The long-term global burden of diarrheal disease

Rachel Mahoney

In the United States and other wealthy global north nations a bout of diarrhea often serves as only a minor inconvenience and discomfort, possibly even the source of some embarrassing bathroom encounters.  This is not reflective of the destructive role diarrhea plays in the rest of the world, where—as the leading cause of infant mortality worldwide—it accounts for the deaths of 4,000 children per day.  The 4 – 6 million people who die of diarrhoeal disease and ensuing dehydration every year represent a tiny fraction of the global suffering and costs that will endure long after those people parish.  One way of estimating the global long-term costs of disease and poor health is by calculating that disease’s disability-adjusted life years (DALYs), which are a measure of overall disease burden—expressed as the number of years an individual or population loses to ill-health, disability, or early death—often used to determine the cost-effectiveness of particular treatment methods.  The DALYs of diarrhoeal disease show that: “as little as a 1% long-term disability can more than double global diarrhea DALY calculations … such an effect would substantially increase the cost-benefit calculation of any interventions that might effectively reduce these potential lasting disability consequences of repeated dehydrating and malnourishing diarrhoeal illnesses in the critically formative first 2 years of life (H.L. Guyatt, et al. 2002).  If a child even survives, the crippling consequences of chronic diarrhea and dehydration extend into his adulthood and pose lifelong and generation-wide problems.

Perhaps most frightening is the fact that these lost years and incurred costs also extend beyond individuals and generations, creating long-term costs on the global scale.  Forces like globalization are driving the growing interconnectedness of the world’s markets and resources and should have also linked and united the human population to end the health disparities that cause disproportionate suffering of minority populations compared to their white counterparts (Weber, 2007).  In reality, however, racism and apathy prevent policymakers from confronting health inequities and effectively saving the lives of billions, including the 5 million people who die diarrhoeal disease, the most treatable and preventable of the ten leading causes of death globally as outlined by the WHO.

Here is a diagram of the cycle between enteric infections (diarrhoeal disease) and malnutrition, which has long-term individual, generational, and global impacts.

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