When researchers set out in the early 1990s to quantify health problems around the globe, they quickly hit a statistical wall. They added up all...
When researchers set out in the early 1990s to quantify health problems around the globe, they quickly hit a statistical wall.
They added up all the mortality figures compiled by different programs within the World Health Organization (WHO) and found the total was three times the number of people who had died.
“Obviously, something was wrong,” said Dr. Christopher Murray, director of the University of Washington’s new Institute for Health Metrics & Evaluation.
As one of the world’s top experts in tracking disease and monitoring health care, Murray is on a mission to stamp out bogus numbers. His institute’s goals include providing reliable data on what works and what doesn’t in the battle against sickness and death in the developing world.
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That zeal has not endeared Murray and his benefactor — the Bill & Melinda Gates Foundation — to some in the global-health establishment. As the United Nations body charged with shaping the world’s health agenda, WHO’s core mission includes monitoring health trends and gathering statistics.
Some critics inside the bureaucracy bristle at an American billionaire encroaching on their turf, though few dare to openly speak out against the world’s richest philanthropy.
Murray has also stepped on toes at another U.N. health organization, the United Nations Children’s Fund (UNICEF) with a report that showed child-death rates are dropping more slowly today than they were 30 years ago.
But Murray and the Gates Foundation hope to quiet the discord this week, as the institute hosts its first international board meeting and scientific conference in Seattle. Participants include officials from WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank — all organizations whose record-keeping Murray would like to help beef up.
The Lancet, a leading British medical journal that is an advocate for global health and sometimes chronicles disagreements between researchers, is co-sponsoring the conference.
“There’s been an enormous rumor mill about potential rivalries between individuals and organizations,” said Lancet editor Dr. Richard Horton, who has scolded WHO and others in print for letting politics influence the way statistics are reported. “I think the conference is very much about saying: Let’s kill these rumors and try to build a proper cooperative relationship.”
Top leaders at WHO and other international bodies are enthusiastic about the UW institute’s push to improve collection, analysis and dissemination of health data, said Dr. Julio Frenk, a former Mexican health minister and senior fellow in global health at the Gates Foundation. The grumbling comes from lower levels.
“In any organization there are people who might feel threatened or react by saying: This is already being done,” said Frenk, who chairs the international board that will advise and guide the UW institute.
Health statistics may sound dry to most people, but like Murray, Microsoft co-founder Bill Gates is a numbers guy. When his foundation was preparing to tackle global health, he pored over a report based on methods Murray developed to put numerical values on the way illness and disability interfere with people’s lives.
Murray was lured to UW from Harvard last year after another billionaire, Oracle founder Larry Ellison, reneged on a pledge to build a public-health institute there. The Gates Foundation stepped up with $105 million, the largest private gift in UW history.
The timing is apt, because it’s crucial now to accurately measure progress in global health, said Murray, a former Rhodes scholar.
Thanks partly to the Gates Foundation, the amount of money flowing from wealthy nations to improve the health of the world’s poorest inhabitants has more than doubled from $8 billion in 2000 to $18 billion this year.
“If you don’t show any progress, that’s just not going to continue,” he said.
But the analyses have to be accurate and free of the political biases or agendas that can creep in at government bureaucracies such as WHO, said Murray, who felt pressure himself when he worked at the Geneva-based organization.
Countries can withhold data or lean on WHO’s leaders to keep bad health news from getting out. Then there are inherent tensions between full disclosure of data and WHO’s other missions of spotlighting disease and health problems, Murray said.
“It’s not a good setup to be charged with convincing people to give you money, spending the money, then evaluating how well you’re doing,” he said.
A recent Lancet editorial criticized UNICEF for rushing to publicize numbers that showed a drop in child deaths worldwide, while ignoring Murray’s conclusions about lackluster progress on death rates. The same editorial took WHO to task for touting an analysis in Kenya that found mass distribution of free bed nets can cut malaria infections, without noting the study’s uncertainties.
“U.N. agencies are willing to play fast and loose with scientific findings in order to further their own institutional interests,” the editorial said.
The sheer difficulty of collecting health statistics in poor countries was underscored by UNAIDS’ recent re-evaluation of the global HIV/AIDS epidemic. Based on surveys of women conducted largely at urban health clinics, the agency had estimated nearly 40 million people worldwide were infected, with more than 4 million new cases a year.
Detailed new surveys that targeted both urban and rural households led the agency to slash its estimate of total cases by about 7 million and downgrade the estimate of new infections 40 percent.
Some critics accused the agency of deliberately inflating the numbers, but Dr. Peter Piot, UNAIDS executive director, says that wasn’t the case.
“What is happening is that we now have new methodologies and the accuracy of what we are doing is becoming better and better,” said Piot, who will lead a session at this week’s conference.
The revised HIV numbers suggest that new infections may have peaked several years ago, and that in most areas the epidemic hasn’t exploded beyond high-risk groups, such as gay men and sex workers, into the general population. That insight will help UNAIDS set priorities.
Now, Piot plans to work with Murray and his team to wring even more detail from the statistics. For example, while UNAIDS deals with the entire world, the university scientists can bore into one country in great detail, or tease out information on where new infections are emerging.
Piot also is eager to use new methods developed at the institute in Seattle to evaluate the effectiveness of programs designed to slow the spread of AIDS.
If the numbers justify it, Murray is even prepared to bite the hand that feeds him: The Gates Foundation has asked the institute to conduct a detailed critique of its $258 million Avahan program, an HIV-prevention program targeted at Indian sex workers and their clients.
Sandi Doughton: 206-464-2491 or email@example.com