Unsafe Medical Care: Global Burden and Policy Needs
By Roberta Attanasio
Accurate and meaningful information deriving from scientific evidence is essential to drive international health policy and improve global public health. However, in many instances and for a variety of reasons, translating health data into policy results problematic. To overcome these challenges, in the 1990s the Harvard School of Public Health, the World Bank and the World Health Organization (WHO) developed a new concept – the Burden of Disease – to describe death and loss of health due to diseases, injuries and risk factors for all regions of the world.
The Global Burden of Disease model is run by WHO and uses disability-adjusted life years (DALYs) to measure how much suffering is caused by individual diseases. Using a slightly different model, a group of investigators led by Ashish Jha at the Harvard School of Public Health found that adverse events due to medical care represent a major source of morbidity and mortality globally.
Unsafe medical care causes patients to be harmed by the medical care designed to help them. In addition to directly harming the patient, unsafe medical care considerably affects the patient confidence in the healthcare system.
In their study published online in the journal BMJ Quality & Safety (September 18, 2013) and entitled “The global burden of unsafe medical care: analytic modelling of observational studies“, the investigators sought to evaluate the global burden of unsafe medical care. On the basis of results obtained from their model, they estimated that there are 421 million hospitalizations in the world annually, and approximately 42.7 million adverse events. These adverse events result in 23 million DALYs lost per year (one DALY represents the loss of one year of life lived in full health).
Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low-income and middle-income countries. It should be noted that the researchers think that their estimates are conservative – the burden of disease might be higher than reported in their study. Indeed, due to factors related to the study design, unsafe surgery, harm due to counterfeit drugs, unsafe childbirth and unsafe blood use, as well as safety issues with ambulatory care, were not included in their evaluation. They believe that adding these important components would substantially raise their estimates.
The investigators conclude that, although a major cause of suffering in many countries is related to lack of access to health care, an additional major factor that may cause unnecessary suffering is the quality and safety of the care provided, once a person accesses health services. These conclusions should be a call to global health policymakers to systematically collect additional data on the global burden of unsafe medical care and to make patient safety an international priority by improving the safety of the healthcare systems that people access worldwide.