Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) 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 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING: Bill & Melinda Gates Foundation

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd

A roadmap to foster reuse practices in the construction sector: A collection of inspiring actions for public authorities

The exponential growth in the development of circular economy strategies across Europe regularly cited reuse as a priority area for action, but relatively few develop in more detail the actions to be taken to promote reuse practices, particularly in the construction sector. This document is developed in the framework of the Interreg NWE - FCRBE project (for Facilitating the Circulation of Reclaimed Building Elements). It aims precisely at proposing concrete and tangible actions to be implemented by public authorities to promote and foster the reclamation and reuse of building materials and elements

Recherche et enseignement en architecture, génie architectural urbanisme: Influences et complémentarités, Chap. Des ponts à concevoir par l'expérimentation: Rénovation énergétique et bilan matière: Cas des BATEX à Bruxelles

Le présent ouvrage propose de rassembler les recherches conduites et émanant de la Faculté d'architecture, d'ingénierie architecturale et d'urbanisme de l'UCLouvain. Faisant suite à la journée de la Recherche et des Doctorants 2015, les diverses contributions abordent des champs de recherche variés et complémentaires au croisement entre sciences sociales, science de l'ingénieur et projet d'architecture: théorie, technique, histoire, ville, bâti et composants techniques ou structuraux participant au projet et alimentant la recherche

How to build a roadmap: the do's and dont's of reuse in the construction sector

In the European Union and around the world, construction materials have a massive impact on climate change, ecosystems collapsing and natural resource overconsumption. As a waste prevention strategy, reuse is a great solution to overproduction and natural resource depletion. The regulations currently in place mainly concern the energy performance of buildings or waste management. They therefore mainly focus on the design, occupation and end-of-life phases of buildings. However, a more global perspective is increasingly required for this sector accompanied by a shift from ‘energy efficiency’ objective to ‘resource efficiency’ objective, as recommended by the European Union. The report aims to set out the essential ingredients for the development of a roadmap and presents a state of the art of circular economy strategies and in particular how reuse applied to the construction sector is represented. This document is developed in the framework of the Interreg NWE - FCRBE project which aims to foster reuse practices in the construction sector

Déchets de construction, matières à conception : analyse des stocks et flux de matières dans le cadre des opérations de rénovation énergétique en Région de Bruxelles-Capitale

La thèse veut répondre à une problématique d’actualité et définie comme ligne d’action par l’Union Européenne à savoir, promouvoir une gestion efficiente de nos ressources par l’économie et la préservation de ces dernières ainsi que par la réduction de la production de déchets et leur valorisation. De plus, au regard du contexte énergétique actuel, la rénovation du parc immobilier ancien et énergivore apparait comme essentielle. Outre le gain énergétique réalisé durant l’occupation du bâtiment, le processus de rénovation signifie également une consommation de matières premières et une génération de déchets importantes dont les impacts ne sont pas suffisamment considérés. À cet effet, nous soutenons que le déchet constitue actuellement un potentiel sous-estimé et sous-exploité de ressources locales pouvant répondre aux enjeux précités. En effet, bien que la question énergétique soit aujourd’hui bien intégrée par les concepteurs, nous observons que la problématique déchets/ressources est peu voire pas du tout prise en compte par les acteurs du secteur. Au regard du contexte énoncé, et s’inspirant de principes théoriques développés par l’Écologie Industrielle, le Cradle to Cradle et le 4Dimensional Design, l’hypothèse formulée par cette recherche est de considérer le bâti comme un gisement de matières susceptibles de représenter des ressources locales à moyen ou long terme. Dans ce cadre, la thèse propose de répondre à diverses questions: • Le déchet, ou matière en fin de vie, peut-il constituer une ressource? • Que sommes-nous en train de mettre en œuvre qui pourrait constituer, à terme, des déchets en puissance ou des ressources potentielles? Et, dès lors, quels impacts la rénovation énergétique du parc immobilier engendrera-t-elle sur les stocks et les flux de matières? Parallèlement, quel impact environnemental aura l’amélioration thermique des parois ? • Enfin, les stocks identifiés sont-ils valorisables et, est-il possible d’identifier leur degré de «valorisabilité» pour tendre vers une valorisation optimale et une gestion intégrée de nos ressources matérielles locales ? Pour y répondre, la recherche propose d’analyser certaines interventions de rénovation énergétique définies comme « durables » par la Région de Bruxelles-Capitale. Dans un premier temps, la thèse étudie les tendances d’intervention de la rénovation durable. Dans un second temps, elle s’attaque à l’identification et la quantification des stocks et flux de matières engendrés par la rénovation, dénommées aussi « bilan matière », dans le but d’identifier l’impact de l’opération sur ces stocks et flux matériels. Enfin, la thèse propose de développer une méthode d’évaluation du potentiel de matières valorisables que constituent les stocks et flux identifiés, appelée aussi « valorisabilité » ou « potentiel matière ». Cette évaluation, d’ordre qualitatif, est considérée de façon complémentaire à l’analyse de l’impact environnemental de la rénovation et ce, dans une démarche prospective et plus globale. La recherche se penche également sur les freins et opportunités rencontrés lorsqu’une meilleure valorisation des déchets est visée. La thèse propose donc d’enrichir notre approche actuelle, principalement tournée vers la performance énergétique, par l’introduction d’une réflexion prospective et d’un nouveau point de vue quant à la matière en fin de vie et sa valeur comme ressource potentielle.(BAUR - Art de bâtir et urbanisme) -- UCL, 201

Reuse in Environmental Impact Assessment Tools : A prospective report

Actors in the construction industry are increasingly required to take into account the environmental impacts of building projects. Since the production stage of the building materials can comprise up to 50% of all the environmental impacts of new and low energy buildings throughout their whole life-cycle, this represents important leverage to minimise the environmental damage of the construction industry. In this regard, reusing building materials and components is a particularly efficient strategy for cutting down these impacts. Indeed, reusing existing elements prevents having to produce new ones and, therefore, avoids all the impacts related to their manufacture. Over the last few years, various organisations have developed different tools aimed at assisting project developers in assessing (and by extension improving) the environmental impact of their building. In this report, we analyse environmental impact assessment (EIA) tools from a triple perspective: set the general context and understand how they work, understand if and how they model the environmental impacts and benefits of reusing building materials, learn from good practices to foster the further adoption of reuse practices by construction professionals. The report is a deliverable of the FCRBE project, an Interreg NWE project aiming at developing reuse practices within the construction industry

Le bâtiment comme gisement de matière : Analyse du bilan métabolique (matières) des opérations de rénovation énergétique en Région de Bruxelles-Capitale

La thèse veut répondre à une problématique d’actualité et définie comme ligne d’action par l’Union Européenne à savoir, promouvoir une gestion efficiente de nos ressources par l’économie et la préservation de ces dernières ainsi que par la réduction de la production de déchets et leur valorisation. De plus, au regard du contexte énergétique actuel, la rénovation du parc immobilier ancien et énergivore apparait comme essentielle. Outre le gain énergétique réalisé durant l’occupation du bâtiment grâce à cette intervention, le processus de rénovation signifie également une consommation de matières premières et une génération de déchets importantes dont les impacts ne sont pas suffisamment considérés dans les processus de conception. S’inspirant de théories véhiculées par l’écologie industrielle, le Cradle to Cradle et le 4Dimensional Design, la recherche propose de considérer le bâtiment comme un gisement de matériaux susceptibles de représenter à moyen ou long terme des ressources matérielles locales à l’échelle régionale. L’étude s’est portée sur certaines interventions de rénovation énergétique définies comme exemplaires par la Région de Bruxelles-Capitale. L’analyse, portant essentiellement sur l’enveloppe, propose dans un premier temps d’aborder les tendances d’intervention de la rénovation durable. Dans un second temps, elle s’attaque à l’identification et la quantification des stocks et flux de matières engendrés par l’opération de rénovation dénommées aussi bilan métabolique ou bilans matières. Ensuite, l’étude se penche sur l’impact environnemental des différentes possibilités d’amélioration de l’enveloppe. L’idée est de pouvoir comparer le bilan environnemental (évaluation quantitative) au potentiel de valorisation des éléments construits appelé aussi valorisabilité (évaluation qualitative) actuellement en cours d’élaboration. Parallèlement, la recherche questionne nos pratiques et interventions architecturales actuelles: que sommes-nous en train de mettre en œuvre qui pourrait constituer, à terme, des déchets en puissance ou des ressources potentielles

Understanding Urban Stocks

If we refer to the concept of Urban Mining (UM), the city can be regarded as an accumulation of resources, arranged and assembled together to form various buildings, roads and networks. In practice, UM studies aim to analyse the dynamic nature of the evolution of cities, including their buildings. But the idea supported by the city as a reservoir of materials implies the fact that the layers and constituent elements of a building that are removed retain and carry a certain value, allowing them to be reused or reintroduced into a new cycle. Reuse practices involve local material resources, which are ‘abundant’ and already manufactured, and whose recovery requires human resources that cannot be relocated. Given the opportunities it represents in terms of circularity, the potential is therefore clearly underestimated and under-exploited. In this sense, UM studies could help identify new opportunities and support ambitious public policies to promote reuse, including the definition of reuse targets and the monitoring of efforts and achievements in this direction (and feed statistical data)