ity they cause, and the resulting economic impact. Brain disorders are responsible for at least 27 percent of all years lived with disability in developing countries. The collective impact of brain disorders is partially captured by disability-adjusted life years (DALYs), a measure of the burden of disease that combines years lost as a result of death and disability, the latter being weighted according to severity. When disability is taken into consideration along with death, brain disorders comprise nearly 15 percent of the burden of disease in developing countries. Current figures are seriously underestimated, however, since many patients with these conditions in developing countries, particularly children, are not diagnosed and do not receive medical care. In the United States, 12 to 18 percent of children are estimated to be disabled in some way. The numbers are likely to be substantially higher in developing countries, where children are also more frequently exposed to infectious diseases and nutritional deficiencies. As improvements in health care and sanitation enable more children in the developing world to survive, the number of children with developmental disabilities is very likely to rise without concomitant efforts to reduce their occurrence.

Today's rapidly changing global economy poses a significant challenge to the developing world. To meet it, developing countries must foster healthy, educated workers, a process that begins with prenatal care and continues to adulthood. Since many brain disorders interfere with education as well as health, they present a threat to economic development. For low-income countries, the social and economic consequences of ignoring the burden of brain disorders are large and will continue to grow.

BACKGROUND

Responding to growing awareness of the impact of brain disorders and initiatives undertaken to address them, the Committee on Neurological, Psychiatric, and Developmental Disorders in Developing Countries, convened by the U.S. Institute of Medicine, was charged to prepare a consensus report that would define the increasing burden caused by neurological, psychiatric, and developmental disorders in developing countries, and to identify opportunities for effectively reducing that burden with cost-effective strategies for prevention, diagnosis, and treatment. The committee was also asked to identify areas for research, development, and capacity strengthening that would contribute most significantly to reducing the overall burden of these disorders in developing countries (Part I of the report) and to focus on several major groups of conditions: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, unipolar depression, and stroke (Part II of the report).

The study was sponsored by the Global Forum for Health Research, U.S. National Institutes of Health's Fogarty International Center, U.S. National Institute of Child Health and Human Development, U.S. National Institute of



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