Mathers Colin D
Consultant on Global Health, Geneva, Switzerland.
College of Medicine & Veterinary Medicine, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX UK.
Arch Public Health. 2020 Aug 24;78:77. doi: 10.1186/s13690-020-00458-3. eCollection 2020.
The World Health Organization collaborated in the first Global Burden of Disease Study (GBD), published in the 1993 World Development Report. This paper summarizes the substantial methodological improvements and expanding scope of GBD work carried out by WHO over the next 25 years.
This review is based on a review of WHO and UN interagency work relating to Global Burden of Disease over the last 20 years, supplemented by a literature review of published papers and commentaries on global burden of disease activities and the production of global health statistics.
WHO development of global burden of disease work in the Millenium Development Goal era resulted in regular publication of time series estimates of deaths by cause, age and sex at country level, consistent with UN population and life table estimates, and with cause-specific statistics produced across UN agencies and interagency collaborations. This positioned WHO as the lead agency to monitor many of the 43 health-related indicators for the UN Sustainable Development Goals.In 2007, the Institute of Health Metrics and Evaluation (IHME) was established to conduct new global burden of disease and related work, funded by the Bill and Melinda Gates Foundation (BMGF). WHO was a core collaborator in its first GBD2010 study, but withdrew prior to publication as it was unable to obtain full access input data and methods. The publication of global health statistics by IHME resulted in user confusion and in debate over differences and the reasons for them. The new WHO administration of Director General Dr. Tedros Ghebreyesus has sought to make greater use of IHME outputs for its global health statistics and SDG monitoring.
WHO work on global burden of disease has positioned it to be the lead agency for monitoring many of the UN Sustainable Development Goals. Current moves to use IHME analyses raises a number of issues for WHO and for Member States in relation to WHO's constitutional mandate, its accountability to Member States, the consistency of WHO and UN demographic and health statistics, and the ability of Member States to engage with the results of the complex and computer-intensive modelling procedures used by IHME. As new global health actors and funders have arisen in recent decades, and funding to carry out WHO's expanding mandate has declined, it is unclear whether WHO has the ability or desire to continue as the lead agency for global health statistics.
世界卫生组织参与了首次全球疾病负担研究（GBD），该研究发表于1993年的《世界发展报告》。本文总结了世卫组织在接下来25年里开展的全球疾病负担工作在方法上的重大改进以及范围的不断扩大。
本综述基于对世卫组织和联合国机构间过去20年与全球疾病负担相关工作的回顾，并辅以对已发表论文以及关于全球疾病负担活动和全球卫生统计数据编制的评论的文献综述。
世卫组织在千年发展目标时代开展的全球疾病负担工作使得能够定期公布各国按病因、年龄和性别划分的死亡时间序列估计数，这与联合国的人口和生命表估计数一致，也与联合国各机构及机构间合作产生的特定病因统计数据一致。这使世卫组织成为监测联合国可持续发展目标43项与卫生相关指标中多项指标的牵头机构。2007年，健康指标与评估研究所（IHME）成立，以开展新的全球疾病负担及相关工作，由比尔及梅琳达·盖茨基金会（BMGF）资助。世卫组织是其首次全球疾病负担2010研究的核心合作伙伴，但在研究发表前退出，因为无法获取全部投入数据和方法。IHME发布的全球卫生统计数据导致用户困惑，并引发了关于差异及其原因的争论。世卫组织新任总干事特德罗斯·盖布雷耶苏斯博士领导的管理层试图更多地利用IHME的产出用于其全球卫生统计和可持续发展目标监测。
世卫组织在全球疾病负担方面的工作使其成为监测多项联合国可持续发展目标的牵头机构。目前利用IHME分析的举措给世卫组织和会员国带来了一些问题，涉及世卫组织的章程授权、对会员国的问责、世卫组织与联合国人口和卫生统计数据的一致性，以及会员国参与IHME所采用的复杂且耗费计算机资源的建模程序结果的能力。近几十年来出现了新的全球卫生行为体和资助者，但用于执行世卫组织不断扩大的任务的资金却减少了，目前尚不清楚世卫组织是否有能力或意愿继续担任全球卫生统计的牵头机构。
