Crunching numbers, fighting disease
Hoo-boy, where do I begin trying to write about a bunch of people who mostly talk numbers and statistics?
How about we start with the fact that much of the time in global health it can seem like we are punching at perceived shadows in a dark room?
Oh, and also it can be a matter of life and death.
That is, global health projects are launched aimed at fighting a particular disease or problem based on the assumption that, first, it’s clear what the problem is and, second, it’s clear how to solve it. Got a problem with malaria? Give everyone a bednet. HIV? Just give everyone drugs. Malnutrition? Food ….
Of course, most of us know (even without knowing all the details) that nothing in life is ever that simple.
Fighting malnutrition requires more than just giving people more food, it turns out. It’s easy enough to say we should give everyone with HIV drugs, but is that the best use of scarce health resources for a poor African community? And are you sure those bed nets are really doing the job? Really? How do you know?
About 600 people who ask these kinds of annoying questions have come from all around to world to gather in Seattle at the Global Health Metrics and Evaluation conference. It’s sponsored by the UW’s Institute for Health Metrics and Evaluation (IHME), Harvard School of Public Health, The Lancet, the London School of Hygiene and Tropical Medicine and the University of Queensland School of Population Health.
The point of this meeting, and all these questions, is to find consensus on the best way to evaluate the effectiveness of the many different health programs out there.
“We have lots of methods and that’s part of the problem,” said Chris Murray, director of the IHME. What’s needed, Murray said, is a more coherent, reliable and independent approach to evaluating global health.
The first session at the number-crunchers’ meeting today was on measuring maternal deaths. That sure sounds simple enough, non-controversial. How complicated could it be to tell if a pregnant woman is still alive or not? And to the uninformed outsider, today’s session had all the drama of listening to accountants debate tax deductions.
But behind the arcane discussion of “co-variants” and statistical confidence was a major dust-up last year that Lancet editor Richard Horton today hinted at when, in his opening day statement, he appeared to be joking when referring to the global health community as having just had a “harmonious year.”
The disharmony came when Murray and his colleagues at the UW published new data showing a rapid decline in maternal mortality.
This conflicted with the standard, higher death rates established by the World Health Organization — and with the political needs of some women’s advocates. Here’s a New York Times story on the flap:
But some advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, Dr. Horton said in a telephone interview.
“I think this is one of those instances when science and advocacy can conflict,” he said.
Dr. Horton said the advocates, whom he declined to name, wanted the new information held and released only after certain meetings about maternal and child health had already taken place.
The WHO officials, some of whom are in Seattle for this meeting, initially challenged the accuracy of Murray and his gang’s new estimates … and then later revised their findings to arrive at about the same numbers and explained how they got in the same ballpark, but through a different route.
There wasn’t much sign of the controversy at today’s meeting, though John Wilmoth from UC-Berkeley (and one of the consultants to the WHO) said he still thinks Murray’s group is a bit off-target based on counting too many deaths from HIV as also maternal deaths.
“It’s important to know because this affects policy decisions,” Wilmoth said. Everyone agrees that maternal mortality is declining, Wilmoth said, but it’s not that easy to determine precisely at what rate.
Or why, as Nandini Oooman of the Center for Global Development describes in this excellent (if older) blog post: Maternal mortality: We already know what works…. or do we?
We need to know if the billions of dollars going to fight AIDS, malaria, TB, childhood infectious diseases, malnutrition or maternal mortality is working. If the efforts are working, we need to know why.
These are the people who will answer those questions, by asking a lot more annoying and boring questions and arguing amongst themselves.
