These new maps point to the power of 'precision public health'

SAN FRANCISCO — Last week, the Institute for Health Metrics and Evaluation published two studies revealing health and education disparities on the African continent. What is significant about these studies is not only the results, but also the process that was used to arrive at them, known as “precision mapping.” With the support of the Bill & Melinda Gates Foundation, IHME is mapping a range of global health metrics using 5x5 kilometer units. Whereas national or provincial maps can hide inequality at the community level, these local maps provide stakeholders with better information on where to direct resources. In an email interview, Devex asked Simon Hay, director of the Local Burden of Disease Study at IHME at the University of Washington in Seattle, to explain the connection between precision public health and sustainable global development. This interview has been edited for brevity and clarity. You explain that national and provincial maps of education and nutrition in Africa often hide inequalities at the community level. Can you expand on why that is, why it’s problematic, and what attempts there have been to solve it? National and provincial maps reflecting averages over wide areas may mask large subnational and 5x5 km community-level variation. For instance, at the national level, the average woman of reproductive age in Nigeria has completed primary school in 2015. At finer geographic levels, however, our study found these probabilities ranged from almost 0-100 percent of the population, depending on the district, or communities within the district. Our maps reveal these “hot spots” of low education, and poor nutrition in young children. They shine a light on communities that have experienced positive socioeconomic development or implemented successful educational and nutritional programs over the past 15 years. As researchers, policymakers, and program implementers determine the optimal mix of interventions to improve health and education outcomes, having precision maps at their disposal will help in the monitoring of subnational inequalities and targeting of interventions to the populations in greatest need. This data will help to effectively and equitably target resources, as African countries strive to meet their Sustainable Development Goals. You mention that these maps are examples of a new discipline in scientific research: “Precision public health.” Can you paint a picture of the landscape of these efforts? Precision public health is an emerging discipline. It will be valuable over the next 12 years — and beyond — as countries work toward meeting their SDGs by 2030. They will help deliver appropriate resources accurately to vulnerable populations, improving health outcomes, and related measures. The new precision public health tools provided by our recently published work in Nature build upon previous efforts in this discipline led by my team at IHME to map malaria, child mortality, and pandemics such as Ebola and Zika virus, among others. Calls for increased precision public health research have been echoed by other stakeholders, including the Gates Foundation. While country-level estimates are useful for international comparisons and benchmarking, they mask disparities in health outcomes at lower administrative units where most health, nutrition, and education program planning and implementation occur. The value of precision public health in this context — the use of more granular data to guide efficient application of interventions to populations in greatest need — will be valuable to the global health community. It also provides a compelling guide and thus responsibility to act, as outlined by Kofi Annan. Without comparable, robust subnational information on health outcomes and related sociodemographic measures, stakeholders face sizeable challenges in equitable targeting and optimal funding allocations for relevant interventions. Can you expand on your partnership with the Gates Foundation on this approach to mapping, and highlight possible next steps? The Gates Foundation funded the work, part of a five-year grant that will enable IHME researchers eventually to map a wide range of health metrics in low-and middle-income countries in 5x5 km units. The Gates Foundation is also a champion of the growing precision public health paradigm. These studies demonstrate that georeferenced survey data, if properly harnessed, can allow for the synthesis of the data into local and community-level maps. A sizable geographic knowledge gap remains, however, with much of our current work focused on mapping the African continent. As IHME expands our analysis of child growth failure, education attainment, and many other health conditions, the availability of data is a key challenge. While our child growth failure study, for example, is informed by more than 200 data sources totaling 1.29 million measured children, areas of greatest uncertainty in our estimates usually correspond to those in need of newer or in some cases any information. This data often is acquired through household surveys. To continue to track progress towards the SDGs it is essential that these surveys are conducted and their information made widely available. Expansion to additional low- and middle-income countries and other health conditions underscores the need for enhanced data collection and retrospective data retrieval as we measure progress toward global goals. Through collaboration with stakeholders and many members of the global health community, we can improve and refine data collection and sharing, in order to continue producing precision maps of health outcomes and related measures. As these maps are produced, they will be made freely and publicly accessible at healthdata.org, allowing audiences — from clinicians and teachers to donors and policy-makers — to access insights into where to direct resources in order to improve lives. They will also provide a great forum for feedback as we iterate updates of these maps in coming years.