Public Health Perspectives on Combating Liver Disease

Abstract

Watch a video presentation of this article Although not one of the World Health Organization’s top four chronic disease priorities, the global burden of chronic liver disease is significant. In 2016, the death toll from cirrhosis alone was 1.2 million, which was not far behind that of tuberculosis (1.3 million) and diabetes (1.5 million). Beyond its mortality impact, chronic liver disease is associated with enormous health care cost and disability-adjusted life years. In addition, it disproportionately affects low- and middle-income countries and vulnerable subpopulations. This series in Clinical Liver Diseases presents a public health perspective on combating chronic liver disease. Chronic liver disease is a unique kind of public health problem. As the consequence of infectious etiologies (hepatitis B and hepatitis C), as well as lifestyle behaviors (alcohol consumption and obesity), it spans both communicable and noncommunicable categories of disease. Its epidemiology varies widely between and even within countries, and is subject to the lifestyle behaviors, socioeconomic factors, cultural influences, and historical events promoting each etiology. Lastly, unlike other chronic diseases, the direct clinical sequelae of liver disease encompass nonmalignant and malignant complications. Public health approaches require efforts on all fronts: prevention, screening, and treatment. Although there is not a set recipe for success, it is useful to learn about best practices from various regions of the world. To that end, in these public health series perspectives on liver diseases, Shantan Cheemerla et al. present an overview of the global burden of chronic liver disease, Andrew Yeoman discusses potential strategies on population-level liver disease detection, Luis Diaz et al. propose local solutions to the alcohol liver disease problem in Latin America, and we present best practice examples for combating hepatitis B from the Sago prefecture in Japan (Yuichiro Eguchi et al.) and hepatitis C among incarcerated persons in Canada (Sofia Bartlett et al.).