Putting pub­lic health on the map

Financial Mirror (Cyprus) - - FRONT PAGE -

Back then, well-mean­ing ad­vo­cates for dif­fer­ent dis­eases pub­lished death tolls that helped them make the case for fund­ing and at­ten­tion. But when all the claims were added up, the to­tal was many times greater than the num­ber of peo­ple who ac­tu­ally died in a given year. And even when pol­i­cy­mak­ers had ac­cu­rate data, it usu­ally in­cluded only causes of death, not the ill­nesses that af­flicted the liv­ing.

To ad­dress this prob­lem, Alan Lopez and I launched the Global Bur­den of Dis­ease project (GBD) in 1990. De­ci­sion-mak­ers need in­for­ma­tion about the world’s big­gest health threats and how they have changed over time, across age groups, and by sex, so they can en­sure that ev­ery­one has the op­por­tu­nity to live the longest, health­i­est life pos­si­ble.

By en­sur­ing that each death is counted just once, and by pro­vid­ing com­pre­hen­sive statis­tics on the causes of ill health, the GBD can com­pare the im­pact of can­cer to that of lower back pain or de­pres­sion. It also en­ables com­par­i­son of among coun­tries.

GBD’s 1990 study and sub­se­quent re­vi­sions raised the bar for pop­u­la­tion health mea­sure­ment, pro­vid­ing de­ci­sion-mak­ers with more re­li­able and use­ful in­for­ma­tion. It also opened the in­ter­na­tional de­vel­op­ment com­mu­nity’s eyes to the i mpor­tance of over­looked af­flic­tions, such as men­tal ill­ness and road in­juries. Donors such as the World Bank and the Bill & Melinda Gates Foundation use GBD data to guide their in­vest­ments, and more than 30 coun­tries have con­ducted their own bur­den-of-dis­ease stud­ies.

Coun­tries such as Aus­tralia, Botswana, China, Mex­ico, Nor­way, Rwanda, Saudi Ara­bia, and the United King­dom are us­ing GBD find­ings to in­form health poli­cies. In China, the re­sults of the GBD project, launched at a pol­icy sum­mit in 2013, raised aware­ness about the deadly im­pact of air pol­lu­tion on the coun­try’s pop­u­la­tion. Those find­ings helped shape the Chi­nese gov­ern­ment’s ef­forts to curb the neg­a­tive ef­fects of pol­lu­tion on health, and Chi­nese re­searchers are now key mem­bers of the global col­lab­o­ra­tive ef­fort.

In Rwanda, when the GBD study re­vealed that in­door air pol­lu­tion from cook­ing with solid fuel was a lead­ing cause of death, the gov­ern­ment launched a pro­gramme to dis­trib­ute one mil­lion clean stoves to the most vul­ner­a­ble house­holds. Rwan­dan sci­en­tists and of­fi­cials from the Min­istry of Health – in­clud­ing the min­is­ter her­self – are im­por­tant con­trib­u­tors to the GBD.

To­day, the GBD is con­stantly im­prov­ing, thanks to the ef­forts of more than 1,300 col­lab­o­ra­tors in 114 coun­tries. Th­ese col­lab­o­ra­tors im­prove the mod­els on which the project is built, vet the study re­sults,


per­for­mance con­trib­ute new data sets, and com­mu­ni­cate the re­sults to me­dia out­lets, ed­u­ca­tional in­sti­tu­tions, and de­ci­sion-mak­ers. The lat­est GBD study re­vealed that an­other dis­ease sel­dom dis­cussed in in­ter­na­tional de­vel­op­ment cir­cles, lower back and neck pain, is the fourth largest cause of health loss glob­ally. It also high­lighted the rapid pace of epi­demi­o­log­i­cal tran­si­tion in mid­dle-in­come coun­tries and the per­sis­tence of com­mu­ni­ca­ble, ma­ter­nal, new­born, and nu­tri­tional dis­or­ders in Sub-Sa­ha­ran Africa.

But the GBD could do more to in­form pol­icy de­bates and spur ac­tion to im­prove health if it were able to pro­vide more de­tailed break­downs of data. Pol­i­cy­mak­ers are ac­count­able, first and fore­most, to their con­stituents, whose unique needs they must meet. Es­ti­mates of lo­cal dis­ease bur­dens will be es­sen­tial for com­bat­ing af­flic­tions like Ebola, check­ing the ris­ing toll of non­com­mu­ni­ca­ble dis­eases in mid­dle-in­come coun­tries, and meet­ing the Sus­tain­able De­vel­op­ment Goals re­lat­ing to ma­ter­nal and child health in Sub-Sa­ha­ran Africa.

To help de­ci­sion-mak­ers make bet­ter use of their data, the In­sti­tute for Health Met­rics and Eval­u­a­tion, which I head, is cre­at­ing geospa­tial maps of dis­ease bur­dens with a ground­break­ing level of res­o­lu­tion. Cre­at­ing th­ese maps is pos­si­ble thanks to meth­ods de­vel­oped by the Malaria At­las Project, which has pro­duced a bet­ter spa­tial un­der­stand­ing of malaria than we have for any pathogen.

Geospa­tial maps can pin­point ar­eas that are mak­ing out­stand­ing progress, al­low­ing us to iden­tify com­mu­ni­ties that have done things dif­fer­ently from their neigh­bors. Th­ese case stud­ies can em­power com­mu­ni­ties to repli­cate one an­other’s suc­cesses. One ex­am­ple is Cali, Colom­bia, which drove down homi­cide rates in the 1990s af­ter the city’s mayor, Rodrigo Guer­rero, tight­ened al­co­hol re­stric­tions, in­tro­duced com­mu­nity-de­vel­op­ment pro­grams in the most im­pov­er­ished neigh­bor­hoods, and im­posed tem­po­rary gun bans in pub­lic places.

The mayor of Colom­bia’s cap­i­tal, Bogota, learned about the pro­gram in Cali and im­ple­mented sim­i­lar mea­sures, which have helped re­duce homi­cides steadily in the city. Since then, Guer­rero has worked with the In­ter-Amer­i­can De­vel­op­ment Bank to de­velop pro­grammes that help other Latin Amer­i­can coun­tries re­duce vi­o­lence in their com­mu­ni­ties. In 2014, Guer­rero won the Roux Prize for his use of data to im­prove health, fur­ther el­e­vat­ing aware­ness of his work. Geospa­tial map­ping will help us iden­tify more Rodrigo Guer­reros and cham­pion their achieve­ments.

As the in­ter­na­tional com­mu­nity comes to­gether to agree on the tools needed to fi­nance and mon­i­tor progress to­ward the MDGs’ suc­ces­sor frame­work, the Sus­tain­able De­vel­op­ment Goals, geospa­tial map­ping will be crit­i­cal for track­ing progress and in­di­cat­ing where course cor­rec­tions might be needed. We are far be­yond where we were in 1990 in terms of health mea­sure­ment. With fo­cused ef­fort and fur­ther in­no­va­tion, we can make even more progress in the next 25 years to help the world make the most of our col­lec­tive health in­vest­ments.

Twenty-five years ago, the state of pub­lic health for large pop­u­la­tions was like that of a doc­tor try­ing to treat a pa­tient with­out a proper di­ag­no­sis. The dis­eases and in­juries that cut lives short and caused wide­spread suf­fer­ing were not rig­or­ously tracked.

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