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

BACKGROUND: 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. FUNDING: Bill & Melinda Gates Foundation

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

BACKGROUND: 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.FUNDING: Bill &amp; Melinda Gates Foundation.</p

CALIPSO observations on the dynamics of dust plumes over West Africa during summer.

International audienceNorth and West Africa is the world's largest source of mineral dust [e.g. Prospero et al., 2002]. Dust emissions over this region are highest during summer (e.g. Engelstaedter and Washington 2007) and are very variable in time and space. A recent study by Schepanski et al., [2009], has demonstrated that the dust activity over West Africa during the monsoon season, when the annual peak of dust emissions is observed, remains underestimated by regional models. Hence, accurate studies of dust emissions and transport over West Africa during the summer monsoon season are particularly important for better understanding the role of dust aerosol in the climate system. In this study, dust emissions and transport are investigated using the space borne Could-Aerosol LIdar Orthogonal Polarization (CALIOP) on board the Cloud-Aerosol and Infrared Pathfinder Satellite Observations (CALIPSO) satellite, the Meteosat Second Generation (MSG) Spinning Enhanced Visible and Infra-Red Imager (SEVIRI) images produced from a combination of three infrared channels, namely channel 10 (12µm), channel 9 (10.8 µm) and channel 7 (8.7µm) and are analysed by mean of numerical simulations using the non hydrostatic mesoscale model MesoNH. Satellites observations allowed the following of the spatio-temporal evolution of dust plumes over the continent and the determination of their vertical structure in connection with meteorological conditions specific to the summer wet-season

Dusty Gust Fronts at Synoptic Scale, Initiated and Maintained by Moist Convection over the Sahara Desert

International audienceSo-called ‘dry’ microburst outflows are well known phenomena in desert environments when rain from moist convection aloft evaporates into deep, dry-adiabatic boundary layers. Extreme synoptic scale versions of this convective scale phenomenon have been documented in this study, in which the collective episodes of convective downdraft feed a common cold pool that expands as a gust front density current, raising large amount of dust in the boundary layer, and initiating new moist convection over the Sahara. Satellite observations from the Spinning Enhanced Visible and Infra-Red Imager (SEVIRI) and the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) combined with selected West African surface station observations have been integrated to study the gust front and its associated dust activity in the period of August 3-6, 2006. The meteorological conditions accompanying this event have been described using the European Centre for Medium-range Weather Forecasts (ECMWF) analyses. The gust front was initiated by a cluster of isolated cumulonimbus clouds over central Niger at 1400 UT on August 3 that lengthened to MCS size over Mali by the end of the day. At maximum expansion on August 5, the extending gust front exceeded 1500 km in length, with a transited area of lofted dust reaching a million square kilometers, mostly over southern Algeria and northern Mali. The northward gust front speed, estimated with SEVERI imagery, is rapid in initial stages but declines with time as the cold air absorbs heat from the hot desert surface and the gust front density contrast is diluted. The synoptic character of this event (both the length and the duration) allows for four intersections with CALIPSO orbits, thereby providing information on the evolution of the characteristics of the dusty gust front during its lifetime. Young dusty gust fronts (i.e. during the first 24 hours of the event) were characterized by lidar reflectivity at 532 nm in excess of 3 x 10-3 km-1 sr-1, temperature drops exceeding 10°C, 1 km visibility and their associated dense dust cloud reached 2 km in altitude. Older dusty gust fronts (i.e. from August 5 on) were associated with weaker lidar reflectivities (below 3 x 10-3 km-1 sr-1), same visibility conditions (~1km), temperature drops at the surface of about 5°C and their associated dust clouds reached higher altitudes (3-4 km). The northward transport of moisture over the Sahara desert associated with the northward excursion of the gust front was evident during this event. All gust front crossings were characterized by moisture increases at the surface. A large area (~400 km over longitude and 100 km over latitude) of high Water Vapor Mixing Ratios (up to 16 g kg-1) covered northeastern Mali and southwestern Algeria, confirming an impact at the synoptic scale. The pronounced northward propagation of the dusty gust front and its associated moisture is shown to have been favored by the presence of an active African Easterly Wave

Solar irradiance reduction to counteract radiative forcing from a quadrupling of CO2 : climate responses simulated by four earth system models

International audienceAbstract. In this study we compare the response of four state-of-the-art Earth system models to climate engineering under scenario G1 of two model intercomparison projects: GeoMIP (Geoengineering Model Intercomparison Project) and IMPLICC (EU project "Implications and risks of engineering solar radiation to limit climate change"). In G1, the radiative forcing from an instantaneous quadrupling of the CO2 concentration, starting from the preindustrial level, is balanced by a reduction of the solar constant. Model responses to the two counteracting forcings in G1 are compared to the preindustrial climate in terms of global means and regional patterns and their robustness. While the global mean surface air temperature in G1 remains almost unchanged compared to the control simulation, the meridional temperature gradient is reduced in all models. Another robust response is the global reduction of precipitation with strong effects in particular over North and South America and northern Eurasia. In comparison to the climate response to a quadrupling of CO2 alone, the temperature responses are small in experiment G1. Precipitation responses are, however, in many regions of comparable magnitude but globally of opposite sign

Microlidar observations of biomass burning aerosol over Djougou (Benin) during African Monsoon Multidisciplinary Analysis Special Observation Period 0: Dust and Biomass-Burning Experiment

International audienceMicrolidar observations have been performed at the Djougou-Nangatchori site in northern Benin during the African Monsoon Multidisciplinary Analysis (AMMA) Special Observation Period 0 in the dry season, combined with the Dust and Biomass-Burning Experiment (DABEX) from mid-January to mid-February 2006. During the dry season, the Djougou area is a region where biomass burning aerosols are heavily produced from agriculture fires. The aerosol vertical distribution is also controlled by dynamics, and the penetration of the winter monsoon flux to the north and northern winds bringing mineral dust to the South leads to a frontal discontinuity location close to Djougou latitude. During the early dry season, the aerosol vertical distribution was observed to be structured in two layers, the lower being the boundary layer reaching altitudes up to 2 km and the upper one corresponding to the trade wind layer extending up to 5 km. Lidar data are used to retrieve the time evolution and vertical profile of extinction and discuss transport processes during the period analyzed. As the monsoon flux during the dry season is steadily progressing to the north but also moving back and forth according to shorter timescale forcings, biomass burning particles are transported from the boundary layer into the upper troposphere. This transport has a strong impact on the distribution of aerosol particles on the vertical, and extinction values larger than 0.3 km−1 have been retrieved at altitudes close to 3 km. A particular event of biomass burning air mass outbreak associated with a synoptic forcing is studied, where satellite observations are used to discuss observations of biomass burning particles over Djougou and at the regional scale

Can a reduction of solar irradiance counteract CO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;-induced climate change? – Results from four Earth system models

Abstract. In this study we compare the response of four state-of-the-art Earth system models to climate engineering under scenario G1 of the GeoMIP and IMPLICC model intercomparison projects. In G1, the radiative forcing from an instantaneous quadrupling of the CO2 concentration, starting from the preindustrial level, is balanced by a reduction of the solar constant. Model responses to the two counteracting forcings in G1 are compared to the preindustrial climate in terms of global means and regional patterns and their robustness. While the global mean surface air temperature in G1 remains almost unchanged, the meridional temperature gradient is reduced in all models compared to the control simulation. Another robust response is the global reduction of precipitation with strong effects in particular over North and South America and northern Eurasia. It is shown that this reduction is only partly compensated by a reduction in evaporation so that large continental regions are drier in the engineered climate. In comparison to the climate response to a quadrupling of CO2 alone the temperature responses are small in experiment G1. Precipitation responses are, however, of comparable magnitude but in many regions of opposite sign. </jats:p