How many people worldwide suffer from malaria? How many children died last year in Bolivia and of what causes? Which clinics in the developing world have adequate medicines? The haunting answer to all the above questions is that we don't know. Accurate statistics on the current state of global health are crucial as they inform policymakers, donors, and researchers on where to allocate their resources and for what diseases. While inaccuracies still plague health statistics worldwide, there has recently been an important push to produce more data that guides public health decisions. If we are to ever fully understand the disease situation globally, more resources, talent, and interest will have to shift towards ensuring quality health statistics.
One of the most promising advances in global health statistics is a report titled the Global Burden of Disease 2010 (GBD) published by the Institute for Health Metrics and Evaluation at the University of Washington. On March 5th, the report released country specific estimates that outline disease burdens and deaths for 291 diseases and injuries in 20 age groups worldwide. This release is an update to the original study published in December that showed estimates by region. For the update, the IHME announced a suite of new data visualization tools to allow countries to see how they are performing in comparison to their peers and to allow researchers new ways to view levels and trends in health. With 488 co-authors from 303 institutions in 50 countries, it is one of the biggest efforts to determine the global health situation.
While the GBD is arguably the best report of its kind and a beacon of hope for more data-driven global health efforts, there still remain disconcerting uncertainties in these estimates and global health statistics in general. There are major holes in global health metrics especially in rural areas where data collection systems are absent. "Where disease burden is greatest, our capacity to measure trends doesn't exist," admonished Margaret Chan, director-general of WHO. The IHME is doing its best to fill these gaps using innovative computer modeling that extrapolates from the few available data sources, such as survey data. These models attempt to account for deficiencies in the data, but because these models are extrapolations their accuracy remains impossible to verify.
Because of the uncertainty, the field of global health statistics has not been without controversy, most notably the dispute surrounding the differences in WHO and IHME estimates of malaria. The IHME actually estimated almost twice as many worldwide malaria deaths as the WHO, highlighting the difficulty in generating even the most simple of health statistics. To ease tensions, a conference was called by the WHO and funded by the Bill & Melinda Gates foundation – who supports IHME. Perhaps the most important conclusion drawn from the meeting was that there is a desperate need to invest in better data collection efforts on the ground.
Luckily there are a few notable members of the public health community channeling their efforts to put data collection technologies in the hands of people in resource-poor settings. Joel Selanikio, a graduate of the CDC's Epidemic Intelligence Service program and founder of DataDyne, has developed a technology called Magpi that allows data to be collected from electronics as simple as the most basic SMS phones. Additionally, Paul Farmer and his organization, Partners in Health, have developed Open Medical Record System (OpenMRS) as a free medical record system platform for developing countries. Efforts like these will hopefully fuel both the WHO and IHME with better data to make their predictions.
The IHME and its statistical firepower, humanitarians working on the ground, and important investors such as the Gates Foundation, are shifting towards tackling global health issues with data and its beginning to prove fruitful. Hopefully through their joint efforts the data will begin to expose where efforts are most needed and public health practitioners can follow the numbers to ensure a healthier world.
