Good morning Hank, it's Tuesday.

This video eventually discusses mental illness, but first I would like to talk to you about the disability adjusted life year, which is very important despite having a boring name, kind of like Bradley Cooper, but perhaps even more important. So if we're gonna figure out how to improve human health, we obviously need to know what is causing human death.

Here's the global picture: IHD aka heart disease is by far the most common cause of death, stroke is also very common. I was surprised to learn that diarrhea causes about as many deaths as lung cancer, but in general this graphic looked pretty much how I expected it to. But that doesn't show us the whole picture because of course there is a big difference between dying at the age of 110 and dying at the age of 30.

And also dying is not the only health problem, although it is a big one. Many diseases can be disabling even if they aren't fatal and can keep people from leading healthy and productive lives. So how do we account for all of that?

Enter the disability adjusted life year or "DALY", which measures the expected years of health lost to a disease. While global causes of death look like this, global disease burden measured in terms of DALYs looks like this. Illnesses like malaria and diarrhea and pneumonia become much more prominent because they disproportionately affect younger people.

One of the biggest shifts you see when you measure health in DALYs is in mental health. In fact, mental illness and substance use disorders become the single biggest category of disease burden in the United States. At least by that measure what is still sometimes dismissed as "all in your head" or "not an actual health problem" is in fact our biggest health problem.

And that isn't a uniquely American phenomenon either. In Brazil for instance, mental illness is also responsible for more lost DALYs than any other single cause including heart disease. The same is true in France and the UK.

In China depression and anxiety robbed people of more years than liver cancer or diabetes. And even in extremely poor countries mental illness is a significant cause of death and disability. Like in Sierra Leone for instance, communicable diseases like malaria and meningitis and pneumonia are overwhelmingly the leading cause of lost life years, but mental illness still causes more disease burden than almost any other non communicable disease.

And while it is certainly a challenge to get good mental health care in most places, in poor countries it is extremely difficult. Many mentally ill people are chained to their beds in hospitals or group homes. In fact in Sierra Leone the practice of shackling just ended thanks to a huge effort from the Ministry of Health and slightly improved mental health funding.

That news should absolutely be celebrated. But Sierra Leone still faces huge mental health challenges. There are only two psychiatrists in a nation of seven million people and in other countries around the world many people are still in chains with absolutely no access to treatment.

When we measure health in DALYs it becomes clear that improving treatments for mental illness and access to those treatments should be a priority for every country's healthcare system. To quote a recent piece from The Economist: "Nobody spends enough on mental health." This is important to me personally because I wouldn't be able to function without the medication I take every day. It allows me to live with my thoughts rather than being controlled by them.

But I also think it's important for all of us to understand that mental illness is common everywhere in the world and it is serious. In fact, it's one of the world's leading health problems. The good news is that the vast vast majority of mental illness is treatable.

As I have said and written many times before, there really is hope, even when your brain tells you there isn't. Like a lot of people with chronic health problems I have lost time to my illness, but I also have a good and fulfilling life.

And I don't just think that's like possible for mentally ill people, I think it is common, at least when there is access to good treatment. But we need more of that access both in rich countries and in poor ones.

So one last note: If you think you might need mental health care, please talk to someone you trust about pursuing a treatment plan or consult some of the links in the doobly-doo below.

Hank, sometimes we just need to look at life daily.

I will see you on Friday.