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Contributor: Karl Hofmann

A 'gold standard' moment for evidence-based decision-making in global health

By Karl Hofmann12 December 2012

Karl Hofmann, president and CEO of Population Services International.

Each year, billions of dollars in foreign aid are earmarked for various global health priorities. The process by which any given health area ascends to priority status may vary with context, but as a global health community, we shoulder a collective responsibility to target our efforts based on reliable data that point to where the need is greatest.

Think of global health spending as denominated in different “currencies” — not dollars, pounds or euros, but impact based on disease burdens. Is there higher mortality from respiratory infection and pneumonia than, say, diarrhea in your country? Then interventions against pneumonia will have a higher value in terms of saving lives. When the United States uncoupled the dollar from the gold standard in the 1970s, global currencies floated free and had to find their own relative value against one another. In global health, we are on the cusp of a periodic revaluing moment, one in which our standard unit of measure is being reset.

On Dec. 14, The Lancet together with the Institute for Health Metrics and Evaluation will release their study on global burden of disease, injuries and risk factors in 2010. These “gold standard” data will quantify the world’s health problems by examining statistics for 291 diseases and injuries and 67 different risk factors for 21 regions across three time periods — 1990, 2005 and 2010. Global health implementing organizations like the one I lead are also looking forward to the highly anticipated announcement that a new IHME burden estimation model will give us more frequent updates on the information we need to increase the relevance and impact of our health programs.

These data paint a picture of the main causes of illness, death and disability for populations in a given country or region. Having this common currency helps to trigger discussions and influence national policy debates that set priorities for funding and further research. Health burden data is also vital for implementing organizations that aim to evaluate where they should allocate resources and advocate for shifts in their or donors’ strategic focus.

The new health burden data are reference points for the units of currency that help us measure our impact, such as on the years of protection against unintended pregnancy, episodes of disease prevented, deaths averted, and years of healthy life saved, among many others.

As global health implementers, it is important that these metrics inform our work, define our impact and demonstrate our value to donors, and more importantly, to those we serve.

If only global health spending were as straight-forward as global currency exchanges. In reality, of course, they are much more political and sometimes less evidence-based. Many health programs and implementing organizations were established with a narrower mandate to tackle specific diseases — allowing them less flexibility to move into new areas as disease trends and patterns shift. Some health areas, such as nutrition, are so cross-cutting that they require the development community to tackle larger systemic issues such as improved agriculture productivity, market creation, food fortification, commodity pricing and eating habits. And in the fortunate event we stand on the threshold of eradicating a disease, as we do with guinea worm and perhaps soon with polio, a disproportionate amount of funding may be needed to ensure its demise.

PSI struggles with these complexities as well, but it has never been more important to get the balance right. It’s important that the global health community embrace a new paradigm — relevance — that will require us to use burden of disease data as a decisive criterion to inform our choices about which health conditions to target, where, and with whom.

The Lancet and IHME health burden data offer us a single common reference standard — a global health “gold standard” — against which to benchmark our various health impact currencies. It is a necessary revaluation for better value in global health spending.

About the author

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Karl Hofmann

Karl Hofmann is the President and CEO of PSI (Population Services International), a non-profit global health organization based in Washington, D.C. PSI operates in 67 countries worldwide, with programs in family planning and reproductive health, malaria, child survival, HIV, maternal and child health, and non-communicable diseases.


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