likely to be controversy over the committee鈥檚 decision to break
with the traditional method of estimating the toll from a particular disease.
Instead of relying on mortality figures, the committee has used a measure called
the DALY, the disability-adjusted life year. This is a measure not just of
deaths but also of loss of health, so it takes greater account of diseases that
disable rather than kill.
鈥淚f you don鈥檛 use a disability weighting you get into silliness because you
pay no attention to, say, psychiatric illness or half the burden of road traffic
accidents,鈥� says Jamison. 鈥淛ust using deaths by cause doesn鈥檛 take notice of
this.鈥� The new system has catapulted mental illness up the league table; the
figure for mental health was previously based only on the number of deaths by
suicide.
The calculations with the DALY system are likely to cause some embarrassment
at the WHO. The report鈥檚 findings indicate, for instance, that for years
researchers have bumped up the mortality rates for their area of interest and
this has led to some huge overestimates of the death toll of certain diseases.
For example, in March the WHO reported that the annual toll from TB was 3
million. The Harvard team that has calculated the DALY figures for the report
has come up with a figure of just over 2 million. 鈥淲e were just trying to get
people to die once,鈥� explains Chris Murray, the health economist who headed the
Harvard team.
The WHO鈥檚 TB programme is trying to come up with a better estimate of how
many people contract the disease and how many die from it. Last weekend saw the
first in a series of meetings to agree a formula for estimating the incidence of
TB. Richard Bumgarner, deputy director of the TB programme, says he is happy
with the Harvard calculations because TB still ranks as a major killer. 鈥淲hat we
need to be doing is concentrating on the top burdens of disease, and stop
fiddling around with those 99th and 100th in the rankings,鈥� he says.
