Taking the measure of global health: Five lessons learned

Crunching numbers, fighting disease
Crunching numbers, fighting disease
Institute for Health Metrics Evaluation

Many, if not most, of the top people in global health were in Seattle last week.

Some 600 people from all around the world were here for the Global Health Metrics & Evaluation conference. Participants discussed the evidence for maternal mortality rates declining worldwide, the difficulty of tracking malaria and a host of other issues that help set the global health agenda.

Critical issues of global importance. But they didn’t get much news coverage. Why not?

I have one theory, and five lessons learned, which I will explain by first recalling a car accident.

Years ago, I was T-boned by another driver. He had been blinded by the sun (or, since it’s gray Seattle, maybe alarmed at the big bright thing in the sky) and slammed his car into my car, driver’s side. My head hit the window before I was flung to other side as the car crumpled. Perhaps it was fortunate, though I hasten to add ill-advised, that I wasn’t wearing a seat belt.

My car was totaled. The offending driver was one of the nicest guys I’ve ever met, constantly asking me if I was okay. There was no blood. I just felt a little dazed.

Two days later, my cervical spine froze up and I could hardly move my head.

That approximates how I felt after attending the Global Health Metrics & Evaluation conference, except for the fact that I enjoyed the process much more than being in a car wreck.

I like data, evidence. My background is in science and I join many who think the global health arena needs to be governed more by evidence and less by habit, politics or even compassion (since compassion is nice, but it sometimes causes us to focus on the wrong problems or the wrong solutions).

Everything these global health experts discussed seemed to me critically important, matters of life and death really. They usually weren’t making heartfelt emotional appeals or arguments based on moral responsibilities, or our common humanity. A bit of that, but mostly they discussed how best to measure and evaluate global health, such as:

  • The impact of a specific disease on a person’s overall health and welfare.
  • The effectiveness of a particular health improvement project.
  • Whether or not one disease, or condition, is a better indicator of health than another.
  • Whether measuring the impact of the effectiveness of a particular health indicator can itself lead to having an impact on a different health outcome which can, in fact, be measured.

Ouch. That last one made my brain seize up!

I felt a little better about my apparently limited mental capacity when one of the top global health experts on maternal mortality measures, John Wilmoth at the University of California at Berkeley, stood up and asked one of the speakers at a particularly thick data-crunching session:

“Are you trying to make this complicated?”

So, it wasn’t just me who felt a little dazed and confused. I decided to give myself a few more days to digest what I learned after hanging out with the global health metrics gang.

Here are five things I learned, and intend to explore further now that my brain is functioning again:

  1. There is still no consensus on what we mean by “global health.”
  2. Maternal mortality and morbidity is the top global health priority right now, even though it isn’t entirely clear why this should be the case (given that the risk of death from childbirth, however tragic, is much less than other health threats).
  3. Every “disease constituency” (i.e., advocates for cancer, for hunger, etc) is now making the case and working the numbers to rank its concerns higher on the global health agenda.
  4. Health metrics experts have a distinct tendency to make things more complicated, if also sometimes more accurate. Maybe they have learned from the legal profession that making things complex is job security.
  5. Seattle is clearly becoming the center of the universe for global health metrics, if not for global health in general. (And not everyone is happy about that.)

For a more serious and in-depth rendering, see public health analyst Amanda Makulec’s post listing seven key ideas that came out of the global health metrics meeting.

Tomorrow, I will examine how the metrics gang originally exposed “the most neglected disease” in global health — mental illness — and why it remains neglected.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.

  • Zara

    I’d argue that childbirth should not be considered a health threat, more like… the only method of reproduction for our species.

  • Amy Hagopian

    Global health is mostly about the health of poor people, in the US or in “poor countries.” Global health would best be served by focusing on infrastructure: health workers, health facilities, health information, financing. Those are not sexy topics. AIDS is sexy (or was). Maternal and child health didn’t used to be, but is becoming so. Do you suppose infrastructure will ever be sexy?

  • Thanks for your post. Your point 3 is a critical barrier to integration of health issues:

    Every “disease constituency” (i.e., advocates for cancer, for hunger, etc) is now making the case and working the numbers to rank its concerns higher on the global health agenda.

    What with that and the fact that many organizations and sectors don’t collaborate because certain individuals ‘don’t get on’ is what keeps everything so polarized and fragmented.

    Besides needing to see beyond this, it’s also really dull when you hear it again and again.

  • Terry

    You are absolutely right that evidence should light the path toward solutions but perpetuating the notion that minimizing politics sounds like a problem to me. I of course could be wrong. Politics is weaponized by the opposition; politics is implementation. Ideas are upstream of evidence and politics, less so with evidence, hopefully, but ideas drive how we understand the evidence. Ideas go to weapons pretty quick, a bit quikcer than to solutions. And less compassion? Really? I hope there will always be a link between ideas and compassion. I think I maybe understand what you are saying but just wanted to advocate for politics and compassion. Not that the two are linked much anymore anywhere, evidence or no….

  • Amkimball

    Tom, nice article. I believe evidence is an important basis for decisionmaking and the work in metrics is refining the numbers. However having worked in Global Health for more than 30 years I have learned that evidence is only part of the process of prioritization within countries or within international organizations. Advocacy is important as AIDS so eloquently demonstrated. But the political and cultural setting are also absolutely central to understanding how countries prioritize their health concerns. I would frankly love to see an institute as liberally funded which would bring in these aspects of policy making forward with the same rigorous science as IHME has brought to us.