What happens when you spend too much time in Seattle

On November 20, 2009, in global health, by Karen Grepin

“Even though HIV has captivated public discourse and funding, including over $5·1 billion in development assistance for health in 2007 alone, there are only rough estimates of its disease burden.”

I could not agree more. That is a quote taken from a comment in the latest Lancet by the class of Post-Bachelor Fellows at the Institute for Health Metrics and Evaluation in Seattle. I know this program well – I was the TA for the first ever class at Harvard back in 2005 – and admire it greatly – many of its alumni are now making their way through top PhD programs and medical school across the US and around the world.

It appears that spending a year or two in Seattle working with Chris Murray will make just about anyone a “skeptical optimist” about global health data. They further expand:

“Despite the instant availability of an abundance of statistics in the information age, accurate statistics about our most basic need—our health—remain elusive. Vital registration systems remain weak in much of Africa and Asia, such that many people’s births or deaths are never recorded. Estimates of costs and outcomes are often modeled with weak data, yielding inconsistent estimates: estimates from WHO and the World Bank of the cost effectiveness of intermittent presumptive treatment in pregnancy for malaria differ by a factor of nearly forty.”

I make this point a lot with my own students, to the extent that now just about every memo or blog they hand in has a one sentence caveat along the lines of “of course, this is all based on data that is next to meaningless”. I love my students.

I have a number of columns of key word searches around global health open in TweetDeck, and it is nearly every day someone out there tweets some statement they gleaned from some newspaper article or some other source which is so far from the truth. I bite my tongue every time. My favorites? Quotes on the biggest killers or claims of increases/decreases in maternal mortality.

While I could not agree more with the statements that the PBFs make in their comment, I also would argue that I think it is not excuse to not use what data we do have when formulating policies. Some data, for example the DHS and MICS surveys, are perhaps the best sources of data in global health and are – in my opinion – greatly underutilized. They may be the greatest public good in global health.

So while yes, we need to do a lot better at collecting better data, we also need to do a better job at using the data we do have. I am happy that there are young guys out there like the PBFs doing this every day, and encouraging the rest of us to do so as well.

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1 Response » to “What happens when you spend too much time in Seattle”

  1. Eresso says:

    Dear Professor Grepin,

    Thank you for keeping your fingers pointed at this crucial issue. How much does the paucity of accurate data contribute to the myriads of failed policies designed to tackle global health problems? Is it the major problem?


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