Knowing for whom the bell tolls: acting locally and thinking globally. Brazil, Latin America and the Global Burden of Diseases, 2015

Abstract

"No man is an Iland, intire of it selfe; every man is a peece of the Continent, a part of the maine; if a Clod bee washed away by the Sea, Europe is the lesse, as well as if a Promontorie were, as well as if a Mannor of thy friends or of thine owne were; any mans death diminishes me, because I am involved in Mankinde; And therefore never send to know for whom the bell tolls; It tolls for thee"-John Donne (1572-1623) Devotions upon Emergent Occasions The Global Burden of Diseases, Injuries and Risk Factors (GBD) study is an initiative from the Institute for Health Metrics and Evaluation of the University of Washington, with unrestricted grants from the Melinda and Bill Gates Foundation. The GBD study has been developing two concepts to enable geographical and temporal trend comparisons. These are the number of years of life lost (YLLs) and number of years of life lived with disability (YLDs). Combination of these two indicators reveals the number of disability-adjusted life-years (DALYs). Moreover, the GBD study is publishing data relating to risk factors. A more detailed description of these indexes can be found in the special issue of The Lancet dated October 7, 2016. The data presented below are based on the results of the articles addressing YLL, 1 YLD, 2 DALY 3 and risk factors. 4 The world can be divided geopolitically in several ways, but there is one grouping that is applied by most agencies: the category of Latin American and Caribbean countries. It represents 50 independent countries and a few colonies with 640 million inhabitants. However, two-thirds of this population and three-quarters of the gross product is concentrated in four countries: Brazil, Mexico, Colombia and Argentina. We will discuss the differences in the GBD indexes among these four countries (Table 1). MORTALITY The ranking of the five most important causes of YLLs shows how important the burden of coronary heart disease and stroke is, both worldwide and in these four countries, for both sexes. The coronary heart disease (CHD) values were similar among the four countries, but the risk of death due to stroke was significantly higher in Brazil for men and women than in Argentina, Colombia and Mexico. Two particular causes in Latin American and the Caribbean countries are violence and road traffic, which are ranked within the top five causes of deaths, in contrast to the global data. The road traffic death rate was highest in Brazil (24 per 100,000) followed by Colombia (17), Mexico (17) and Argentina (14). However, the proportion of pedestrian deaths was greater in Colombia (62%) followed by Mexico (44%), Brazil (35%) and Argentina (28%).