Dinámica de la humedad del suelo y el nivel freático, y su influencia sobre el régimen de caudales en la cuenca Los Gavilanes, Veracruz - México

Resumen: La cuenca Los Gavilanes (Veracruz – México) juega un papel importante en el abastecimiento de agua a ciudades como Xalapa, Coatepec y otros municipios en la región; además provee agua para riego agrícola, uso recreativo y pesca local. La vegetación asociada actualmente es la presencia de relictos de bosque de niebla y cubriendo gran parte de la cuenca, parches de cultivos, pastizales y plantaciones de pino; usos que parecen haber alterado el régimen de caudales y el funcionamiento hidrológico de la cuenca. Con el objetivo de conocer cuáles son las variables que han sido afectadas y que conllevan a que presente dicha alteración de los caudales, se estudió el control que tiene la humedad del suelo y el nivel freático sobre la respuesta hidrológica en tres microcuencas con cobertura de bosque de niebla, bosque de pino y pastizal, en una escala de ladera. El comportamiento de la humedad del suelo evidencia que se mantuvo una conectividad hidráulica en toda la ladera entre la humedad del suelo, el nivel freático y el caudal de las microcuencas. El comportamiento de la humedad del suelo a través de la ladera fue estadísticamente diferente en las tres microcuencas (p0.05) y las mayores diferencias entre coberturas ocurren entre los sitios del pastizal, donde la cantidad promedia de humedad volumétrica fue siempre mayor. El nivel freático presentó una relación de tipo lineal y directa con la humedad del suelo, especialmente cuando ésta estuvo por encima de la capacidad de campo. Asimismo incrementos en el nivel freático presentaron una relación directa con el periodo de tiempo sin precipitación, siendo más rápida y mayor la respuesta mientras más corto fue dicho periodo. De manera similar, la respuesta hidrológica de las microcuencas varía considerablemente en función de la magnitud del evento de lluvia y periodo antecedente y aumenta en la medida en que se presenta un aumento en el nivel freático, especialmente en las partes bajas de las laderas. Los picos de crecidas fueron mayores en la microcuenca bajo pastizales que bajo bosque de niebla, lo que remarca la importancia de la cobertura vegetal en la frecuencia y magnitud de los caudales de tormenta. Finalmente, es importante destacar que variaciones en la humedad del suelo condicionan el comportamiento del nivel freático y éstas a su vez condicionan la aparición de procesos subsuperficiales y de saturación del suelo, contribuyendo de manera muy significativa a la respuesta del caudal.Abstract: Los Gavilanes watershed (Veracruz - Mexico) plays an important role in supplying water to large cities like Xalapa, Coatepec and other municipalities in the Southeast of México; also provides water for irrigation, recreation and local fishing. Most vegetation in this watershed is related the remnants of cloud forest, covering much of the basin, patches of crops, pastures and pine plantations; uses that appear to have altered the flow regime and the hydrological functioning of the watershed. In order to identified and characterize the most outstanding hydrological variables affecting watershed flows, I studied the control variables and parameters related to soil moisture dynamics at different soil depths, and their relation with ground water dynamics and discharge, in three catchments with natural cloud forest, pine forest and pasture, on a slope to catchment scales. Dynamics of soil moisture during the studied period evidence that hydraulic connectivity was maintained throughout the hillside between soil moisture, water table and runoff from the watersheds. This behaviour at the slope scale was statistically different in the three watersheds and the major differences between hedges occur among grassland sites, where the average amount of volumetric soil water content was always higher than in the other two land uses. The water table presented a direct linear relationship with soil moisture type, especially when it was above field capacity, or saturated conditions. In addition, increases in the water table had a direct relation to the antecedent time or a period without rain, being faster and greater the response as shorter was the period. Similarly, the watershed hydrologic response varies considerably depending on the magnitude of the rainfall event and antecedent period, to the extent that an increase occurs in the water table, especially in the lower parts of the slopes. Flood peaks were higher in the watershed under pasture than under cloud forest, which highlights the importance of vegetation cover in the frequency and magnitude of storm flows. Finally, it is important to note that variations in soil moisture controlled the behaviour of the groundwater table and this, in turn, influence the occurrence of subsurface processes and soil saturation, contributing significantly to the stream flow response or runoff.Maestrí

Variáveis associadas ao fenômeno da deserção dos estudantes na Fundação Universitária Konrad Lorenz

Advances in research into university desertion reveal multiple social, economic and academic causes, among others, of this phenomenon. However, the university population is heterogeneous and there are no defined profiles that can describe and accurately explain how each factor behaves. The Spadies system at the Colombian Ministry of National Education aims to analyze desertion rigorously; however, universities have to generate their own study processes. It is within this context that the Konrad Lorenz Foundation University is conducting this research, whose general objective is to identify the socio-demographic, financial and academic variables associated with student desertion at this higher education institution. This is an ex- post- facto retrospective single-group study. Its design is focused on reconstructing the events associated with student desertion at this institution among semester II of 2005, I and II of 2006 and I of 2007-II cohorts, by establishing possible relationships to sociodemographic, financial and academic variables. The population under study consists of a total of 846 undergraduate students from the abovementioned cohorts of the Systems Engineering, Mathematics, International Business Administration and Psychology programs. The results indicate that student desertion at this institution stems from academic reasons, particularly those associated with the cumulative grade average. This points to a predictive power for students who drop out, but not necessarily in relation to other socio-economic and socio- demographic variables. According to this study, the percentage of men who drop out is higher than that of women, even though more women enroll in the professional programs offered.Los avances investigativos sobre deserción reflejan múltiples variables causales de dicho fenómeno, variables sociales, económicas y académicas, entre otras. No existen perfiles definidos para describir y explicar con precisión la forma en que se comportan cada una de estas variables por la heterogeneidad de población. La presente investigación, cuyo objetivo general fue identificar las variables sociodemográficas, financieras y académicas relacionadas con la deserción de los estudiantes en la Fundación Universitaria Konrad Lorenz, es un estudio ex post facto retrospectivo de grupo único, cuyo diseño estuvo orientado a reconstruir los hechos relacionados con la deserción estudiantil de la institución en las cohortes 2005-II, 2006-I, 2006-II y 2007-I, estableciendo posibles relaciones con variables sociodemográficas, financieras y académicas. La población objeto de estudio la constituyeron los estudiantes de pregrado de las cohortes mencionadas de cuatro programas de pregrado, sumando un total de 846 estudiantes. Los resultados indican que la deserción estudiantil en la institución ocurre por razones académicas, específicamente por el promedio acumulado que mostró poder predictivo para los estudiantes que desertan, y no necesariamente por otras variables de tipo socioeconómico y sociodemográfico, siendo los hombres quienes porcentualmente desertan más, aunque son más lasmujereslas que ingresan a los programas profesionales ofertados.  Os avanços investigativos sobre deserção refletem múltiplas variáveis causais desse fenômeno, variáveis sociais, econômicas e acadêmicas, entre outras. Não existem perfis definidos para descrever e explicar com precisão a forma na qual se comportam cada uma dessas variáveis pela heterogeneidade de população. A presente pesquisa, cujo objetivo geral foi identificar as variáveis sociodemográficas, financeiras e acadêmicas relacionadas com a deserção dos estudantes na Konrad Lorenz, é um estudo ex post facto retrospectivo de grupo único, cujo desenho esteve orientado a reconstruir os fatos relacionados com a deserção estudantil da instituição nas coortes 2005-II, 2006-I, 2006-II e 2007-I, estabelecendo possíveis relações com variáveis sociodemográficas, financeiras e acadêmicas. O público-alvo deste estudo foi constituído por estudantes de graduação das coortes mencionadas de quatro programas de graduação, que somou um total de 846 estudantes. Os resultados indicam que a deserção estudantil na instituição ocorre por razões acadêmicas, especificamente pela média acumulada que mostrou poder preditivo para os estudantes que desertam, e não necessariamente por outras variáveis de tipo socioeconômico e sociodemográfico, sendo os homens os que percentualmente desertam mais, embora sejam mais as mulheres as que ingressam nos programas profissionais ofertados

EVALUACIÓN ECONÓMICA DEL COMPONENTE EDUCATIVO DEL PROGRAMA FAMILIAS EN ACCIÓN DEL PLAN COLOMBIA

El presente artículo desarrolla una metodología para evaluar proyectos de educación formal mediante la cuantificación del ingreso promedio de un individuo, de acuerdo a los niveles de escolaridad alcanzados, la experiencia y el género. Esto con el fin de obtener una estimación confiable del retorno promedio de la educación y determinar los beneficios económicos esperados por versiones de este tipo. Los efectos de los subsidios por educación del Programa Familias en Acción en la población beneficiaria, son evaluados y analizados en el presente estudio a través del enfoque de la teoría del capital humano. Esta teoría parte del supuesto de que existe una relación directa entre los niveles de educación de los individuos y sus niveles de productividad, en este sentido, individuos con niveles altos de preparación y por ende con mayor productividad devengarán ingresos más altos. De acuerdo a lo anterior, a través de una función de ingresos minceriana y con base en la información de la Encuesta Nacional de Hogares para el año 2002, se estimo una tasa de retorno promedio de la educación del 12.71% para dicho año.Función de ingresos minceriana

Percepciones de las familias rurales sobre el acceso a los servicios básicos y su relación con en el desarrollo de sus miembros

Difficulties in accessing basic services is a problem that afflicts many countries, especially those that are in developing process, where the most vulnerable population is rural. This situation generates problems that substantially affect proper development of human beings and their fundamental relationships, such as family relationships. The objective of this research was to analyze the perceptions of rural families in the municipality of La Vega, regarding the right and access to basic services and the scope that this access has in the physical, emotional, intellectual and social development of their members. The research paradigm used was the interpretive hermeneutic, with a qualitative approach and a phenomenological research method. The convenience sampling technique was used, and the research instrument was the semi-structured in-depth interview, which was validated by expert peers. Among the main findings are that there is no clear concept of what a citizen's right is and therefore an example is used, in this case housing, public service, education or health, among others. Understanding of civic duty is defined as good behavior in general. The predominant home services are water and electricity; the one most needed in times of pandemic is the internet. In conclusion, rural families in the municipality of La Vega perceive a slight dependency relationship between the physical, emotional, intellectual and social development of their members, with access to basic public services as a fundamental right.La dificultad en el acceso a servicios básicos es una problemática que aqueja a muchos países, especialmente los que se encuentran en vía de desarrollo, donde la población más vulnerable es la rural. Esta situación genera problemas que afectan considerablemente el desarrollo adecuado del ser humano y de sus relaciones fundamentales, como son las familiares. El objetivo de la investigación fue analizar las percepciones de las familias rurales del municipio de la Vega sobre el derecho y el acceso a los servicios básicos y sobre el alcance que este acceso tiene en el desarrollo físico, emocional, intelectual y social de sus miembros. El paradigma de investigación empleado fue el hermenéutico interpretativo, con enfoque cualitativo y método de investigación fenomenológico. Se utilizó la técnica de muestreo por conveniencia y el instrumento de investigación fue la entrevista a profundidad semiestructurada, la cual fue validada por pares expertos. Dentro de los principales hallazgos están que no hay un concepto claro sobre lo que es un derecho ciudadano y por tanto se recurre al uso de un ejemplo, en este caso vivienda, servicio público, educación o salud entre otros. La comprensión del deber ciudadano se define como buen comportamiento en general. Los servicios domiciliarios predominantes son el agua y la luz; el de mayor necesidad en tiempo de pandemia es el internet. En conclusión, las familias rurales del municipio de la Vega perciben una leve relación de dependencia entre el desarrollo físico, emocional, intelectual y social de sus miembros, con el acceso a los servicios públicos básicos como derecho fundamental

Global and national Burden of diseases and injuries among children and adolescents between 1990 and 2013

Importance The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. Objective To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. Evidence Review Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. Findings Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905 059 deaths; 95% UI, 810 304-998 125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115 186 deaths; 95% UI, 105 185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world’s deaths from neonatal encephalopathy. Half of the world’s diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. Conclusions and Relevance Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

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