Rethinking the social acceptance of solar energy : Exploring "states of willingness" in Finland

Although most studies present willingness to adopt as a pre-adoption facet, very few studies can be found that include pre- and post-adoption willingness factors/conditions in adopting solar energy. This study was carried out to explore public willingness to adopt solar energy in residential areas through the lens of different states (stages) of willingness to adopt, and consequent patterns of social acceptance. This qualitative study found the existence of four states of willingness to adopt solar energy among laypersons and expert Finnish respondents, forming quadrants in the interplay between decision and actions. This gave rise to five segments of customers, most representing the ‘acceptance in principle’ pattern of social acceptance. The results of this study emphasize the necessity for an effective and meaningful approach to those states of willingness to adopt in the growth and diffusion of renewable energy technologies such as solar energy.Peer reviewe

Social acceptance of solar energy as intention, willingness, and readiness

As the world transitions from fossil-based energy to more environmentally friendly, sustainable, and decentralised energy sources, cries of ‘non-acceptance’ give way to ‘acceptance and adoption’ as part of the process of social acceptance. This multidimensional concept is interpreted differently across various disciplines. Still, its core and general conceptualisation remain vague, and no Finnish studies have thoroughly addressed social acceptance in solar energy adoption behaviour among Finnish households. This dissertation addresses how the social acceptance of renewable energies such as solar energy can be conceptualised comprehensively as an aggregate of various acceptance and non-acceptance responses or reactions that pass-through intention, willingness, and the readiness of Finns. Based on semi-structured interviews with 17 Finnish energy experts (especially the fields in solar and other renewable energies) and 25 Finnish laypersons (living in the Eko-Viikki residential area in Helsinki, where there are ten solar-integrated buildings, among other dwellings), this dissertation includes three articles on the intention-behaviour gap, willingness to adopt (WTA), and readiness to adopt solar energy in response to respondents’ personal experiences (primarily those of laypersons) and their perceptions about others. Finally, based on those empirical results, this dissertation presents a conceptual framework. It establishes the key themes – intention (including intention-behaviour gap), willingness, and readiness to adopt – as pre-behavioural mental states that create preferences among actors to express certain behavioural responses. It explains such responses as patterns of social acceptance and clarifies the conceptual and empirical status in terms of adoption, acceptance in principle, rejection, and opposition. My empirical results, as explained in Article I and summarised in Section 4.2 of this dissertation, focus on understanding and explaining the intention-behaviour gap to adopt solar energy as an output of personal and contextual factors, the justification behind the intention-behaviour gap, and the suppressed structure of social acceptance based on three forms of the intention-behaviour gap: (a) ‘impression in principle’ intention-related, (b) ‘‘Impression in practical [practice]’ intention-related, and (c) ‘actual intention’-related. The ‘totality’ of intention can be understood through the third form of the intention-behaviour gap. Without viewing this gap merely as a deviation between intention and behaviour, the empirical investigation suggests using the ‘actual intention’ to understand the intention-behaviour gap. Article II (see also Section 4.3 of this dissertation) discloses the presence of activated, unconditional, conditional and unwillingness as states of WTA. Actors fall into five categories of ‘customer segments’ based on WTA states. The first category, ‘activated WTA adopters’, represents the adoption pattern of social acceptance. The second (‘unconditional WTA would-be adopters’), third (‘conditional WTA would-be adopters’), and fourth (‘conditional WTA non-adopters’) categories represent acceptance in principle in the pattern of social acceptance. The fifth category, ‘non-WTA non-adopters’, represents rejection and opposition patterns of social acceptance. Currently, customer acquisition often tends to approach only the unconditional WTA without regard for filling the pipeline by moving people into the next adopter group. By identifying different customer segments and showing how they represent various patterns of social acceptance under multiple pre- and post-adoption conditions, the empirical results emphasised this matter in a Finnish context. The way prepared actors in a given society adopt new technologies can determine the level of change to occur in their everyday life. Article III assesses public readiness to adopt solar energy in a Finnish context (see also Section 4.4 of this dissertation). The empirical results present public readiness to adopt solar energy in terms of existing routes of adoption and customer preferences, those who choose different routes, the links between readiness and patterns of social acceptance, and how respondents envision the future of solar energy in Finland (see Article II and Section 4.3 of this dissertation). Article III emphasises that it is crucial to consider different routes of adoption (including business models, facilities, and support structures) and the preferences of different customer segments to address solar energy acceptance behaviour of multiple actors. This dissertation joins the empirical results discussed in articles (summarised in Section 4.2, 4.3, and 4.4) that demonstrate that the intention-behaviour gap, WTA, and readiness to adopt form the conceptual framework of social acceptance of solar energy. This framework could be practically assessed to obtain a comprehensive understanding and findings with regard to filling the pipeline by moving actors into the next adopter group without focusing solely on unconditional would-be adopters. By compiling the empirical results, this dissertation concludes by discussing key factors in terms of personal and contextual situations the respondents mentioned so that adequate attention can be given while addressing the diffusion of solar energy among individual households in Finland. It also explains some lessons in Finnish contexts in terms of community networks, giving adequate and unruffled information, sharing feedback, mobilising community members, etc., which are expected to influence the adoption of solar energy in the country. The study then discusses how social acceptance should be approached, along with directions for future research. Although this dissertation presents the conceptual framework of social acceptance considering intention, willingness, and readiness to adopt solar energy-related data, it is open to addressing other technology acceptance issues for which individual adoption is a vital concern.Maailman siirtyessä fossiilipohjaisesta energiasta ympäristöystävällisempään, kestävämpään ja hajautetumpaan energiantuotantoon kieltäytyjien protestit vaimenevat hyväksynnän ja käyttöönoton laajetessa. Tämä on osa sosiaalisen hyväksynnän prosessia. Tämä monitahoinen käsite tulkitaan eri tavoin eri aloilla. Silti sen ydin ja yleinen käsitteellistäminen ovat edelleen epäselviä, eikä Suomessa ole tehty perusteellista tutkimusta aurinkovoiman sosiaalisesta hyväksymisestä ja siitä seuraavasta toiminnasta suomalaisissa kotitalouksissa. Tämä väitöskirja käsittelee sitä, miten uusiutuvien energianlähteiden kuten aurinkovoiman sosiaalinen hyväksyminen voidaan käsitteellistää kattavasti niin, että yhteen kerätään erilaiset hyväksynnästä ja kieltäytymisestä seuraavat reaktiot ja toiminta, jotka ilmenevät osana suomalaisten aikomuksia, halukkuutta ja valmiutta. Tätä väitöskirjaa varten toteutettiin osittain jäsennelty haastattelu 17 suomalaisen energia-alan asiantuntijan kanssa (asiantuntijat olivat erikoistuneet aurinkoenergiaan ja muuhun uusiutuvaan energiaan) sekä 25 suomalaisen maallikon kanssa (nämä asuivat Helsingissä Eko-Viikin alueella, missä on mm. kymmenen aurinkopaneelein varustettua asuinrakennusta). Haastatteluiden pohjalta väitöskirjaan kirjoitettiin kolme artikkelia, jotka käsittelevät aikomuksen ja toiminnan välistä kuilua, käyttöönottohalukkuutta (WTA, willingness to adopt) sekä valmiutta ottaa käyttöön aurinkoenergiaa. Ilmiöiden tarkastelussa näkökulmana olivat vastaajien (enimmäkseen maallikoiden) henkilökohtaiset kokemukset sekä heidän käsityksensä muista. Näiden empiiristen tulosten pohjalta väitöskirjassa esitellään lopuksi käsitteellinen viitekehys. Se hahmottaa avainteemat (aikomus sekä aikomuksen ja toiminnan välinen kuilu, halukkuus sekä käyttöönottovalmius) toimintaa edeltäviksi mielentiloiksi, jotka saavat kuluttajat toimimaan eri tavoin. Se selittää, kuinka toimintareaktiot havainnollistavat sosiaalisen hyväksynnän kaavaa, ja selventää käyttöönoton, periaatteellisen hyväksynnän, hylkäämisen sekä vastustamisen käsitteellistä ja empiiristä tilaa. Empiiriset tulokseni on selitetty artikkelissa I ja tiivistetty tämän väitöskirjan luvussa 4.1, ja ne keskittyvät ymmärtämään ja selittämään aurinkoenergian käyttöönottoon liittyvää aikomuksen ja toiminnan välistä kuilua henkilökohtaisten ja kontekstuaalisten tekijöiden ilmentymänä, aikomuksen ja toiminnan välisen kuilun oikeutusta sekä sosiaalisen hyväksynnän tukahdutettua rakennetta aikomuksen ja toiminnan välisen kuilun kolmen ilmentymän kautta: (a) ”periaatteellinen käsitys” ja aikomus, (b) ”käytännön käsitys” ja aikomus sekä (c) ”todellinen aikomus”. Aikomuksen ”kokonaisuus” voidaan ymmärtää aikomuksen ja toiminnan välisen kuilun kolmannen muodon kautta. Sen sijaan, että kuilu nähtäisiin pelkästään poikkeamana aikomuksen ja toiminnan välillä, empiirinen tutkimus viittaa siihen, että ”todellista aikomusta” tulisi käyttää aikomuksen ja toiminnan välisen kuilun ymmärtämiseen. Artikkeli II (ks. myös tämän väitöskirjan luku 4.2) paljastaa aktivaation, ehdottomuuden, ehdollisuuden ja haluttomuuden ilmentymät käyttöönottohalukkuuden muodoiksi. Kuluttajat jaotellaan viiteen ”asiakassegmenttiryhmään” käyttöönottohalukkuuden mukaan. Ensimmäinen kategoria, ”aktivoituneet käyttöönottajat”, edustaa sosiaalisen hyväksynnän käyttöönottokaavaa. Toinen (ehdottomat käyttöönottohalukkaat), kolmas (ehdolliset käyttöönottohalukkaat) ja neljäs (ehdolliset käyttöönottohaluttomat) kategoria edustavat periaatteellista hyväksyntää sosiaalisen hyväksynnän kaavassa. Viides kategoria, ”käyttöönottohaluttomat”, edustaa kieltäytymistä ja vastustamista sosiaalisen hyväksynnän kaavassa. Tällä hetkellä asiakashankinnassa keskitytään usein ehdottomiin käyttöönottohalukkaisiin ja sivuutetaan kuluttajien siirtäminen seuraavaan käyttöönottoryhmään. Tunnistamalla erilaisia asiakassegmenttejä ja osoittamalla, miten ne edustavat sosiaalisen hyväksynnän erilaisia kaavoja monine käyttöönottoa edeltävine ja seuraavine ehtoineen, empiiriset tulokset toivat esiin tätä asiaa suomalaisessa kontekstissa. Tapa, jolla valmiit kuluttajat ottavat uutta teknologiaa käyttöön tietyssä yhteiskunnassa, määrittää muutoksen määrää heidän arkielämässään. Artikkeli III arvioi yleistä aurinkoenergian käyttöönottovalmiutta suomalaisessa kontekstissa (ks. myös tämän väitöskirjan luku 4.3). Empiiriset tulokset kuvaavat yleistä valmiutta ottaa käyttöön aurinkoenergiaa olemassa olevien käyttöönottotapojen ja asiakkaiden toiveiden näkökulmasta, niitä, jotka valitsevat erilaisen käyttöönottotavan, yhteyttä valmiuden ja sosiaalisen hyväksynnän kaavojen välillä sekä vastaajien käsityksiä aurinkovoiman tulevaisuudesta Suomessa (ks. artikkeli II sekä tämän väitöskirjan luku 4.3). Artikkeli III tuo esiin, että on äärimmäisen tärkeää ottaa huomioon erilaisia käyttöönottotapoja (ml. liiketoimintamallit, mahdollisuudet ja tukirakenteet) sekä eri asiakassegmenttien toiveet, jotta eri kuluttajien hyväksyvää toimintaa aurinkoenergiaa kohtaan voidaan tarkastella. Tämä väitöskirja tarjoaa lisää empiirisiä tuloksia artikkeleissa (sisältö tiivistettynä luvuissa 4.1–4.3) käytyyn keskusteluun, josta käy ilmi, että aikomuksen ja toiminnan välinen kuilu sekä käyttöönottohalukkuus ja -valmius muodostavat aurinkoenergian sosiaalisen hyväksyttävyyden käsitteellisen viitekehyksen. Tämä viitekehys voidaan arvioida käytännössä, jotta saadaan kattava käsitys ja tuloksia siitä, miten kuluttajia siirretään yhdestä käyttöönottoryhmästä seuraavaan niin, että prosessissa ei keskitytä ainoastaan ehdottomiin käyttöönottohalukkaisiin. Keräämällä yhteen empiiriset tulokset tämä väitöskirja käsittelee lopuksi avaintekijöitä, eli vastaajien mainitsemia henkilökohtaisia ja kontekstuaalisia tilanteita. Näin voidaan keskittyä oikeisiin asioihin käsiteltäessä aurinkoenergian leviämistä suomalaisiin kotitalouksiin. Väitöskirja selittää myös suomalaista kontekstia muun muassa viestintäverkkojen, riittävän ja kiihkottoman tiedon jakamisen, palautteen antamisen ja yhteisön jäsenten aktivoinnin näkökulmasta, sillä niiden oletetaan vaikuttavan aurinkoenergian käyttöönottoon maassa. Tämän jälkeen tutkimus käsittelee sitä, miten sosiaalista hyväksyntää tulisi lähestyä, ja tarjoaa neuvoja tulevaa tutkimusta varten. Vaikka tämä väitöskirja käsitteleekin sosiaalisen hyväksynnän käsitteellistä viitekehystä keskittyen aikomukseen, halukkuuteen ja valmiuteen ottaa käyttöön aurinkoenergiaa, se on avoin myös keskustelulle muiden teknologioiden hyväksynnästä, kun yksilötason käyttöönotto on elintärkeässä roolissa

PROBLEMS FACED BY THE STREET CHILDREN : A STUDY ON SOME SELECTED PLACES IN DHAKA CITY, BANGLADESH

The aim of this study was to shed light on the predicaments of the street children in their street life, their coping mechanism in response to innumerable problems and survival status. Pondering the gravity of the research topic qualitative method with the juxtaposition of FGDs (focus group discussion) and case studies was employed to generate descriptive data. With the organizational support of Underprivileged Children's Educational Programs (UCEP) 4 FGDs were administered on a total respondent size of 74 beneficiary and non-beneficiary street children in Mirpur and Lalbagh areas in the Dhaka city of Bangladesh. Meanwhile, 9 case studies were conducted that gave extra flavour in the research to present more vivid and cross-checked data. The findings drew the flamboyant picture of the ongoing endangered livelihood mostly and mainly triggered by poverty, insecurity, powerlessness, weak or no social network and social capital, insufficient institutional support etc. Since the respondents lacked proper capabilities to secure a descent job, they had to endure oppression, torture, insecurity and other problems to survive on the streets. Drawing upon their problems this research finally dismantled some specific coping mechanisms adopted by the street children whether by avoidance of or approach to the predicaments and stress they face to survive on the street.Peer reviewe

Results of intention-behaviour gap for solar energy in regular residential buildings in Finland

With a purpose to comprehend intention-behaviour gap about acceptance of solar energy and solar community concept (houses and/or block of flats under specific solar power plant) among Finnish respondents, this qualitative study found respondents’ positive responses towards solar energy and their rationality and honesty in admitting their real behaviour. It focuses on the qualitative interpretation of individual’s intention that corresponds to specific behaviour. In terms of their ‘impression in principle’ by thinking solar energy as a non-polluting, inexhaustible and renewable energy source although all respondents were positive, the highest numbers were non-adopters. However, they were optimists. They mentally accepted (acceptance in principle) solar energy. They would adopt it later on after being satisfied with their most contextual conditions (‘impression in practical’). This study provides recommendations that indicate more future adoption and future research direction.Peer reviewe

Perceived service quality and tourists' cognitive image of a destination

This paper examines the impact of tourists’ perceived service quality on cognitive image they have towards the built environment dimension in Bangladesh.A survey was conducted through self-administered questionnaires among tourists visiting Bangladesh.Factor analysis and multiple regression analysis were used to find the influence of perceived service quality on cognitive image.The findings of the study indicate that perceived service quality factors are highly significant for the built environment dimension of the cognitive image that respondents have towards Bangladesh.The findings also reveal that there are high correlations among perceived tour services quality, perceived hospitality services quality, and built environment dimension of cognitive image.The study concludes that the cognitive image that the tourists have towards a destination is modified by their perceptions of service quality experience during their visit

A new cytotoxic carbazole alkaloid from Clausena excavata

A new carbazole alkaloid, 3-carbomethoxy-2-hydroxy-7-methoxycarbazole, Clausine-TY (1),together with two known carbazole alkaloid, Clausine-H (2) and Clausine-B (3), were isolated from the ethyl acetate extract of the stem bark of the Malaysian Clausena excavata. The structures of these compounds were elucidated by spectroscopic analyses. The new carbazole alkaloid shows significant cytotoxicity against CEM-SS cell line

Fabrication Principles and Their Contribution to the Superior In Vivo Therapeutic Efficacy of Nano-Liposomes Remote Loaded with Glucocorticoids

We report here the design, development and performance of a novel formulation of liposome- encapsulated glucocorticoids (GCs). A highly efficient (>90%) and stable GC encapsulation was obtained based on a transmembrane calcium acetate gradient driving the active accumulation of an amphipathic weak acid GC pro-drug into the intraliposome aqueous compartment, where it forms a GC-calcium precipitate. We demonstrate fabrication principles that derive from the physicochemical properties of the GC and the liposomal lipids, which play a crucial role in GC release rate and kinetics. These principles allow fabrication of formulations that exhibit either a fast, second-order (t1/2 ∼1 h), or a slow, zero-order release rate (t1/2 ∼ 50 h) kinetics. A high therapeutic efficacy was found in murine models of experimental autoimmune encephalomyelitis (EAE) and hematological malignancies

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 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