Showing papers by "Christopher J L Murray published in 2005"

Rethinking the “Diseases of Affluence” Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development

Abstract: Background Cardiovascular diseases and their nutritional risk factors-including overweight and obesity, elevated blood pressure, and cholesterol-are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. Methods and Findings We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about I$5,000 (international dollars) and peaked at about I$12,500 for females and I$17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about I$8,000 and I$18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI. Conclusions When considered together with evidence on shifts in income-risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol.

From wealth to health: modelling the distribution of income per capita at the sub-national level using night-time light imagery.

Abstract: Sub-national figures providing information about the wealth of the population are useful in defining the spatial distribution of both economic activity and poverty within any given country. Furthermore, since several health indicators such as life expectancy are highly correlated with household welfare, sub-national figures allow for the estimation of the distribution of these health indicators within countries when direct measurement is difficult. We have developed methods that utilize spatially distributed information, including night-time light imagery and population to model the distribution of income per capita, as a proxy for wealth, at the country and sub-national level to support the estimation of the distribution of correlated health indicators. A first set of analysis are performed in order to propose a new global model for the prediction of income per capita at the country level. A second set of analysis is then confirming the possibility to transfer the country level approach to the sub-national level on a country by country basis before underlining the difficulties to create a global or regional models for the extrapolation of sub-national figures when no country data set exists. The methods described provide promising results for the extrapolation of national and sub-national income per capita figures. These results are then discussed in order to evaluate if the proposed methods could not represent an alternative approach for the generation of consistent country specific and/or global poverty maps disaggregated to some sub-national level.

Monitoring global health: time for new solutions Correction to (vol 329, pg 1096, 2004)

Abstract: using similar doses of vector. One set of questions on toxicology related to gene transfer arises because most studies in humans—as with many other trials of hazardous agents—enrol participants with advanced illness. Such participants are likely to misinterpret the purpose of the trial as providing therapy rather than producing generalisable knowledge. Enrolment in studies on the safety of gene transfer is therefore susceptible to being based on “misinformed” consent. Also, participants who perceive a trial as providing therapy may be less willing to comply with intrusive procedures (for example, long term follow up and autopsy) that are aimed at testing safety. By policing consent procedures for language that promotes misconceptions about therapy, investigators may encourage participants to cooperate with a trial’s toxicological aspects. Premarketing studies of drugs often have insufficient power to expose rare adverse events; the collection of toxicity data is further hampered because gene transfer trials generally enrol participants with severe illness. For instance, attributing causes for adverse events is confounded by underlying medical conditions. Moreover, such populations are unlikely to survive and experience theoretically predicted latent adverse events. Therefore, many risks will only be characterised once gene transfer extends to populations with less severe medical conditions; patients and the public (rather than trial participants) will likely bear many of the risks involved in characterising latent toxicity. Owing to the uncertainties and inexperience surrounding risks from gene transfer, systems may need to be established for postmarketing surveillance (for example, registries) and the long term follow up of trial participants. In the United States, such long term follow up is not mandatory, and anecdotal evidence indicates that it is not widely practised. In contrast, the United Kingdom and Australia (www7.health.gov.au/ nhmrc/research/gtrap.htm) track the medical records of recipients of gene transfer. Follow up and postmarketing surveillance are potentially costly, can medicalise people’s lives, and infringe on their privacy. Nevertheless, spontaneous reporting of adverse events is unreliable for detecting latent adverse events, and more active measures may be necessary to protect the public, and patients and their descendants, should gene transfer expand to milder medical conditions. Although recent trials confirm the feasibility of gene therapy, they also highlight that its risks are poorly understood. The task for researchers in gene transfer will be to characterise these risks while attending to the complex ethical challenges of conducting gene transfer studies in humans.