Tracking Global Health Improvements with New Method to Count the Dead

November 8/2019

by Françoise Makanda, Communications Officer at DLSPH

Getting a snapshot of a country’s health statistics is as easy as using simple causes of death and disability surveys with open-source data. Best of all, the method is low cost and reproducible.

Professor Prabhat Jha did just that with his National Burden Estimates (NBE) method. It combines open-source data from the United Nations, the World Health Organization (WHO) and data from his Million Death Study in India. He published the methodology in The Lancet Global Health journal today. DLSPH professors are eager to train international scholars to apply the method at the next SAVE-QES Summer Institute in June 2020.

“NBE is a simple way to enable every country to determine their local burden of disease, what’s killing people, and what’s disabling them,” says Jha, Professor of Epidemiology at DLSPH and lead investigator of India’s Million Death Study.

The UN’s Population Division has death counts and estimates for every country in an open dataset. The WHO’s Global Health Estimates has data on the relationship between every death and how much disability occurs.  In turn, the NBE method works for countries which are obtaining simple, but representative, local data estimates of deaths.

With NBE, Jha and co-authors observed that death by suicide was common in southern India. Young adults are taking their lives at an alarming rate compared to the north; a previous Million Death Study paper corroborated these results. Other findings demonstrated that cancers were more concentrated in the north. Disability rates—also known as DALYs—in rural areas were at least twice those of urban areas for chronic respiratory disease, diarrhea and fevers of unknown origins.

headshot of Professor Prabhat Jha

Professor Prabhat Jha

The method offers a solution—a new GPS-type method that provides countries with a transparent path to improving health. It also allows governments to prioritize public health programming efficiently and take ownership of health statistics. “If you can get India right, which is one-sixth of the humanity, you’re off to a reasonable start,” says Jha.

The third UN’s Sustainable Development Goals seek the advancement of good health and well-being, yet very few countries have the resources to meet this goal. Poorer countries are often too strapped for resources to measure death statistics. Many are still taking data from countries like the United States, a tactic Jha says can be misleading.

Although he is pleased with the results he obtained with lead author Dr. Geetha Menon who is also a 2018 Advanced QES Scholar, the next SAVE-QES Summer Institute will put the method to the test. A key goal of SAVE-QES is to expand the global understanding of mortality statistics and their uses. It also aims to accelerate the introduction of novel, low-cost mortality monitoring systems and expand the use of existing mortality data systems.

Jha and SAVE-QES program co-lead, Professor Erica Di Ruggiero, will be leading a group of researchers from different countries on a week-long training collaboration at DLSPH to use the NBE method for their host countries. Should the collaboration be successful, Jha and Di Ruggiero would like countries to use the method over time to track their progress. This is a part of an overall strategy that will allow DLSPH to have a greater impact on a global scale.

“This is a really great opportunity to demonstrate how improved measurement of mortality rates globally can contribute to several Sustainable Development Goals,” said Di Ruggiero, Associate Professor of Social and Behavioural Health Sciences and Director of the Office for Global Public Health Education and Training.

“Strengthened information systems put countries in a good position to be able to make effective decisions about health investments,” Di Ruggiero adds.

SAVE-QES scholars will be applying the method as they learn to strengthen their skills in quantitative analysis and mortality data.

“We believe U of T is leading the world in how we count the dead and make sure that information helps the living,” says Adalsteinn Brown, Dean of the Dalla Lana School of Public Health.

The QES Program is managed through a unique partnership between Universities Canada, the Rideau Hall FoundationCommunity Foundations of Canada and Canadian universities. It is made possible with financial support from the International Development Research Centre and the Social Sciences and Humanities Research Council.