Our supermarket, with stores all over Florida, stocks shelves according to the store-specific demographic—elderly, families with children, Hispanic, Asian, West Indian, Kosher, etc—which they know from what products are regularly purchased in each one. Likewise, my computer distracts me with unwanted pop-up ads, for products based on the web sites I frequent. So, what has the established purveyors of global health statistics been doing with those numbers, to solve life-or-death problems globally? Apparently, not much!
Christopher Murray earned his Ph.D. in Medical Health Economics from Oxford, and a Medical Degree from Harvard. Dr. Murray, however, neither practices medicine, nor does he even follow the stock market. While researching his Dissertation at Oxford, he realized how sorely inconsistent, and useless, many of the statistics amassed by the various institutional bureaucracies actually were.
The focus was mostly limited to Early Childhood (ages 0 to 5) and Maternal Deaths. The World Health Organization and World Bank statistics for Life Expectancy for Men in Congo, for instance, between 1980 and 1984, differed by 15 years, with similar discrepancies for other nations, as well. In another case, identical statistics for a particular disease were reported, for economically disadvantaged Somalia as it was for Sweden, which has one of the world’s best health care systems. My supermarket, on the other hand, knows shopping patterns and re-supply needs, for each of its stores, and acts on them in order to enhance profits. Why not enhance Global Health?
It appears that political motives might be involved, such as maintaining an organization’s level of stature within the overall Global Health arena, perhaps, are of greatest importance. And focusing on Children’s Deaths might possibly make the fund-raising efforts much more engrossing. But, why raise the funds to collect the statistics and, then, fail to act effectively on them?
Also, wouldn’t the elimination, or even the control, of a particular global health problem, such as Small Pox, enable those resources to be shifted to other life-threatening diseases? Wasn’t that the original purpose—perhaps a long, long time ago—to collect meaningful data, analyze it, set realistic expectations, and get the data and the appropriate resources out to the field?
Dr. Christopher Murray, a New Zealander by birth, met Dr. Alan Lopez, an Australian, at WHO Headquarters, in Geneva, Switzerland, and they began a collaboration to bring some sense to the global health statistics field. They realized, however, that WHO would not be a suitable launching pad! Throughout the ensuing 30 years, Murray and Lopez have encountered considerable skepticism among some in the Establishment, primarily at WHO. But many other groups, within the global health care community, have embraced their ideas, and even promoted them to colleagues.
Besides expanding the data collection landscape beyond just Early Childhood and Maternal Deaths, Murray and Lopez also included Disabilities—illnesses which generally do not kill people—into their metric. Early on, Chris Murray had developed his own measure of heath, the Disability-Adjusted Life Years, or DALYs. The DALY reflects the average degree of health for a nation, from which Labor’s legitimate contribution to the GDP might be identified, as well as the potential future demand for health care services.
For instance, let’s assume that a 75 year-old person, in perfect health, is assigned a DALY of 75. (Apparently there was apparently nothing to adjust for.) Then, a similar-aged person, who developed a partially incapacitating illness, assigned a 20% disability rating at age 40, would have a DALY of 68 (40 + [80% of the remaining 35 years]). This metric is much more relevant to Labor and National Ministers of Public Health. (Also, the disability ratings would be updated regularly, by country.)
With their Global Burden of Disability metric in hand, Murray and Lopez began selling the on-line concept to National Ministers of Public Health. The fact that anyone—ministers, politicians or the general public—can access the data base, free of charge, (http://www.healthdata.org), means that the Public Health Ministers can more easily sell it to their colleagues, refute politicians’ objections, and encourage a buy-in by the general population.
The Bill and Melinda Gates Foundation had provided initial funding, which began the (now) Institute for Health Metrics and Evaluation, at the University of Washington. The Gates Foundation had recently begun focusing on health care in impoverished nations, and its recognition of the importance of comprehensive statistical analysis in monitoring its funding, provided obvious legitimacy. The metric’s focus can also be narrowed to individual cities, or regions, as is currently the case for Seattle, Washington, as well as a few other areas.
Additionally, the benefits of education have been cited, time and again, in various areas, and it appears to very specifically have a direct correlation with health care—especially for women and girls. For instance, IHME has found that national health care seems to improve by ten percent with just one additional year of school, on average. When China had a stunning surge in its GDP of ten percent; however, that only improved health care by one percent.
Just yesterday, I went on to the WHO web site, and I noticed that it still doesn’t appear to have embraced the IHME’s GBD concept. In 2012, Dr. Richard Horton, Editor of the prestigious peer-review medical journal, “The Lancet”, suggested that Murray’s and Lopez’s GBD Metric is on a par with the Human Genome Project. And, then, he went on to say that: “Even Galileo was considered a radical in his time.”
NOTE: The compelling story of Dr. Christoper Murray, and his collaboration with Dr. Alan Lopez, is a compelling, and vitally, important one. It is eloquently told in “Epic Measures”, by Jeremy N. Smith.