The world-wide burden of neurologic disease

``The search for the appropriate balance in development, for globally acceptable human life styles, is one which has to be undertaken together by rich countries as well as poor ... In this search the global concern for human health must take a central place.'' World Health Organization The economic, social, and personal burdens of the most common neurologic disorders in the United States and other developed countries have been the subject of intense study by their neurologists. But 85% of the world's population lives in countries other than those with established market economies and the formerly socialist economies of Europe, in the so-called ``developing world.'' The enormous impact of neurologic diseases in the developing world is less well-known, and is the focus of this article. In 1990, in the United States there was one neurologist per 29,000 people; in the same year India had one neurologist per 3.2 million, and Pakistan one per 10 million. [1,2] In 1993, 15 African countries had no neurologists at all. These figures are typical of the developing world, and therefore of a majority of the world's population. Lack of local training centers ensures that many of those seeking careers in neurology or the neurosciences will be trained abroad. Yet many who finish their neurologic training in economically advanced countries do not return to practice in their own countries. [3] For a joint 1993 report, the World Bank and the World Health Organization undertook an analysis of the loss of expected life and function resulting from most causes of death or disability. [4] For fatal disorders, disability-adjusted life-years (DALYs) lost were defined as the difference between the actual age at death and the expectation of life at that age. Years lost through disability (as from polio or depression) were calculated using a severity scale for …