Methodology to Predict Daily Groundwater Levels by the Implementation of Machine Learning and Crop Models

The continuous decline of groundwater levels caused by variations in climatic conditions and crop water demands is an increased concern for the agricultural community. It is necessary to understand the factors that control these changes in groundwater levels so that we can better address declines and develop improved conservation practices that will lead to a more sustainable use of water. In this study, two machine learning techniques namely support vector regression (SVR) and the nonlinear autoregressive with exogenous inputs (NARX) neural network were implemented to predict daily groundwater levels in a well located in the Mississippi Delta Region (MDR). Results of the NARX model indicate that a Bayesian regularization algorithm with two hidden nodes and 100 time delays was the best architecture to forecast groundwater levels. In another study, the SVR and the NARX model were compared for the prediction of groundwater withdrawal and recharge periods separately. Results from this study showed that input data classified by seasons lead to incremental improvements in the model accuracy, and that the SVR was the most efficient machine learning model with a Mean Squared Error (MSE) of 0.00123 m for the withdrawal season. Analysis of input variables such as previous daily groundwater levels (Gw), precipitation (Pr), and evapotranspiration (ET) showed that the combination of Gw+Pr provides the optimal set for groundwater prediction and that ET degraded the modeling performance, especially during recharge seasons. Finally, the CROPGRO-Soybean crop model was used to simulate the impacts of different volumes of irrigation on the crop height and yield, and to generate the daily irrigation requirements for soybean crops in the MDR. Four irrigation threshold scenarios (20%, 40%, 50% and 60%) were obtained from the CROGRO-Soybean model and used as inputs in the SVR to evaluate the predicted response of daily groundwater levels to different irrigation demands. This study demonstrated that conservative irrigation management, by selecting a low irrigation threshold, can provide good yields comparable to what is produced by a high volume irrigation management practice. Thus, lower irrigation volumes can have a big impact on decreasing the amount of groundwater withdrawals, while still maintaining comparable yields

Methodology to Predict Daily Groundwater Levels by the Implementation of Machine Learning and Crop Models

The continuous decline of groundwater levels caused by variations in climatic conditions and crop water demands is an increased concern for the agricultural community. It is necessary to understand the factors that control these changes in groundwater levels so that we can better address declines and develop improved conservation practices that will lead to a more sustainable use of water. In this study, two machine learning techniques namely support vector regression (SVR) and the nonlinear autoregressive with exogenous inputs (NARX) neural network were implemented to predict daily groundwater levels in a well located in the Mississippi Delta Region (MDR). Results of the NARX model indicate that a Bayesian regularization algorithm with two hidden nodes and 100 time delays was the best architecture to forecast groundwater levels. In another study, the SVR and the NARX model were compared for the prediction of groundwater withdrawal and recharge periods separately. Results from this study showed that input data classified by seasons lead to incremental improvements in the model accuracy, and that the SVR was the most efficient machine learning model with a Mean Squared Error (MSE) of 0.00123 m for the withdrawal season. Analysis of input variables such as previous daily groundwater levels (Gw), precipitation (Pr), and evapotranspiration (ET) showed that the combination of Gw+Pr provides the optimal set for groundwater prediction and that ET degraded the modeling performance, especially during recharge seasons. Finally, the CROPGRO-Soybean crop model was used to simulate the impacts of different volumes of irrigation on the crop height and yield, and to generate the daily irrigation requirements for soybean crops in the MDR. Four irrigation threshold scenarios (20%, 40%, 50% and 60%) were obtained from the CROGRO-Soybean model and used as inputs in the SVR to evaluate the predicted response of daily groundwater levels to different irrigation demands. This study demonstrated that conservative irrigation management, by selecting a low irrigation threshold, can provide good yields comparable to what is produced by a high volume irrigation management practice. Thus, lower irrigation volumes can have a big impact on decreasing the amount of groundwater withdrawals, while still maintaining comparable yields

La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia. Departamento de Caquetá.

Este trabajo de perfil individual y colaborativo está enfocado a la parte investigativa donde por medio de diez unidades se extrae la información para la elaboración del análisis sobre relatos de violencia y esperanza, seleccionándose uno de ellos, de acuerdo a criterios de pertenencia y claridad en el proceso argumentativo del mismo, donde en la parte colaborativa se hace una reflexión de él. Luego se procede a una formulación de preguntas estratégicas, circulares y reflexivas del caso de Carlos Arturo. Referente al caso de Pandurí se plasmó tres estrategias de acompañamiento psicosocial, también se anexa unos puntos de la fase anterior (3) donde se realizó un informe analítico y reflexivo de la experiencia de la foto voz, conclusiones y link del blog. Nuestra investigación se basa según en los hechos que relato el joven Carlos Arturo, evidenciándose actos de violencia o de lesa humanidad, donde los niños y niñas muchas veces son el punto blanco de tanta crueldad, afectando familias enteras que no tienen nada que ver con el conflicto interno de este país colombiano. Comunidades que de una forma u otra han sido desplazadas, trayendo con ella desintegración familiar, daños psicológicos, pérdidas de familiares, y bastantes problemas económicos, muchos de ellos han superado estas situaciones solos sin el apoyo del gobierno, y otros con muy pocas ayudas, y no solo hablo de la parte económica sino psicosocial. Quienes de forma de resiliencia han superado tanto dolor y han logrado salir adelante con su proyecto de vida, desarrollando habilidades para poder sobrevivir, convirtiendo la tragedia quizás en nuevas oportunidades. En conclusión, el diplomado de acompañamiento psicosocial en escenario de violencia es de gran importancia para el aprendizaje de los psicólogos en formación, donde vamos a tener la oportunidad de trabajar de manera interdisciplinar con otros profesionales, para intervenir por medio de la investigación, caracterización, guía y apoyo psicosocial, importante para que las victimas recobren confianza y seguridad en ellos mismos y también en el estado. El resarcimiento emocional es una medida que podemos utilizar para ayudar a quienes soportaron hechos victimizante a tornar a su vida y abandonar el pasado.This work of individual and collaborative profile is focused on the investigative part, in which through ten units it extracts the information for the elaboration of the analysis on stories of violence and hope, selecting one of them, taking into account the criteria of belonging and clarity in the argumentative process of the same one, in this way, the collaborative part makes a reflection of it. Later, we proceed to formulate strategic questions, circular and reflexive on the case of Carlos Arturo's. With reference to the case of Panduri, three strategies of psychosocial accompaniment were outlined, as well as some points from the previous phase (3) where an analytical and reflexive report of the experience of photovoice was made, as well as conclusions and a link to the blog. Our investigation is based on the facts told by the young Carlos Arturo, evidencing acts of violence or of lesa humanity, in which the boys and girls are often the target of so much cruelty, affecting entire families that have nothing to do with the internal conflict of this Colombian country. In addition, communities that in one form or another have been displaced, bringing with it family disintegration, psychological damage, loss of relatives, and quite a few economic problems, many of them have overcome these situations alone, without the support of the government and others with very little help, we are not only talking about the economic but also the psychosocial part. Those who through this process of resilience have overcome so much pain and have managed to move forward with their life project, developing skills to survive, perhaps turning the tragedy into new opportunities. In conclusion, the diploma of psychosocial accompaniment in the scenario of violence is of great importance for the learning of psychologists in training, where we will have the opportunity to work in an interdisciplinary way with other professionals, to intervene through research, characterization, guidance and psychosocial support, important for the victims to regain confidence and security in themselves and also in the state. Emotional healing is a measure that we can use to help those who have endured victimizing events to return to their lives and leave the past behind

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamento del Tolima Ibagué.

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamento del Tolima Ibagué.En la fase final del diplomado, se hizo una profundización y acompañamiento psicosocial en escenarios de violencia, para lo cual se trabajó a través de narrativas en forma de historias de vida (relacionadas con entornos atroces ocasionados por actores del conflicto armado que ha acontecido en nuestro país), con el fin de establecer un escenario de reflexión. Desde la lógica narrativa que integra los relatos, se desarrolló un ejercicio de análisis del contexto, exaltando los esfuerzos personales, familiares, colectivos y comunitarios que en él se movilizaron. Además, se realizó énfasis de las actividades y acciones que generaron impactos psicosociales por parte de los protagonistas en cada una de las historias relatadas dentro de esos escenarios de violencia (entornos ligados al empoderamiento y resiliencia), con el fin de generar proactividad ante esas situaciones adversas que han tenido que enfrentar las víctimas, y así buscar mejorar la calidad de vida de los protagonistas y sus comunidades, ante los flagelos generados por el conflicto armado.In the final phase of the course, a depth and psychosocial accompaniment was made in the scenes of violence, for what can be seen through the narratives in the form of life stories. country), in order to establish a reflection scenario. From the narrative logic that integrates the stories, it has become an exercise in analyzing the context, extolling the personal, family, collective and community efforts that were mobilized. In addition, it is about the activity of the activities and the actions that are produced psychosocial by the protagonists in each of the stories. the victims have had to face, and thus improve the quality of life of the protagonists and their communities, before the errors generated by the armed conflict

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18 : a geospatial modelling study

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km x 5 km resolution in 98 LMICs based on 2.1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205000 (95% uncertainty interval 147000-257000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens