Abstract:
The health of populations living in extreme poverty has been a long-standing focus of global
development efforts, and continues to be a priority during the Sustainable Development
Goal era. However, there has not been a systematic attempt to quantify the magnitude and
causes of the burden in this specific population for almost two decades. We estimated dis-
ease rates by cause for the world’s poorest billion and compared these rates to those in
high-income populations.We defined the population in extreme poverty using a multidimensional poverty index. We
used national-level disease burden estimates from the 2017 Global Burden of DiseaseStudy and adjusted these to account for within-country variation in rates. To adjust for
within-country variation, we looked to the relationship between rates of extreme poverty and
disease rates across countries. In our main modeling approach, we used these relationships
when there was consistency with expert opinion from a survey we conducted of disease
experts regarding the associations between household poverty and the incidence and fatal-
ity of conditions. Otherwise, no within-country variation was assumed. We compared results
across multiple approaches for estimating the burden in the poorest billion, including aggre-
gating national-level burden from the countries with the highest poverty rates. We examined
the composition of the estimated disease burden among the poorest billion and made com-
parisons with estimates for high-income countries.The composition of disease burden among the poorest billion, as measured by disability-
adjusted life years (DALYs), was 65% communicable, maternal, neonatal, and nutritional
(CMNN) diseases, 29% non-communicable diseases (NCDs), and 6% injuries. Age-stan-
dardized DALY rates from NCDs were 44% higher in the poorest billion (23,583 DALYs per
100,000) compared to high-income regions (16,344 DALYs per 100,000). Age-standardized
DALY rates were 2,147% higher for CMNN conditions (32,334 DALYs per 100,000) and
86% higher for injuries (4,182 DALYs per 100,000) in the poorest billion, compared to high-
income regions.The disease burden among the poorest people globally compared to that in high income
countries is highly influenced by demographics as well as large disparities in burden from
many conditions. The comparisons show that the largest disparities remain in communica-
ble, maternal, neonatal, and nutritional diseases, though NCDs and injuries are an important
part of the “unfinished agenda” of poor health among those living in extreme poverty.
