OBJECTIVES: While considerable progress has been made, the overall global burden of disease continues to escalate. The promise of translational medicine assumes matching basic science to greatest unmet need can reduce the burden of disease. Few studies have investigated the relationship between drug development and public health priorities; fewer still have correlated funding, development and global burden as a systemic response to unmet need. To fill crucial evidence gaps, we investigated the relationship between the number of drugs in development and global burden of disease measures.  METHODS: Burden of disease data (DALYs, YLL, YLD, and mortality) for the top 29 most prevalent conditions were obtained from WHO 2004 Global Burden of Disease Project.  Data on drugs in development were obtained from Adis R&D Insights (Adis International Limited). Our a priori hypothesis was no relationship between the number of drugs in development (2011) and 2004 GBD metrics. Predictor and outcomes variables were log-transformed to reduce positive skew; following univariate linear regression analysis all measure of burden of disease or public interest whose p<0.05 were included in a stepwise multivariate regression model. RESULTS: Univariate linear regressions demonstrated no measures of current GBD (DALYs, YLL, YLD, mortality; p = 0.31, 0.66, 0.2, 0.15 respectively) correlated with the current drug development pipeline.  Further, we found no correlation between future DALY projections (2008, 2015, and 2030) and global pipeline (p = 0.2, 0.26, 0.33). CONCLUSIONS: Data suggest that global R&D pipeline is not optimally poised to reduce current or future burden. The lack of correlation demonstrates the need for a better metric to guide healthcare resource allocation. We propose a “public health index” that incorporates public health variables such as the number of available interventions, economic impact, adherence, education and prevention to prioritize disease areas for drug development targeted to maximum public health impact.