Confusing cause and effect in public health policy.

Abstract

When studying the literature on current public health policy challenges, a number of rankings can be found, created from data collected and processed by different methods and from different sources, ordering the challenges by their significance. Inevitably, in global studies, there are errors caused by averaging data across populations that differ significantly in population size and the causes of the decline in disability-adjusted life years (DALYs), potentially in combination with years of life lost (YLL) and years of life lived with disability (YLD), that may serve as indicators of the health status of a given population (Lopez 2005). Averaging data from populations that differ significantly in size, the larger population dominates and the main causes of health problems may be the same in both populations, and malnutrition and infectious diseases should be targeted, although in the smaller population cardiovascular disease is the main risk. A study published in 2018 shows that there are significant differences between countries and regions in the causes of the decline in DALYs and the increase in YLL and YLD (Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017 2018). Some similarities in the order of factors influencing the above indicators can be found in populations with comparable economic performance. In the so-called developed countries, demographic development, in other words, low birth rates resulting in aging of the population, and a significant increase in psychological disorders, are considered to be the core problem (Walker et al. 2015). Caution is needed in assessing the latter issue; bias may arise because mental health is given more attention in developed countries than in areas where even basic needs such as sufficient food and drinking water are not fully met, or where stressors such as military conflict or terrorism are present. On the other hand, lifestyles, associated with an abundance or surplus of resources and, thanks to generous social systems, the risk of dissolving the line between work and reward and the consequent absence of meaningful activity can pose a risk to the development of mental disorders (Dogra et al. 2022; Kim et al. 2013). Even with a cautious approach to global data, time is another factor that increases the opacity of the public health landscape. Over the last 30 years, there has been a significant rearrangement in the ranking of the most important factors influencing DALYs, YLL, and YLD. The top spot occupied in 1990 by lower respiratory tract infections has been taken by coronary heart disease in 2020, diarrheal diseases by unipolar depression and perinatal conditions, perhaps somewhat surprisingly, by traffic accidents (Anish and Sreelakshmi 2013).