Chris Murray

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Call for global health geeks to join forces with human rights activists | 

Editor of The Lancet, Richard Horton, wants human rights activists and global health geeks to come together in common cause.

More than 500 public health experts, policy makers and academics from 50 different countries have gathered in Seattle this week to dig deeper into what one of the leaders in the field characterized as having done for global health what the Human Genome Project has done for biomedical science and medicine.

“This is the golden era for global health,” said Julio Frenk, dean of the Harvard School of Public Health, on the opening day of the conference.

Part of what makes it golden, Frenk said, is the new Global Burden of Disease Study – a massive worldwide assessment of what’s killing, injuring and disabling people around the planet. The GBD, as its known, was created by some 500 researchers in 187 countries looking through hundreds of millions of reports on nearly 300 causes of death and disability.

GHME crowd

It’s the global health community equivalent of sequencing all human DNA, Frenk said, and a sign that this field has entered its ‘Big Data’ stage. But data alone is not enough, Frenk said, adding that what’s needed is to use this data to create a truly global and ‘pluralistic’ community aimed at improving health.

And just as the human genome project did not proceed without controversy, neither has the Global Burden of Disease. As Lancet editor Richard Horton noted in his comments at the opening session of the Seattle meeting (and in the video above), contained within all these GBD measurements of death and disease are dicey political issues of justice, power and equity.

“Human rights and health metrics is not the most obvious marriage,” Horton said. In fact, he added, the human rights community often tends to look upon the health data community with suspicion, and vice versa. But numbers are not facts, he said, and disease charts do not naturally translate into policy decisions.

The next step for making the best use of this powerful new tool, he said, is to focus on translating the data into meaningful policy decisions and political action.

“We can use these new data, with the combined forces of the human rights and global health community, to make the uncounted count, to make the invisible more visible and to bring more attention to those now marginalized,” said Horton.

Scientists identify China’s mysteriously massive cancer burden | 

Tai Chi in the park

Flickr, PTorrodellas

Tai Chi in the park

Scientists in Seattle, Australia and China report in The Lancet today on the leading causes of death and disability – as well as the many positive health trends – in a rapidly modernizing China.

Perhaps unsurprisingly, the study, based on Global Burden of Disease data compiled at the University of Washington’s Institute for Health Metrics and Evaluation (IHME), found that China’s rapid economic development over the past few decades has been accompanied by a decline in ‘diseases of poverty’ like malaria, vaccine-preventable infectious diseases and child malnutrition.

The world’s largest nation and new emerging superpower also has seen remarkable progress at lowering childhood and maternal mortality, along with an equally unsurprising rise in the burden of diseases and disorders familiar to wealthier countries such as heart disease, stroke and dementia. Air pollution gets special attention as well.

NPR reported As China Gets Richer, First World Diseases Take Hold, which was the primary theme of the The Lancet special report on China. Similarly, Forbes reported that China’s health problems mirror wealthy nations.

Not quite.

One surprising – and not completely understood or explained – finding out of the study is that China appears to be the undisputed world leader for certain cancers: Liver, stomach and esophageal.

I asked a policy translation specialist at IHME, Katie Leach-Kemon, to dig into this a little deeper using one of IHME’s data visualization tools known as a ’cause pattern’ analysis. Leach-Kemon compiled this graphic below showing age-standardized rates of years-of-life-lost due to different cancers around the world. Here’s a link to the active chart online. Notice my red highlights:

China Cancer GBD CompareMarked

UW IHME

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Visualize Global Health | 

It’s a new dawn for global health data borne of necessity, mind-numbing numbers, Netflix and a desire to avoid insanity.

“For our own sanity, we needed to create a new way to look at this stuff,” said Peter Speyer.

Speyer, head of data development at Seattle’s Institute for Health Metrics and Evaluation, explained why he and his colleagues are transforming a massive collection of health data known as the Global Burden of Disease (GBD) into a stunning collection of powerful online and interactive visual tools. Go to the link; below is just a screen grab. Seriously, go there and try these out. You’ll have fun even if you don’t know yet what you’re doing.

GBD visualizations

Today, Bill Gates and Speyer’s boss, IHME director Chris Murray, officially unveiled some of those tools aimed at allowing anyone (even you) to dig deeper into these global estimates arrived at by some 500 researchers working in collaboration worldwide for five years on more than 200 million results tracking the impact of nearly 300 causes of death and disability in 187 countries.

Phew. It makes your head hurt just to read that sentence. Imagine trying to compile a complete report including all of the numbers, statistics and charts.

“That’s one of the most exciting things about this phase of the project,” said Murray, who with his long-time partner in death-and-disability number crunching, Alan Lopez of the University of Queensland in Australia, has been trying for decades to create a reliable yardstick for measuring what’s going on in global health.

Chris Murray
Chris Murray
IHME

“I think these visual tools represent a significant paradigm change for global health,” Murray said. “They engage even the most data-resistant people. It’s an incredible revelation to me how profoundly influential it can be to present the data in this way. I think data visualization will be revolutionary for global health.”

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Global health spending is stable, non-communicable diseases neglected | 

Some of the world’s leading global health number-crunchers, at the Seattle-based Institute for Health Metrics and Evaluation, wanted to know if a perceived slowdown in what had been a rapidly increasing war chest for fighting diseases of poverty represented The End of the Global Age for global health.

Funding has flattened out, the study reports, but on a plateau that reveals one category of huge neglect – non-communicable diseases.

“From the late 1990s to 2010, we saw a period of rapidly increasing funding for global health,” said Michael Hanlon, one of the lead authors of the report released today entitled Financing Global Health 2012: The End of the Golden Age? The IHME report follows up several earlier, similar reports which revealed a plateau, and even a decline between 2010 and 2011, in new funding for global health activities.

Mike Hanlon IHME“I think the good news here is that we’re not seeing a decline yet and are maintaining a high level of funding,” Hanlon said. “That could change, of course, but I think it’s fair to say we’ve ended the phase of rapid increases in funding and entered a new phase, a maintenance phase.”

Here’s an illustration from the IHME report showing, over the past 10 years or so, the overall increase in development assistance for health (DAH).

IHME Global Health FinancingSo it’s mostly good news, at least for those who believe spending on global health is good.

Whether this is good enough (relative to what we spend on dog food, cosmetics and bottled water – not to mention military adventures or bailing out struggling bankers) is another question, of course. And whether the money is going where it’s most needed is another question raised by this report. Following are some highlights: Continue reading

The burden of a new global health agenda | 

Flickr, Oliver Erdmann

A massive study of death, disability and disease on Earth, coordinated out of Seattle and to be officially published in The Lancet on Friday, could do for global health something like what Galileo did for the solar system.

It’s called the Global Burden of Disease (technically, the Global Burden of Disease, Injuries and Risk Factors Study 2010) and it is, like its earlier incarnations dating back to 1990, almost guaranteed to provoke and disrupt the international community’s approach to improving global health.

The good news is that people, in general, are living longer.  The bad news is more of them seem to be fatter, still smoking too much and suffering from disabilities.

Just as the 16th century astronomer Galileo – much to the dismay of the religious orthodoxy of the time – displaced Earth from its celestial prominence in favor of the Sun, the new Global Burden of Disease may displace infectious disease from its position as the categorical center of the global health universe.

Think the top three killers in the world are scourges like AIDS, tuberculosis and malaria? Think again, of heart disease, respiratory infections and stroke.

Think preventing death is the best way to tell if we’re winning the war on disease? You better think again about that as well since rates of obesity, chronic pain, injury and mental illness may say more….

Chris Murray

“We were surprised by many of the findings,” said Chris Murray, one of the founders of the study and director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

“The simple purpose of this study has always been to provide the best scientific evidence on patterns of disease and disability to help us make sense of what’s happening out there and set priorities,” Murray said.

Sounds simple enough. So why did it take some 500 researchers more than five years to do it? Continue reading

Study: Malaria death toll nearly twice the official count, kills many adults | 

Flickr, ACJ1

A new global estimate of malaria deaths by researchers in Seattle has revealed the death toll is much greater than most experts had thought — and is not, as had been universally assumed, mostly a killer of children.

The study found more than 1.2 million people died from malaria in 2010, nearly twice the official estimate put out by the World Health Organization, and more than a third of the deaths were in adults.

The common wisdom has been that 99 percent of malaria deaths are in young children because adults develop immunity.

“This radically changes the picture,” said Dr. Christopher Murray, lead author of the study and director of the University of Washington’s Institute for Health Metrics and Evaluation (IHME).

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Global health funding still growing, but slowing | 

Despite the global economic downturn, funding for projects aimed at fighting the diseases of poverty around the world continued to increase — but at a slower pace — throughout 2011, according to a report from Seattle researchers.

IHME

Chris Murray

“Even though we continue to see growth in global health funding through 2011, it is troubling to see so many funders pulling back,” said Dr. Christopher Murray, director of the UW’s Institute for Health Metrics and Evaluation and one of the report’s authors. “We are just now beginning to see the impact from the extraordinary growth in global health funding over the past decade. If we give up now, we may lose that momentum.”

The massive increase in global health spending over the past decade has produced significant improvements in maternal and child mortality, reductions in malaria incidence as well as preventing and treating HIV infections worldwide, Murray noted. The IHME report is published online in Health Affairs.

But now, say the Seattle number crunchers, major international health initiatives like the Global Fund to Fight AIDS, TB and Malaria are seeing donations decline (to the Global Fund, a 16 percent decline last year).

On the upside, given everything else going on, it is good news that global health funding has continued to increase overall. On the downside, the increase in 2011 was about 4 percent — the slowest rate of growth for this sector over the past decade. Continue reading

If 7 billion people are living on Earth, how many are dying? | 

Flickr, aldinegirl87

One of the big news items this week was that the global human population was expected to reach 7 billion with a baby born on Halloween, according to a gang of UN statisticians.

That was yesterday. Today is Day of the Dead, or Día de los Muertos in Mexico.

So let’s talk about dying.

No, this is not a Malthusian strategy for popluation control. What we will examine is  how death actually causes population growth — and how little we know about why people die.

This will lead us into a discussion about a technique known as “verbal autopsies,” which some Seattle scientists are working to refine, and a new phone app that could help reduce the global birth/death burden on the planet.

It is truly a killer app.

First, it needs to be said that we can’t really know when the global population will have precisely crossed the 7 billion person threshold. In fact, as the BBC notes, we may be off by many months — or even years — in either direction with this estimate.

Secondly, we are equally in the dark about how and why people die, about 50 million per year. Most countries around the world have very poor mortality statistics.

But one thing we do know for certain is that those countries with the highest mortality rates are also the countries with highest population growth.

Huh? Yes, you read that right. Continue reading