- Email: [email protected]
Understanding death, extending life
Comment
Understanding death, extending life One of the biggest contributors to preventable deaths isn’t a health problem but a record-keeping problem— and it is one that can be solved. According to WHO, nearly two-thirds of all deaths—38 million each year—go unreported.1 Millions more deaths lack a documented cause. Many countries do not have complete birth records, while others lack reliable data about risk factors associated with poor health and non-communicable diseases—for instance, rates of tobacco use or access to nutritious food. Without that data, governments, donors, and nongovernmental organisations can’t accurately target resources to prevent deaths and diseases, and have no way to measure whether their efforts are working. The absence of health data threatens our ability to reach all of the UN’s recently proposed Sustainable Development Goals for public health,2 and it means that millions of people each year are dying prematurely or suffering needlessly from disease. The good news is that there is strong evidence that proven strategies can greatly improve the quality and availability of public health data. Government reforms in countries such as Turkey and South Africa have led to substantial gains in the number of recorded deaths with a documented cause.3 Those countries now have better information to guide their public health policies, and countries with high-quality health data are shown to have better health outcomes than those that don’t.4 In addition, several national and international organisations are now providing resources to improve the quality of global health data, including WHO, The World Bank, and the governments of Canada, Norway, and the USA. Efforts led by the UN Economic Commission for Africa and the UN Economic and Social Commission for Asia and the Pacific have also made progress mobilising government support for improvements in health data in those regions. However, much more needs to be done. As noted by Lene Mikkelsen and colleagues3 in the Lancet Counting Births and Deaths Series, during the past 15 years, registered deaths have increased only moderately, from 36% in 2000 to 38% today. To help accelerate global progress and provide technical resources to countries that need them, earlier this year Bloomberg Philanthropies and the Australian Government joined together to launch www.thelancet.com Vol 386 October 17, 2015
an ambitious new effort called Data for Health. This US$100 million initiative aims to provide better health data for more than 1 billion people in the next 4 years. To reach that goal, we brought together a group of leading partners that includes the US Centers for Disease Control and Prevention, the Union North America, the University of Melbourne, Johns Hopkins University, and WHO. To assess where this initiative might have the greatest impact, we began by identifying a group of 20 countries that had already expressed interest in improving their public health data, and where there is especially great potential for gains. Over the past 6 months, we have been meeting with leaders in each of these countries to learn more about their priorities and how the Data for Health initiative can help them reach their goals. After visits with 19 countries and intensive dialogue with health leaders in each, we have already created partnerships with ten countries—Brazil, Morocco, Tanzania, Bangladesh, Malawi, Zambia, the Philippines, Indonesia, the Solomon Islands, and Myanmar—as well as the Chinese city of Shanghai. Together these places are home to nearly 900 million people. In the months to come, we hope to expand this partnership group to 20 participating countries or cities. In each place, our work is guided by local priorities, and focused on finding innovative ways to help countries improve how data are collected and used. For instance, some participating countries are seeking a better understanding of the effect of non-communicable diseases but in many cases these data are still collected through in-person surveys, which are time intensive, especially in the remote regions that are often in greatest need of improved health services. Our programme will help countries begin to collect data using mobile phones and other technology, which is faster, less costly, and will allow them to update data much more frequently. In countries that have prioritised better documentation of causes of death, we will help create systems for training medical staff, which will lead to more data on why and where people are dying. Other countries we are working with are focused on organising the data they do have to make it easier for policy makers to access, understand, and analyse. In addition, we will help make high-quality birth and death certificates a standard practice in more countries.
Published Online October 2, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)00400-6 See Editorial Lancet 2015; 386: 1312 See Comment Lancet 2015; 386: 1313 See Series Lancet 2015; 386: 1373, 1386, 1395, and 1407 For Data for Health see http:// www.bloomberg.org/program/ public-health/data-health/
e18
Comment
For innovationXchange see https://innovationxchange.dfat. gov.au/about-us
e19
Improving global health data is one of the greatest opportunities we have to help people live longer, healthier lives—and it is a natural collaboration for Bloomberg Philanthropies and the Australian Government’s innovationXchange, which was also launched this year to catalyse innovation and drive effectiveness in Australia’s aid programme. We both share an emphasis on the use of data to identify opportunities, ensure accountability, and maximise the impact of limited resources. We hope that, by coordinating with existing efforts, working with committed countries, and highlighting innovative practices which can easily be replicated in other countries, Data for Health can have an impact that extends around the globe and benefits billions of lives.
*Michael R Bloomberg, Julie Bishop Bloomberg Philanthropies, New York, NY 10075, USA (MRB); and Department of Foreign Affairs and Trade, Australian Government, Canberra, Barton ACT, Australia (JB) [email protected] We declare no competing interests. MRB is Founder of Bloomberg Philanthropies and Bloomberg LP. JB is Minister of Foreign Affairs for the Australian Government. 1
2
3
4
WHO. Civil registration: why counting births and deaths is important. May, 2014. http://www.who.int/mediacentre/factsheets/fs324/en/ (accessed Sept 29, 2015). AbouZahr C, de Savigny D, Mikkelsen L, Setel PW, Lozano R, Lopez AD. Towards universal civil registration and vital statistics systems: the time is now. Lancet 2015; 386: 1407–18. Mikkelsen L, Phillips DE, AbouZahr C, et al. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet 2015; 386: 1395–406. Phillips DE, AbouZahr C, Lopez AD, et al. Are well functioning civil registration and vital statistics systems associated with better health outcomes? Lancet 2015; 386: 1386–94.
www.thelancet.com Vol 386 October 17, 2015
Understanding death, extending life One of the biggest contributors to preventable deaths isn’t a health problem but a record-keeping problem— and it is one that can be solved. According to WHO, nearly two-thirds of all deaths—38 million each year—go unreported.1 Millions more deaths lack a documented cause. Many countries do not have complete birth records, while others lack reliable data about risk factors associated with poor health and non-communicable diseases—for instance, rates of tobacco use or access to nutritious food. Without that data, governments, donors, and nongovernmental organisations can’t accurately target resources to prevent deaths and diseases, and have no way to measure whether their efforts are working. The absence of health data threatens our ability to reach all of the UN’s recently proposed Sustainable Development Goals for public health,2 and it means that millions of people each year are dying prematurely or suffering needlessly from disease. The good news is that there is strong evidence that proven strategies can greatly improve the quality and availability of public health data. Government reforms in countries such as Turkey and South Africa have led to substantial gains in the number of recorded deaths with a documented cause.3 Those countries now have better information to guide their public health policies, and countries with high-quality health data are shown to have better health outcomes than those that don’t.4 In addition, several national and international organisations are now providing resources to improve the quality of global health data, including WHO, The World Bank, and the governments of Canada, Norway, and the USA. Efforts led by the UN Economic Commission for Africa and the UN Economic and Social Commission for Asia and the Pacific have also made progress mobilising government support for improvements in health data in those regions. However, much more needs to be done. As noted by Lene Mikkelsen and colleagues3 in the Lancet Counting Births and Deaths Series, during the past 15 years, registered deaths have increased only moderately, from 36% in 2000 to 38% today. To help accelerate global progress and provide technical resources to countries that need them, earlier this year Bloomberg Philanthropies and the Australian Government joined together to launch www.thelancet.com Vol 386 October 17, 2015
an ambitious new effort called Data for Health. This US$100 million initiative aims to provide better health data for more than 1 billion people in the next 4 years. To reach that goal, we brought together a group of leading partners that includes the US Centers for Disease Control and Prevention, the Union North America, the University of Melbourne, Johns Hopkins University, and WHO. To assess where this initiative might have the greatest impact, we began by identifying a group of 20 countries that had already expressed interest in improving their public health data, and where there is especially great potential for gains. Over the past 6 months, we have been meeting with leaders in each of these countries to learn more about their priorities and how the Data for Health initiative can help them reach their goals. After visits with 19 countries and intensive dialogue with health leaders in each, we have already created partnerships with ten countries—Brazil, Morocco, Tanzania, Bangladesh, Malawi, Zambia, the Philippines, Indonesia, the Solomon Islands, and Myanmar—as well as the Chinese city of Shanghai. Together these places are home to nearly 900 million people. In the months to come, we hope to expand this partnership group to 20 participating countries or cities. In each place, our work is guided by local priorities, and focused on finding innovative ways to help countries improve how data are collected and used. For instance, some participating countries are seeking a better understanding of the effect of non-communicable diseases but in many cases these data are still collected through in-person surveys, which are time intensive, especially in the remote regions that are often in greatest need of improved health services. Our programme will help countries begin to collect data using mobile phones and other technology, which is faster, less costly, and will allow them to update data much more frequently. In countries that have prioritised better documentation of causes of death, we will help create systems for training medical staff, which will lead to more data on why and where people are dying. Other countries we are working with are focused on organising the data they do have to make it easier for policy makers to access, understand, and analyse. In addition, we will help make high-quality birth and death certificates a standard practice in more countries.
Published Online October 2, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)00400-6 See Editorial Lancet 2015; 386: 1312 See Comment Lancet 2015; 386: 1313 See Series Lancet 2015; 386: 1373, 1386, 1395, and 1407 For Data for Health see http:// www.bloomberg.org/program/ public-health/data-health/
e18
Comment
For innovationXchange see https://innovationxchange.dfat. gov.au/about-us
e19
Improving global health data is one of the greatest opportunities we have to help people live longer, healthier lives—and it is a natural collaboration for Bloomberg Philanthropies and the Australian Government’s innovationXchange, which was also launched this year to catalyse innovation and drive effectiveness in Australia’s aid programme. We both share an emphasis on the use of data to identify opportunities, ensure accountability, and maximise the impact of limited resources. We hope that, by coordinating with existing efforts, working with committed countries, and highlighting innovative practices which can easily be replicated in other countries, Data for Health can have an impact that extends around the globe and benefits billions of lives.
*Michael R Bloomberg, Julie Bishop Bloomberg Philanthropies, New York, NY 10075, USA (MRB); and Department of Foreign Affairs and Trade, Australian Government, Canberra, Barton ACT, Australia (JB) [email protected] We declare no competing interests. MRB is Founder of Bloomberg Philanthropies and Bloomberg LP. JB is Minister of Foreign Affairs for the Australian Government. 1
2
3
4
WHO. Civil registration: why counting births and deaths is important. May, 2014. http://www.who.int/mediacentre/factsheets/fs324/en/ (accessed Sept 29, 2015). AbouZahr C, de Savigny D, Mikkelsen L, Setel PW, Lozano R, Lopez AD. Towards universal civil registration and vital statistics systems: the time is now. Lancet 2015; 386: 1407–18. Mikkelsen L, Phillips DE, AbouZahr C, et al. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet 2015; 386: 1395–406. Phillips DE, AbouZahr C, Lopez AD, et al. Are well functioning civil registration and vital statistics systems associated with better health outcomes? Lancet 2015; 386: 1386–94.
www.thelancet.com Vol 386 October 17, 2015