Why invest in health evidence? Q&A with Chris Murray of IHME

Chris Murray, professor of global health at the University of Washington and director of the Institute for Health Metrics and Evaluation, first met Bill Gates when the Bill & Melinda Gates Foundation was just getting started. “Bill’s hunger for data and evidence and science is uniquely high,” Murray told Devex at a recent event celebrating the 10 year anniversary of IHME and a number of other Seattle global health organizations. “He really does just love information.” When the Gates Foundation launched in 2000, Murray was at the World Health Organization, where he was a founder of the Global Burden of Disease approach. That caught the attention of the Seattle-based philanthropists, who decided early on that they wanted to use GBD metrics to help set their own priorities, as they built what is now the largest charitable foundation in the world. In 2007, Murray returned to Seattle, this time to pitch the idea for IHME, which would provide an evidence-based picture of global health to inform the kind of data-driven work the foundation is now known for. “They took a gamble on the idea,” he said. “And it worked out.” IHME, based at UW, launched a decade ago with a $105 million grant from the Gates Foundation. Last month, the foundation announced another $279 million grant — the largest private donation in the university’s history — so that IHME can continue and expand its work over the next decade. “We’re committed to providing the best measurement of health outcomes and health determinants and what health systems do in response to those outcomes in every country of the world over time and to make that freely available for everybody to use,” Murray said. At the “Next Decade: Next Generation” event at UW last week, Murray spoke with Devex about the importance of improving the quality and use of evidence in the field of global health. Here are excerpts of that conversation, edited for length and clarity. I want to talk with you about positive outliers in datasets. I’ve written for Devex about how the growing emphasis on data-driven development presents an opportunity for global development professionals to learn from and perhaps even replicate the successes of the best performers within a data set. What is your advice for our audience when it comes to taking advantage of this opportunity? We’re very interested in this. By the nature of looking for positive deviants, you have to ask yourself, is it real or is it a measurement problem? Because when you’re looking out at the tail of distribution, the risk of error goes up. So this is always the worry people have. We do lots of things to protect against that. Because there’s so much interest in this, we’ve tried to build into what we do this analysis of observed versus expected. Expected on the basis of development status alone. In the past, people used to put up a graph showing anything you’re interested in — infant mortality rate or life expectancy versus income per capita — and say, “Oh these people have lower maternal mortality or higher life expectancy than other countries at that level of income.” Income, we thought, was a pretty imperfect way to think about development. So we created the Socio-demographic Index — which is income, education and fertility — which we think is a more stable measure of development status. And now what we’ve built into each cycle — and you’ll see it more fully in the GBD 2016 cycle — is an analysis of the average you’d expect for a disease or an outcome historically based on development status, and where a country sits compared to that expected value. And that allows you to really quickly pinpoint who is a positive deviant for a disease, for an age group, overall for healthy life expectancy. And we’re just writing up this cycle of results. There are some interesting ones that stand out. There’s also a difference in thinking about who may have always been better than expected — and so maybe there’s some sort of cultural or environmental factor going back 50 years or earlier — and who has been making better progress than expected. You can have a snapshot view or a temporal view. You can take someone much worse than expected, say Ethiopia 30 years ago, and see they really made more progress than they should have and that’s a different type of positive deviant. That’s a recent progress positive deviant. We’re trying to add both dimensions and that makes it a little complicated because people just say, “Oh tell me who are the positive deviants.” But deviants in a snapshot and deviants over time give you different insights, and I think the ones over time are more actionable in a way. If you were actually worse than expected, and then suddenly made faster progress, hopefully there are some lessons you can learn. Speakers from IHME are represented in a number of panels at this event, one on pandemic preparedness and response, and the other on prevention and care for noncommunicable diseases. What would your message for Devex readers be, if you were to take the stage? There are two different messages. For the audience that’s involved in the research, the process around global health, the message is that despite all the investments in global health, there are these huge gaps in what we know. You can do more and more sophisticated analyses, but at some level you also have to improve the fundamental data systems. And so there is still a long way to go on that. There has been remarkably little progress, actually, in the lowest development status countries in the quality of death data, one of the more bread and butter things we need to know. And that’s been kind of hard to make progress on. For the decisionmaking user audience, it’s almost the reverse. Despite these gaps in data, there are much better tools around the likely causes of illness and death in different locations, as well as information on the new threats on the horizon. And just having that more baked into national discussion about priorities is what needs to happen. So there are a lot of resources available. We produce them and others produce them. But they could be used much more. A big theme of the discussion today, and this is the case at so many events related to global health and global development, is the importance of collaboration. I know IHME has shifted its model toward a global collaborative effort. Can you expand on that, as well as what the future may hold for IHME when it comes to partnerships? Through our global collaborative scientific model, we have 2,100 collaborators in 130 countries now, and that’s been a big change. It changes the way we work and it also means at the end of the day, when you have results, you have people who own them. We don’t quite know how to handle the volume of engagement, so we have some challenges there. But we are working on better tools to think about and quantify what the big threats are and they are going to keep getting better as they are produced by a global community working together. But our approach is not collaboration for the sake of collaboration. It’s collaboration because that’s the best way to do the job. What’s bringing everybody together is a shared view of wanting to track health in great detail to be better prepared to deal with health problems. We’ve got a mechanism by which people can engage, and that improves both the quality of what’s done and the use of it. In many ways, task oriented or goal oriented collaboration is a great vehicle because it does lead to better work. And you can convince funders of that by the quality of what you do. The best route to enhancing collaboration — and donor support for collaboration — may be demonstrating that if you want to achieve something, that is the way to do it. We run what is probably the largest collaboration in all of science that publishes together. We’re looking to expand that — to find some lead partners in countries where we have local champions, leadership and ownership — to go the next step. We’ve seen that happen in a places like India or Brazil, where there is an organized structure around the work in those countries with deep engagement with researchers and decision-makers who are working to improve the quality and use of the information. Then there is the use of what we produce, which I think is far more detailed than most people know. We track most things you can think of in global health. But underneath these high-level things that people tend to focus on, there is a lot of granular detail. Take smoking, for example. We track smoking by age, sex, country, not only the prevalence but details like cigarettes consumed per capita. There are just so many potential uses — for advocacy, policy, influence, evaluative purposes — for all this data. So we’re very much now in this next decade thinking about partners our data could help and therefore make what we do more impactful. Let’s talk about the $279 million grant from the Gates Foundation. How will this allow you to continue and expand your work? There are three global public goods in this funding. The Global Burden of Disease; our work on tracking resources for health; and our work on the forecasting of different scenarios. The forecasting is a new area. We’ve done it haphazardly in the past, but to do that on a sustained basis and try to go through all the complexities of that is a new area. And then even for the GBD, the ambitions keep growing. We’ve built this collaborative network, and our attempts to deliver this to decision-makers at different levels have become much more extensive. Those resources and the long-term funding — it’s really rare to get such long-term funding — allow us to recruit the best talent, to commit to countries that are interested in using these global public goods, and to say “Those are going to be there, reliably there for you, every year going forward for a very long time.” It also means that we can serve the needs of the Gates Foundation, where they’re very data driven. They’re an organization that’s really focused on using the evidence both to set their own internal priorities and to evaluate where they’re making progress. A good example is the forecasting work where, because of development, because of improvements in education and rising income per capita, there are certain things that are going to happen anyway. And they want to assess their contribution relative to what would have happened anyway. Are they bending the curve? And that’s a very progressive view of the role of an organization. It just reflects how you can use data and metrics to help inform that sort of decision-making. Read more international development news online, and subscribe to The Development Newswire to receive the latest from the world’s leading donors and decision-makers — emailed to you free every business day.