For better health, countries must understand death

By Michael Igoe 23 August 2016

Dr. Kelly Henning, head of Bloomberg Philanthropies’ public health program. Photo by: Bloomberg Philanthropies

Last week the World Health Organization announced a new partner in its effort to combat noncommunicable diseases such as cancer, cardiovascular disease and diabetes, which — together with injuries — account for roughly 80 percent of deaths worldwide. Michael Bloomberg, the former New York City mayor and billionaire philanthropist, is the WHO’s new global ambassador for noncommunicable diseases.

Bloomberg takes a famously data-driven approach to public policy, and the same is true for the foundation he founded, Bloomberg Philanthropies. Last year the foundation launched a four-year, $100 million Data for Health initiative that seeks to help ministries of health understand what people are dying from in their countries.

“The goal here is really to address this giant gap, whereby we know 65 percent of deaths in the world — that’s about 35 million — go unrecorded,” said Dr. Kelly Henning, who has led the Bloomberg Philanthropies public health program since it started in 2007.

International health organizations and country governments have dedicated a great deal of time and resources to improving the registration of births. But in many cases, cause of death data goes unrecorded, particularly at the national level.

“We have quite good global estimates on burden of disease, and we all use them, and I think they’re invaluable. But we don’t have really robust data that governments have a lot of confidence in, in terms of cause of death at their own government level. They really need it for planning purposes, for tracking disease control and disease management, and for funding priorities,” she added.

Data for Health currently works in 18 countries, with plans to expand into two more. While it’s too early to glean much from the statistics that the initiative is working with countries to compile and analyze, Henning said the program has already seen some early returns.

For example, the government of Australia urged Bloomberg Philanthropies to work with the Solomon Islands, where the standard death certificates used to record people’s cause of death were often hard to interpret. In what Henning described as an “early win” for Data for Health, that country’s government has now committed to using best practice death registrations.

Henning also hopes Data for Health will help countries shorten the distance between data and decisions. When Brazil’s ministry of health faced a surging Zika virus epidemic, the program team pivoted to help the government link together the large amounts of health data it already collects on births, congenital malformations, laboratories, and mosquito infestation levels in ways that could help them target and deploy resources to combat Zika. They also worked to build data visualization tools to replace the cumbersome practice of sifting through reams of collected data manually. That’s the kind of real time response effort Henning believes Data for Health can help deliver when its partner countries find themselves facing an urgent health response need.

Here are the highlights of our conversation with Henning, edited for length and clarity:

How is it possible to have good global cause of death estimates without having good national level information?

It’s a matter of scale. The leading cause of death in the world today, across the globe is cardiovascular disease. Do I believe that improving country level cause of death data is going to change that fact? Most likely not. Cardiovascular disease is far and away the leading cause of death globally. However, once you get below the number one, number two, number three causes of death at the country level, those rankings may change somewhat from the global estimates. In addition, the actual number of deaths is important to countries, because they want to do programming and management that can help address and bring down those deaths. But they don’t have their own estimates. They just have a global estimate that says, “based on my 10 nearest neighbors, I probably have about X number of deaths.” It’s not very precise and it’s not very useful for planning purposes.

There seems to be a general consensus that data is critical, but at the same time it also seems to be true that a lot of the pressure create data is coming from the top down, rather than the bottom up. How do you make sure that the things you’re focused on are the things countries want to be focused on?

We’re really very proud of the approach that we’ve set out here. We’ve spent over a year now reaching out to governments, ministries of health, national statistical offices, census bureaus, whatever it is in the country — those ministries that are key to birth and death registration and data use. In many cases that’s several ministries. We, Bloomberg Philanthropies’ partners, have gone to visit those countries and those groups, brought them together — sometimes for the first time, maybe ever — and talked with them about, is this something you’re interested in doing? There are a lot of countries in the world, so we don’t want to just randomly pick countries. It takes work and we wanted them to be ready.

In those initial meetings we set out a scheme whereby all the appropriate agencies in the government would need to sign off and commit that this was something they really wanted to get involved with. In return what we have offered the governments is not just a lot of technical assistance, which is very important to try to address some of their data needs, but also we’ve actually provided them with staff. We’ve actually funded some focal points to sit in their ministries, to be their go-to person, people they identify who can be their go-to. A lot of times there’s not a person who’s able to take this on as a full time commitment.

Where are they finding those people? Are they hiring locally, or are they finding international experts who can fill those posts?

They’re hiring local people. They’re largely epidemiologists who are trained in country. It’s very useful to have a designated counterpart, but more importantly it’s useful for the government to have this extra capacity. It’s not so much about providing computers and software. That mostly exists out there. It’s more about the manpower to get the project going and to help with the inter sectoral coordination that’s needed.

What is the constraint for them in hiring those people now? Is it purely a budgetary constraint?

It is largely a budgetary constraint. Although — we don’t have analytics on this — I think some of it is also just raising this issue in the basket of all the things they have to deal with. Well, if we have a person to deal with this, let’s take this on and see if we can do it. It can spur action as well.

What does this effort — its focus and design — say about the way that Bloomberg Philanthropies engages in global health challenges?

We see this at Bloomberg Philanthropies as underpinning all of our public health work. We have a very large emphasis on noncommunicable diseases and on injuries, and the mortality information around those conditions is very sparse. There’s a giant, unmet need. So we see this as kind of supporting all of what we’re trying to do at Bloomberg, but more importantly, what the countries want to do. They now have these goals and objectives that they’re trying to meet, and the information that’s available to them —  they don’t think project by project. They’re thinking about their whole health system and whole data system, and they have a lot of needs. The appetite for countries to engage with us on this has been very powerful.

For more Devex coverage on global health, visit Focus On: Global Health

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About the author

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Michael Igoe@AlterIgoe

Michael Igoe is a senior correspondent for Devex. Based in Washington, D.C., he covers U.S. foreign aid and emerging trends in international development and humanitarian policy. Michael draws on his experience as both a journalist and international development practitioner in Central Asia to develop stories from an insider's perspective.

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