Elena Varavikova

• MD PhD MPH
• Researcher at Federal Research Institute for Health Organization and Information Moscow Russia

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of D...

Background Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to i...

Background Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to i...

This appendix provides detailed information on the methods for the paper “Global fertility in 204 countries and territories, 1950–2021 with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021”

Background National rates of COVID-19 infection and fatality have varied dramatically since the onset of the pandemic. Understanding the conditions associated with this cross-country variation is essential to guiding investment in more effective preparedness and response for future pandemics. Methods Daily SARS-CoV-2 infections and COVID-19 deaths...

Background Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant...

The GBD in the Russian Federation Data sources The database used to produce GBD estimates includes 445 sources that contain data on the Russian Federation. Many different types of sources are represented in that total, such as surveys, scientific studies, censuses, and disease registries. Sources in the GBD database are scrutinized to ensure they m...

Background The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the associatio...

BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the associati...

Background: Data about the global, regional, and country-specific variations in the levels and trends of colorectal cancer are required to understand the impact of this disease and the trends in its burden to help policy makers allocate resources. Here we provide a status report on the incidence, mortality, and disability caused by colorectal canc...

Background: Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and...

This appendix formed part of the original submission and has been peer reviewed. Supplement to: GBD 2017 SDG Collaborators. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. L...

The pandemic of chronic noncommunicable diseases (NCDs) poses substantial challenges to the health financing sustainability in high-income and low/middle income countries (LMICs). The aim of this review is to identify the bottle neck inefficiencies in NCDs attributable spending and propose sustainable health financing solutions. The World Health Or...

Background Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use stan...

This paper estimated mortality for 282 causesof death in 195 countries from 1980 to 2017, adding 18 causes to its estimates compared to GBD 2016. In 2017, the GBD study added numerous data sources, including 127 country-years of vital registration data and 502 country-years of cancer registry data.

Background Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use stan...

Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used...

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. He...

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved method...

Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used...

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-leve...

Background How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifi...

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used...

Summary Background: How long one lives, how many years of life are spent in good and poor health, and how the population’s state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which...

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-leve...

Summary Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improv...

За последние десятилетия социальные и экономические изменения оказали сильное влияние на здоровье и благосостояние в России. В ходе работы был произведен анализ данных, полученных в результате Исследования Глобального Бремени Болезней, Травм и Факторов Риска 2016 (ГББ), с целью определения тенденций смертности, а также причин смерти, числа лет ж...

Background: Over the past few decades, social and economic changes have had substantial effects on health and wellbeing in Russia. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to evaluate trends in mortality, causes of death, years lived with disability (YLDs), years of life lost (YLLs),...

Environmental and occupational health is affected by chemical, physical, radiological, and biological agents in the air, water, and soil. Health risks include injury, and exposure to toxic radiation, carcinogenic and teratogenic agents, leading to cancer, lung and heart diseases. Environmental factors may result in instant death or long-term illnes...

Public health depends on information derived from monitoring population health status to identify community health problems, and to diagnose and investigate health problems and hazards in the community. These depend on vital statistics and disease reporting systems, including for non-communicable diseases, injuries, risk factors, health care resour...

Non-communicable diseases (NCDs) are the leading causes of death and the central issue in contemporary and future public health globally. NCDs are amenable to health promotion, prevention, and medical interventions. Improved social conditions, quality of diet, body weight, smoking cessation, and increased physical activity can greatly reduce the bu...

A health system is an expensive knowledge-based industry made up of professionals, paraprofessionals, and administrative and support personnel. Human resources to provide and manage public health and clinical services are crucial to developing and sustaining national and global health systems. High-income countries are replete with highly trained a...

Populations are not homogeneous or uniform in terms of health. There are differences in age, gender, socioeconomic status, risk factors of lifestyle, and groups whose burden of disease requires special attention. This chapter addresses special needs such as mental health, oral health, and the many groups in a population whose needs are greater and...

Sanitation, food control, vaccines, and antibiotics have reduced the toll of communicable diseases, saving millions of lives. Smallpox was eradicated in 1977, and poliomyelitis eradication is close. Measles mortality has reduced drastically yet outbreaks occur where immunization lags. HIV/AIDS emerged in the 1980s, grew into a global pandemic costi...

Health care systems ideally include universal access to comprehensive prepaid medical care along with health promotion and disease prevention. National health insurance and national health services of various models have evolved in the developed world and increasingly in developing countries as well. Some models, such as the Bismarckian social secu...

Nutrition is a cornerstone to population health status. In developing countries there are severe problems in lack of access to food resulting in malnutrition and stunted growth patterns especially for the most vulnerable subsets of the population. Foodborne diseases are problematic in all countries irrespective of the level of development, with soc...

Ancient societies recognized the needs of sanitation, food safety, workers’ health, and medical care to protect against disease and to promote well-being and civic prosperity. New energies and knowledge since the eighteenth century produced landmark discoveries such as prevention of scurvy and vaccination against smallpox. The biological germ theor...

Preface: Looking Back Helps in Looking Ahead We greatly appreciate the warm reception that the first (1999) and second (2008) English editions of this textbook has received from students, teachers and practitioners of public health in many countries over the past 14 years. It has also been well accepted in translated editions in Russian, Bulgaria...

The New Public Health has established itself as a solid textbook throughout the world. Translated into 7 languages, this work distinguishes itself from other public health textbooks, which are either highly locally oriented or, if international, lack the specificity of local issues relevant to students understanding of applied public health in thei...

Purpose: Prenatal alcohol exposure can result in a range of adverse pregnancy outcomes including stillbirth and Fetal Alcohol Spectrum Disorders (FASD). Russia is a country with high alcohol consumption among women. This presentation describes a line of international studies aimed at developing FASD prevention in Russia and discusses implications f...

The New Public Health is a contemporary application of a broad range of evidence-based scientific, technological, and management systems implementing measures to improve the health of individuals and populations. Its main objectives are the political and practical application of lessons learned from past successes and failures in disease control an...

Life expectancy at birth in Russia is over 12 years less than in western Europe. This study explores the possible role of medical care in explaining this gap by examining the evolving pattern of mortality amenable to timely and effective medical care in Russia compared with Estonia, Latvia, and Lithuania, and the UK. Analysis of standardized death...

More than half the global population is extremely poor. Many live in substandard housing, can’t read, earn barely enough to feed themselves and their families, and have few opportunities to better their circumstances. Their struggle to survive is often compounded by feelings of helplessness, terror, and despair. Although most of these people are re...

In sports or the arts, some people have natural talents. Others need considerable training to develop passable abilities. Some start off as "naturals" and when they receive training, it helps them to soar that much higher--to fine-tune their natural abilities. Teach a natural athlete a new throw or serve or swing and he or she will pick it up right...

The death rate among working age men in Russia increased by over 70 percent between 1990 and 1994, and similar increases in male death rates occurred in many other former Soviet republics during the same period. The timing of this extraordinary increase in mortality is coincident with the introduction of market reforms in these countries, suggestin...

Technology, quality, the law, and ethics are closely interrelated in public health. Well-informed and sensitive analysis of all aspects of their development is a part of the New Public Health. The balance between individual and community rights is very sensitive and must be under continuous surveillance. The New Public Health is replete with techno...

A balance between primary health care and hospital care is an essential element of the health system. Primary care and health promotion are the most cost-effective interventions in improving the health status of the population. Where there has been an excessive emphasis on institutional care, there is real potential for transfer of resources and em...

Public health is organized at the local, state, and national levels to define and work toward health targets. A balanced health care system requires that resources be rationally allocated to the different preventive, curative, or environmental elements of health. Resources must be directed to all vulnerable groups in the population, recognizing tha...

The history of public health is directly related to the evolution of thinking about health. Ancient societies realized the connection between sanitation and health and the role of personal hygiene, nutrition, and fitness. The sanctity of human life established an overriding human responsibility to save life derived from Mosaic Law from 1500 BC. The...

Health care is one of the largest and most important industries in any country, consuming anywhere from 3 to 14% of GNP. It is a service, not a production industry, and it is vital to the health and well-being of the individual, the population, and the economy. Because it employs large numbers of skilled professionals and many unskilled persons, it...

Traditionally public health has paid great attention to some groups because of their particular vulnerability, as in maternal and child health. The benefits to society as a whole are great where such programs are well developed. Middle-aged men and women are important target groups for primary and secondary preventive programming in preparation for...

Information is the basis for planning, organizing, managing, and providing high quality care. The process begins with basic vital statistics and the epidemiology of infectious and noninfectious diseases in order to identify the health needs of the population. It extends into health information systems in order to manage and monitor the functioning...

Chronic conditions are major public health problems in most industrialized countries, and are rapidly becoming so in developing countries. Cardiovascular disease, cancer, and trauma are the major causes of death in most western countries, but the leading cause of years of potential life lost is trauma. Increasing longevity, improved nutrition, soci...

Education and training of medical and allied health personnel are important issues in health care systems development, and include issues of both quantity and quality. Regular reassessment is needed lest the numbers of practitioners produced be larger or fewer than the needs of the services, and lest standards decline. Preparation of managers and p...

Transportation, colonization, and commerce have been responsible for the dissemination of disease throughout history. With rapid movement of large numbers of people by sailing ships, steamships, rail, and later air, the possibility of disease transmission by travelers has increasingly become a global public health problem. Events in any part of the...

Most industrialized countries have implemented national health programs as health insurance systems or national health services. Each was developed in the political context of the country and continues to evolve with its own and international experience. Assuring access to health care for all is a basic principle of the New Public Health. Medical c...

The objective of public health is better health for the individual and for society. Public health works to achieve this through indirect methods, such as by improving the environment, or through direct means such as preventive care for mothers and infants. Clinical care focuses directly on the individual patient, mostly at the time of illness. But...

A society is often judged on how it treats its minorities, its poor, its prisoners, and its refugees as much as how it cares for the main population groups. All such groups need special attention because they are people in need, but also because they can affect the health of others. Public health agencies are often the advocates and pioneers in imp...

Nutrition is one of the major public health issues of developed countries. The problems are largely of over nutrition or inappropriate balance and excessive caloric intake. In developing countries, mass nutritional deprivation is perhaps the most important public health problem, resulting in wide-scale deficiencies of calories, protein, and essenti...

This paper reviews Russia's health crisis, financing, and organization and public health reform needs. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are...