Lifting The Burden. WHO s Global Campaign to Reduce the Burden of Headache Worldwide. TJ Steiner

Transcription

1 Lifting The Burden WHO s Global Campaign to Reduce the Burden of Headache Worldwide TJ Steiner Division of Neuroscience and Mental Health Imperial College London 04/03/09 TJ Steiner 1

2 The argument (as put to World Health Organization) 1. Headache disorders are ubiquitous, prevalent and disabling, and mostly treatable 2. Barriers to care everywhere maintain large gaps between the need for treatment and its provision 3. Heavy burdens persist that could be alleviated WHO s response If you believe that headache should be amongst our priorities, prove to us that it should be 04/03/09 TJ Steiner 2

3 Leading causes of years of life lost to disability (YLDs) WHO s World Health Report /03/09 TJ Steiner 3

4 Lifting The Burden WHO s Global Campaign to Reduce the Burden of Headache Worldwide 04/03/09 TJ Steiner 4

5 Defining the problem Headache care needs assessment for 1,000,000 people Estimated number of adults/children with headache-care needs 120,000/15,000 04/03/09 TJ Steiner 5

6 Defining the problem Headache care needs assessment for 1,000,000 people Estimated number of adults/children with headache-care needs Expected demand (hours of medical consultation time per week) 120,000/15,000 04/03/09 TJ Steiner 6

7 Defining the problem Headache care needs assessment for 1,000,000 people Estimated number of adults/children with headache-care needs Expected demand (hours of medical consultation time per week) 120,000/15, hours (28 full-time equivalents) 04/03/09 TJ Steiner 7

8 Defining the problem Headache management cannot (mostly) be provided by specialists most headache diagnosis and management requires only interest, allocation of time, plus basic knowledge of very common disorders standard clinical skills no special investigations or equipment How to get people with headache to interested, adequately-resourced primary health-care providers? 04/03/09 TJ Steiner 8

9 A global campaign, under the auspices of WHO, in 3 stages 1. Know the scale and scope of the problem: 2. Use knowledge to measure the raise headache awareness: burden worldwide amongst people 3. Exploit with awareness headache, health-care providers and healthcare policy-makers effective local healthcare solutions to produce change: education 04/03/09 TJ Steiner 9

10 A global campaign, under the auspices of WHO, in 3 stages 1. Know the scale and scope of the problem: measure the headache burden worldwide 04/03/09 TJ Steiner 10

11 Stage 1: Knowledge for action Global Burden Working Group collate all existing data into maps 04/03/09 TJ Steiner 11

12 Migraine in adults: 1-year prevalence 11.7 Stewart 14.0 Stewart 11.6 Lipton 10.0 Morillo Patel Miranda Morillo 8.2 Morillo 5.3 Jaillard 14.7 O Brien 13.3 Schwartz 12.2 Lipton 8.5 Kryst Africa Asia 8.5 Australia 11.6 Population or community-based surveys of >500 participants covering ages y, using IHS or modified IHS criteria 7.3 Mean: 11.2 Europe 13.8 (9 studies) Lavados /03/09 N. America TJ Steiner 12.6 (8 studies) Median: Morillo 15.2 Queiroz Lyngberg Rasmussen Launer Steiner Morillo Morillo Wiehe 15.5 S. America Hagen Lampl 4.0 (2 studies) Zivadinov 10.6 (6 studies) 9.6 (10 studies) Dahlof Bank 3.0 Tekle Haimanot 5.0 Dent 10.1 Deleu Roh Sakai Takeshima Wang 9.0 Alders

13 Stage 1: Knowledge for action Global Burden Working Group data much better for Western Europe and North America than for elsewhere much better for migraine than for other headache disorders new studies to fill in the knowledge gaps 04/03/09 TJ Steiner 13

14 Stage 1: Knowledge for action New burden of headache studies: former USSR: Georgia and Moldova completed Russia (validation phase done) India (pilot underway) China (pilot underway) 04/03/09 TJ Steiner 14

15 Stage 1: Knowledge for action New burden of headache studies: South America: Brazil (in planning) Africa: Zambia (in planning) Senegal, Ethiopia (await funding) Pakistan (awaits security issues) Gulf countries? Yemen? 04/03/09 TJ Steiner 15

16 Stage 1: Knowledge for action Work Impact Studies Working Group measure productivity losses attributable to headache USA (population 300 million) lost productivity to migraine cost US$ 13.3 billion in 1998 Japan (population 130 million) cost of migraine: US$ 2 billion pa cost of all headache: US$ 4.2 billion 04/03/09 TJ Steiner 16

17 Stage 1: Knowledge for action Work Impact Studies Working Group measure productivity losses attributable to headache show that these losses are (at least in part) recoverable through the provision of health care for headache 04/03/09 TJ Steiner 17

18 A global campaign, under the auspices of WHO, in 3 stages 1. Know the scale and scope of the problem: 2. Use knowledge to measure the raise headache awareness: burden worldwide amongst people 3. Exploit with awareness headache, health-care providers and healthcare policy-makers effective local healthcare solutions to produce change: education 04/03/09 TJ Steiner 18

19 Preparing for Stage 3: Clinical management supports A set of practical management aids for primary care headache disorders overview diagnostic aids based on ICHD-II disability measure (HALT index) management principles outcome measure for all primary headaches (HURT index) information leaflets for patients diary cards all in 12 languages 04/03/09 TJ Steiner 19

20 Preparing for Stage 3: Translations Working Group for Translations: translation protocols standards for (volunteer) translators build (volunteer) translator panels for 12 Campaign languages 04/03/09 TJ Steiner 20

21 Stage 3: Service organisation and service quality evaluation What does a good headache service look like? How do we know it is good? what features of a headache service contribute to quality? technical success; uptake; clinical outcomes; satisfaction; cost effectiveness; equity which are most important, from whose perspective, and how are they measured? 04/03/09 TJ Steiner 21

22 Stage 3: Intervention Project Georgia: new headache service for defined populations of 10,000 in Tbilisi and 5,000 each in a small town and a rural area neurologist diagnosis and treatment supplied free initially (3-6 months) drugs (including a triptan) to be imported main outcome measure: self-sustainability based on willingness to pay 04/03/09 TJ Steiner 22

23 Paying for change in a world of competing demands and scarce resources through more efficient use of resources through avoidance of wastage and through reduction in consequential financial costs 04/03/09 TJ Steiner 23

24 Further information Our website: the primary source for everyone of all relevant information 04/03/09 TJ Steiner 24