SEATTLE, APRIL 23-24, 2018
The 10th meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) was convened from April 23-24th, 2018 at IHME in Seattle.
IHME presented on updates on the GBD and on the increased collaboration with World Health Organisation and the impact that the new collaboration will have on the GBD production schedule. Other items on the agenda included updates on; the inclusion of tobacco, education and temperature in the GBD risk factors; developments on machine learning; the forecasting and scenario work and the local burden of disease work. The meeting also included a discussion with the IHME team and IAC members on the future of the IAC. Following discussions with the group, the IAC made the following comments and recommendations:
- The IAC once again commends the major progress that IHME has made on the GBD, geospatial and forecasting work and on the swift follow-up to a number of issues that were raised at the last IAC meeting. It was specifically noted that there have been remarkable developments on the AI/machine learning components of the work, following a Committee member’s recommendation last year.
- The IAC found the presentations highly informative but suggested that when presenting to external audiences, that the GBD team always fully explain any acronyms on the slides and do not pack the slides too heavily with data so that they are easy to comprehend.
- On the collaboration with WHO and the new MoU agreement, the IAC was very supportive and commends the partnership whilst also noting that it represents a major change in the GBD enterprise. As the collaboration develops, the IAC agreed that it is vitally important that IHME maintains its independence.
- The IAC suggested that IHME shares some updates on the WHO collaboration between now and the next IAC meeting, especially if any issues emerge that IHME need advice on. This could be in the form of an interim report or a conference call with the IAC Chair and available IAC members.
- The IAC suggested having a rotation of IHME staff who could spend time working with WHO in Geneva (e.g. 3-6 months) which would both facilitate the partnership and would serve as an incentive or development opportunity for IHME staff. WHO staff could equally spend some time at IHME in Seattle.
- The IAC recommended that under the new working relationship with WHO, there should be an agreed process or mechanism for endeavouring to resolve any disputes over the estimates, including an established timeframe for these to be resolved in, so that disputes do not impact the GBD production schedule. The IAC recognizes the spirit of a commitment to working together will be critical to the success of this collaboration. It also recognised that, at least for an interim period, there may be circumstances in which the two parties “agree to differ” in their estimates. However, in such situations it would be important to explain, as far as possible, the reasons for the differing estimates.
- The IAC noted that close attention will need to be paid to the communication to countries about the WHO collaboration. The “how and why” of the new MOU will need to be explained carefully, especially during the transition period where there may be still be 2 sets of published data.
- The IAC noted that during the transition period under the new collaboration with WHO, because of the need to align the timing of the release of estimates, there will be no GBD papers released in 2019 and this represents a major opportunity for IHME who can use the time to focus on some of the areas that are usually difficult to schedule such as key infrastructure upgrades.
- The IAC commended the major progress on the geospatial/local burden of disease work since last meeting. The IAC recommends that IHME now invests time and effort into defining the problems and needs of the GBD end-users who will ultimately be using the maps. Going through a disciplined process of problem identification will help shape how the maps can be better tailored to decision makers’ needs.
- The IAC noted that the maps produced in the local burden of disease work are a useful communication tool and can be highly valuable for advocacy. Whilst the 5x5km level is useful, the IAC recommends also aggregating the data to above the 5x5 level for example to the local administrative levels (which might vary between geographies) as this is likely to be more useful to decision makers.
- The IAC urged IHME to use data from countries with high-level geospatial coverage, such as the USA, to demonstrate the performance and validity of the cross-validation process of their models.
- The IAC recommends not to going down to the 1x1km level which is unlikely to be useful to policy makers because of the uncertainties in estimates at such a fine level.
- The IAC noted that there is still a challenge on how to show uncertainty of the estimates on the maps which needs to be addressed.
- The IAC recommends that at some stage it would be useful to also include resource allocation to the maps as this will be of considerable value and interest to policy makers.
- The IAC acknowledged that there is still a data sparsity issue across GBD. The IAC recommended that maps can be a useful advocacy tool for IHME to illustrate the global data gaps and to help with efforts to retrieve more data where it exists and to promote the need for additional data collection at a local level.
- For the local burden of disease work in high-income countries, the IAC suggests that IHME could charge those country clients amounts that could also subsidise some of the work for low and middle-income countries.
- The IAC continues to be supportive of the efforts to include level of education into their risk factor work (this came from some of the IAC’s earlier recommendations). The IAC recognises that this work has raised a lot of issues, including data sparsity, such as the lack of published literature on cause-specific mortality by level of education. The IAC recommends that IHME continues with this work and recommends publishing the education paper separately to the main GBD papers for the time being.
- The IAC also recommended that it also might be useful to begin by working specifically with one country which is education data rich and to feed those data into the model to understand better the issues around education before scaling up globally.
- The IAC welcomed the new work on temperature and noted that messaging will be critical for this area of work. It will be vitally important to contextualise the results and be clear about what these models do and do not show. The IAC recommended that IHME also connect with other partners like the Intergovernmental Panel on Climate Change (IPCC) regarding the language, messaging and positioning of this work.
- The IAC also suggested including mental health as a health outcome for the temperature work.
- The IAC were very impressed with the new approach taken for the tobacco work but noted that their findings on the duration of risk following smoking cessation might be controversial and may provoke reaction. The IAC recommended engaging with relevant stakeholders and public health authorities before the tobacco specific paper is published.
- The IAC was supportive of including smokeless tobacco in this work. When it comes to products like e-cigarettes, IHME should focus on the data and not label as harm reduction (as this is a policy issue).
- The IAC commended the developments on the scenarios work. For policy makers, the IAC recommended changing the time frame on the models to 2030 to align with the UN goals.
- The IAC recommended that IHME should be very explicit about their assumptions in the scenario work. They need to be clear in the language about the “scope for change” for policy makers (i.e what future scenarios outcomes are down to specific changes in policy vs general GDP improvements).
- The IAC were very impressed with the developments on machine vision, initially as a quality control tool, and noted the huge potential for IHME in this work with major gains in efficiency with regards to the allocation of human resources as well as mediating attrition and keeping staff motivated by reducing some work burden. The IAC recommended that has this work develops, IHME will need to have multiple trainers and assessors.
- Regarding country level engagement, particularly for the local burden of disease work in key GBD countries, the IAC recommended some staff rotations with staff at the country level spending time at IHME and IHME staff also spending time in country (following the Ethiopia example). This will encourage country level ownership of GBD.
- The IAC acknowledged that the quality of data issue remains a highly complex issue and the IAC recommends a publication on this topic.
- The IAC also suggested the inclusion of social capital or social cohesion as a new covariate in the model as there is a strong emerging literature in this area. The IAC would like to add a discussion on this to the agenda of the next meeting.
- On the future of the IAC the Committee recommended that it should continue to serve as an independent forum for an exchange of feedback and constructive criticism. IAC members will review the IAC’s terms of reference and future milestones which will be presented at the next IAC meeting.
NEW DELHI, INDIA, NOVEMBER 15-16, 2017
The ninth meeting of the Independent Advisory Meeting (IAC) of the Global Burden of Disease (GBD) was held in New Delhi, India from the 15th-16th November 2017.
The delegation from the IHME began by presenting a summary of the GBD 20th anniversary event that was held in Seattle in September 2017. This was followed by updates on the planned GBD 2016 papers, the development in GBD methodology including changes in the cause list, risk factors, geospatial modelling and causation scores. Discussions also focused on the sub-national burden of disease estimation for India, GBD data quality and data gaps, as well as collaboration with the World Health Organization.
Prior to the IAC meeting, the IHME team and IAC members joined for the launch of the India State-level Disease Burden report on November 14th which was hosted by the Public Health Foundation of India (PHFI) and the Indian Council of Medical Research (ICMR).
GBD IAC Comments and Recommendations
- The IAC commends the consistent high quality of the work produced by the IHME including an impressive list of published and planned papers, and the launch of the India sub-national burden of disease estimation.
- The IAC notes the growing demand for sub-national analyses and supports the criteria set by the IHME to prioritize such demands from different countries.
- The IAC applauds the successful launch of the India State-level Disease Burden report. The Committee is mindful that continuing commitment by the Indian government and support by the IHME will be needed to continue this worthwhile effort.
- On the topic of sub-national estimates, members of the Committee commented on the potential ‘fatigue’ by policy makers by annual releases of new sub-national estimates. A major release every 3 years supplemented by annual releases based on thematic local disease burden results was suggested as an alternative. Malnutrition and air pollution were suggested as potential themes.
- The incorporation of ‘interventions’ into the GBD risk methodology was discussed again and discussions focussed on how this can be incorporated into GBD whether this should be looked at separately with its own analyses. The Committee agreed to revisit this topic in the next IAC meeting in spring 2018.
- The IAC supports the implementation of the new DisMod AT tool (undergone a 3-year development) for a number of models for GBD 2017, trialling it before its full deployment for GBD 2018.
- The IAC welcomes the development of separate GBD teams with specific areas of work which may help address a number of issues previously raised by the IAC. The issues include: streamlining workflow, staffing, and the separation of the methodological development and the production of GBD results.
- The IAC recommends increasing investment in communications with an aim to bring about enhanced policy impact attributable to the use of GBD in general.
- The IAC recognized that while the largest policy impact may result from the adoption of GBD, local burden of disease, scenario planning, and effective communications, the IHME should be mindful of the resource implications and the tension between generating burden estimates and aiding policy decision-making or advocacy.
- The IAC strongly supports IHME’s assistance to monitor WHO’s Global Programme of Work (GPW) for 2019 to 2023 on request by the Director-General. This may include the monitoring of a new “3 billions” target: 1 billion increased Universal Health Care coverage, 1 billion safer, 1 billion with enhanced SDG intervention target achievement.
- The IAC discussed some of the issues around managing the membership of the extensive GBD collaborator network and criteria of authorship of GBD papers. It was agreed that a statement could be added to the GBD protocol allowing IHME to remove collaborators in particular circumstances. There was also support for creating a new “student” category of collaborators.
- The IAC strongly recommends that all parts of the GBD enterprise, including the geospatial analysis, use the same approach to collective authorship by all those involved. The geospatial analysis should be more fully integrated within the wider GBD and a communication strategy should be integral to this whole program of work.
- The IAC welcomes the development of the GBD evidence grading system and supports the proposed strategy of its development. The evidence score is derived based on three components of conclusion of study, study design, and quality of study. The latter is a composite function of different aspects that affect the quality of a study.
- The IAC welcomes the development of local burden of disease (BoD) studies using GBD geospatial analysis and mapping. The level of viewership of the newly developed visualization tools for these BoD studies was reportedly to be relatively low. The Committee suggested communication is the key to increase uptake. A communication strategy is needed to drive demand. One approach suggested is to pursue a “pull” rather than “push” strategy by engaging high-level local stakeholders to adopt maps and have them incorporated into their work at the outset. The importance of drawing on local reports and publications to increase uptake was also discussed.
- A committee member suggested that one idea for further discussion is for IHME to develop standardized (and automated) map templates for the online format that allow an easy export of “branded” maps for regional and country-level reporting. That way the look and feel of local/regional outputs is standardized and the geospatial communication becomes a familiar and expected piece of reporting and may help with uptake and adoption.
- The IAC commends IHME’s development of a GBD data quality assessment framework. The latest development of the framework was presented to the Committee. The Committee would like an update on this item in the agenda for the next IAC meeting.
SEATTLE, MAY 15-16, 2017
The eighth meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) took place on May 15 and 16, at IHME in Seattle. On May 17, an additional one-day workshop on the development of reference and alternative scenarios was held at IHME with IAC members and external experts.
At the IAC meeting, the delegation from IHME presented on the latest updates to the GBD papers and outlined developments on areas including the subnational disease burden estimates, new risk factors and causation scores. There were also presentations and discussions on data quality and data gap measurement, scenarios and the inclusion of interventions as risks.
GBD IAC Comments and Recommendations
- The IAC commends the great progress that IHME has made in the last six months, since the last IAC meeting.
- The IAC strongly welcomes the fact that so many of the IAC’s past meeting recommendations have been addressed by IHME. This includes, but is not limited to, the work that has been done to refine the GBD risk factors, the development of the scenarios work, the addition of the new “star rating” system on data quality, the separation of the GBD production and development workflows and the improvements on data visualization tools. It will be very useful now for the IAC to record and track how the Committee’s recommendations have been taken on by IHME.
- The Committee acknowledged that a major challenge moving forward is how to better ensure the use of GBD for policymaking, guiding investment and de-investments.
- The Committee applauded the GBD team for the much-improved data visualization tools. The IAC acknowledges that further work might now need to be taken on with regard to development and branding of new versions of the tools for different types of users (e.g., academic audiences versus policymakers). At the next IAC meeting, it was agreed that it would be useful to review how to make best use of the data visualizations for policymakers. The IAC recommends again taking on a user-centred design approach for the development of these tools.
- At a future meeting, the IAC would like to review the GBD collaborator network protocol again to better understand how IHME manages its collaborations and its wider community engagement.
- The IAC commended the work that has been done on the new Healthcare Access and Quality Index, which brings additional precision to the frontier analysis using mortality amenable to individual healthcare relative to the use of Life Expectance (LE) or Healthy Life Expectancy (HALE) in the context of health(care) system performance and efficiency assessments.
- There was great support by the IAC for the huge amount of work that IHME has done with on the subnational estimates. The IAC feels that the subnational work is likely to have the most relevance for policymakers. This work will be essential for continued user engagement with GBD and is likely to have the greatest impact.
- With regard to the criteria for when to conduct subnational estimates, the IAC felt that in addition to objective criteria such as population size (for which they recommended lowering the threshold to 100 million), IHME should look at those locations that are most likely to use the results to guide decision-making (i.e., where the demand is). Other suggested criteria for deciding on subnational locations could be progress toward the SDGs, the level of decentralization, the diversity/heterogeneity within a national population, and the relative scale of the disease burden. Also consideration should be given to those locations with growing populations that are likely to have a population over the threshold criteria in the near future.
- The IAC agreed that there is a need to consolidate the gains and evaluate the usefulness of the estimates for the policymakers before taking on subnational estimates for new countries.
- The IAC suggested that IHME consider new techniques such as adversarial machine learning which may be useful for reducing the burden for some of the close-level human screening of the GBD results. As the number of subnational analyses grows, there is a major feasibility concern for IHME being able to keep up with the level of demand and adversarial machine learning techniques may help reduce the human burden of the workload.
- On the LBW risk factor preliminary analyses, the IAC commended the work that has been done but suggested that the IHME team expand their data sources on this area. (The group suggested that some of the studies done on maternal supplementation in different geographies, for example, may prove useful).
- On (low) education as a risk factor, the IAC was pleased to see this being incorporated into the GBD work as this was one of the IAC’s earlier recommendations. It was acknowledged that this is a very complex addition, which requires a different approach to the other universal risk factors. Despite the challenges, the IAC agreed that this is something that is very worthwhile to include in GBD.
- The IAC noted that while education and income are major predictors for modeling, the level of social support structures in a country might also be useful to explore in the future as a possible covariate, since these have been shown to be very important in explaining mental health outcomes in particular.
- The IAC acknowledged the real progress that has been made on the risk factors work and agreed that there will need to be a continuing dialogue on risk factors to further refine this work.
- On the data quality, the IAC applauded the newly introduced four levels of garbage coding. The IAC also strongly endorsed the newly introduced “star rating” system, which is something that was also recommended by the IAC in earlier meetings. The IAC recommended a filtering system to be built into the data visualization tools so that users can filter their results based on the quality of the data. Different users will likely have different preferences on what levels they would like to include (i.e., precautionary principle type users versus those who would like to include only the top quality, 4*-5* data).
- On the idea of establishing unique data identifiers for each data collection source as a global public good, the IAC are supportive of the idea and feel like it is worthy of exploring further. The Committee recommended looking into existing technologies such as Blockchain to support this initiative. On the question of where the data repository would be, the IAC recommended that this should not be hosted by IHME.
- On the causation scores, there was wide support from the IAC but the Committee recommended that the same process should be applied to the data from both observational studies as well as randomized control trials (RCTs).
- The IAC commended the major developments that have been done on the forward-looking, scenarios work. There has been great progress and this work is moving GBD into a very relevant policy space.
- The IAC endorsed the current suggestion of developing three types of scenarios (i.e., reference scenarios, “best case,” and “worst case” scenarios). The IAC also affirmed the current scenario threshold levels used by IHME (i.e., 85th percentile and 15th percentile of observed rates of change in the recent past).
- The IAC welcomes the shift in language and mindset from forecasts and predictions to reference scenarios.
- The IAC was pleased to see the comparison work that was done to compare the GBD’s GDP estimates and those of the IMF. The IAC welcomes the publication of the paper detailing this work.
- The IAC suggested that thought now needs to go into the global branding of the scenarios work. Lessons can be taken from the WEF Global Competitiveness report for example, where annually two to three key messages are drawn out of the analysis which can serve to create visibility and generate conversations. It was acknowledged that there is currently a gap in the landscape when it comes to global health futures, so there is a real opportunity for IHME to fill this space.
- The IAC recommended reporting on the intermediary SDG 2020 targets as well as the final 2030 deadline in the GBD and scenarios work, for monitoring country-level progress on the SDGs.
- On the interventions as risks work, the IAC commended the work done so far and recognized that this is still a work in progress. The Committee recommended taking on this work in a piecemeal approach as it would be impossible to include everything at once. Grouping interventions by disease cluster (e.g., HIV/malaria/TB) might be a useful start. The IAC also recommended keeping this part of the work separate from the other GBD risk factor work.
- The IAC raised concerns regarding the security of data infrastructure, including the website, and suggested that a security audit maybe warranted in the near future.
- There was very positive feedback from IHME on work of IAC and the high uptake of IAC recommendations was applauded by the Committee. IHME confirmed that they think that the IAC has a continued role to play on guiding the overall strategic direction of GBD. They would like the IAC to continue to advise on, for example, making the GBD outputs relevant for policymaking, advising on country updates, packaging GBD for different audiences, and promoting country ownership. It was agreed that moving forward, the IAC will continue to meet in person, twice annually.
CUERNAVACA, NOVEMBER 7-8, 2016
The seventh meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) was convened on November 7-8, 2016, at the Instituto Nacional de Salud Pública (INSP), in Cuernavaca, Mexico. Meeting participants included 13 GBD IAC members, the two IAC observers, five IHME staff, one participant from the Bill & Melinda Gates Foundation, and the members of the IAC Secretariat.
The delegation from IHME presented on updates to the GBD 2015 papers and outlined the major goals for improvement for the GBD 2016 cycle. There were also presentations and discussions on the Sustainable Development Goal (SDG) analysis, geospatial mapping, health futures work, and the latest GBD HIV/AIDS estimates.
Rafael Lozano and Héctor Lamadrid-Figueroa of INSP and Sebastian García-Saizo (General Director of Quality and Health Education, Secretaría de Salud) also presented on building local capacity for GBD in Mexico and on the use and uptake of GBD results in Mexico.
Following discussions with the group, the IAC made the following comments and recommendations:
GBD IAC comments and recommendations
- The IAC strongly commends the recent work of IHME and the GBD team and were very impressed with the progress and the level of activity since the last meeting, particularly with regard to the new areas of analyses. The IHME team were commended for always exploiting the GBD data in new and interesting ways, which keeps the annual results exciting and relevant for users. The group agreed that a very constructive relationship has developed between IHME and the IAC. The meetings allow for a very useful and productive dialogue between the two groups.
- It was agreed that the GBD subnational results remain highly relevant for policymakers and health program managers. The IAC recommends that subnational datasets, results, and launches should always be organized separately from the release of the global papers in order to achieve maximum impact at the country level.
- The IAC recognized that there are still challenges with some technical inconsistencies in the GBD data that often get picked up at the national or subnational level. The IAC recommends that IHME develop a more systematic approach to dealing with users at the country level by developing a formal quality assurance policy or quality process which would outline how users can provide feedback on issues that they have identified in the GBD estimates. It was agreed that it would be useful for IHME to present on this process at the next meeting. It was suggested that before the official release of the results, previews or “sneak peaks” should be organized for priority countries, to ensure that there are no surprises and to help key countries to leverage the results. A community manager-type role was suggested for key countries to act as a specific focal point who could help to detect inconsistences in country-level data, field the feedback from country-level users, handle media relations, help facilitate the national launches, and assist in national outreach activities.
- With regard to plans for GBD 2016 and the risk factor work, the IAC agreed that the inclusion of the lack/absence of interventions (e.g., vaccines), as previously recommended by the IAC, is a very encouraging and useful development. The group noted that including the coverage of interventions in GBD papers will be difficult to do but it is worth putting effort into.
- The IAC commended the GBD on their recent management restructuring efforts at IHME, which is something that has been discussed in previous meetings. The IAC agreed that it would be useful to get an update at the next meeting on how this is going.
- The IAC commended the work that was going on in Mexico with regard to investing in local capacity-building and the GBD training at the master's and PhD level which promotes the sustainability of GBD use. The IAC recommends that PhD students working on GBD theses should be seen as a valuable resource for GBD – they provide an additional (albeit informal) form of reviewing the methods and results, and PhD students can potentially help to put the results in the hands of users. The session on GBD use in Mexico was seen as being very useful to see how GBD data and results are used at the country level. Some questions still remain over how this use actually influences policy and brings about change. The IAC suggested it would be informative to try to document the process of how GBD is used at the national level. Such an exercise would not necessarily be conducted IHME but by a third-party organization like INSP.
- With regard to the SDG work, the IAC recommends that IHME not develop its own targets where they have not been specified in the official SDGs. Rather, IHME should concentrate on measuring progress and identifying trends. On tracking progress on non-health SDG indicators, the IAC recommends that IHME just focus on those indicators that it is already measuring as part of the wider GBD work.
- The IAC recognized that the geospatial mapping work has come on substantially and this area of work has really benefited from the expansion of its team. It was recommended that while the 5x5 km-pixel, granular detail is useful, the results should also be presented at administrative levels (e.g., districts or sub-districts) to impact policymakers. The IAC recommended that on the geospatial work that the team should consider a user-centered design (UCD) approach in its next phase of the work, working together with and listening to users in selected priority areas. An iterative UCD approach, working side by side with users through workshops and other means, could be used to refine the design and development of this work. This UCD approach can and should be taken on for the GBD outputs as a whole.
- On the health futures/forecasting work, the IAC welcomed IHME’s response to past IAC suggestions with regard to the ensemble modeling and commended the recent developments with regard to the GDP models that have established baseline projections. This was regarded by the group as a major qualitative step forward. The IAC strongly recommends that for the health futures work that scenarios are developed and not just projections and extrapolations. This will require consulting with potential users to see what their expectations and needs are, as well as bringing in a wide range of external experts to think through all of the “what ifs.” The IAC encourages IHME to host a workshop or consultation exercise in the coming year (akin to the risk factors workshop), and IAC members would be keen to participate in this. A date of May 17, 2017, (directly after the next IAC meeting) has since been tentatively agreed for this.
- On the HIV/AIDS work it was agreed by the IAC that there has been great progress in reassessing and triangulating the ART data. It was suggested that IHME could write a paper on where the key data gaps and discrepancies are.
- On the extension of GBD and the inclusion of the concept of mortality amenable to health care, the IAC felt that this was a very useful and positive development but also warned that this area of work requires very careful and thoughtful presentation. It is likely to be very exciting for GBD users but it is also politically sensitive and IHME needs to ensure that this concept is communicated correctly so that users understand how to interpret the results.
SEATTLE, APRIL 21-22, 2016
The sixth meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) was convened on April 21-22, 2016, at the Institute for Health Metrics and Evaluation, Seattle, US. Meeting participants included 13 GBD IAC members, the two IAC observers, members of the IAC Secretariat, and a number of IHME staff.
Christopher Murray and the delegation from IHME presented updates to the IAC on GBD 2015 as well as updates on GBD scenario forecasting, risk factors, geospatial mapping work, subnational burden of disease work, and the collaborator network. A review of the GBD Data Access Plan and Implementation was also presented. Following discussions with the group, the IAC made the following comments and recommendations:
IAC comments and recommendations
- The IAC praised IHME for being responsive to their comments, including in the areas of transparency and credibility, and welcome progress made and the considerable outputs.
- Having built the whole GBD estimation platform and having successfully separated development and production, the IAC recognized that the GBD enterprise is entering into a new phase where the IAC considers strategy, use, and advocacy as rapidly becoming critical in GBD’s path of development. The IAC suggested that more attention should go on the policy implications of GBD results, beyond academic considerations.
- The IAC welcomes discussions with IHME on GBD’s high-level strategy. The IAC requests IHME to present a structured strategy including areas such as production, development of new areas (forecasting and others), methodology, use, communications, and country engagement.
- The IAC raised concern about the sustainability of annual GBD reporting in The Lancet. The IAC recognized the importance of keeping publication incentives for academics but at same time felt that innovations with new ways of presenting the data should be explored.
- While commending the work on malaria, HIV, Ebola, and Zika, the IAC felt that it is important for the IHME team to think through the use of the geospatial approach to the long list of health outcomes currently proposed, e.g., TB and pneumonia, and to clarify the methodology. The IAC invites IHME to explore further the specific purpose and value of geospatial work and its link to services and delivery.
- The IAC recognized the huge potential impact of the new health services research work including the work on the US and suggested that IHME should think how to apply such work to LMICs. The IAC suggests a cross-country comparative disease expenditure (DEX) analysis which may lead to impactful output. The IAC praised the significant progress in this area of work and particularly commended IHME for their attention to and quality of DEX graphics produced. The IAC also highlighted the need to clearly outline what is included in the IHME definition of health care spending and make explicit the assumption of randomness of missing information.
- The IAC raised concern over the potential duplication of governance roles between the IAC, SOG, and IHME Board, and the burden on IHME staff for all of their respective meetings. The IAC suggests that IHME look into these issues and report back to the Committee.
- The IAC recognizes a country’s support of GBD as well as local burden of disease initiatives may not be always sustained by local partners in the long term. IHME’s roles in training, capacity development, and ownership transfer should be carefully balanced with its core functions.
- On “Health Futures” (or forecasting) the IAC recommends that IHME clearly define the aims of this area of work and then consult with stakeholders to ensure that they are fully aware of existing debates in this area.
- The IAC strongly recommended that IHME clarify which creative commons license currently applies to their shared data and ensure most appropriate licensing is being used going forward.
- There was support from IAC for the following methodological developments:
- age to be categorized to 100 years to avoid having to reinitiate this work again in the future
- GBD causation scoring system to improve transparency and help identify neglected topics/data gaps and to identify priority areas of research
- current GBD approach to widen uncertainty intervals of effects of risk exposure to reflect the state of knowledge of such effects, for example, those that are currently involved in scientific controversies.
- Two potential papers or publications identified by the IAC include a piece explaining why IHME believes SDI to be a superior metric to HDI; and a paper on why joining up cause-specific and all-cause mortality seems to result in an underestimate of the decline in mortality.
- The IAC requested IHME to circulate questions to the IAC ahead of IAC meetings in order to allow Committee members the time to reflect and respond at the meetings. Improvements to meeting room acoustics were also registered for future IAC meeting planning.
GURGAON, OCTOBER 13-14, 2015
The fifth meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) was convened on October 13-14, 2015, at the Public Health Foundation of India (PHFI) in Gurgaon, India.
Christopher Murray and a delegation from IHME presented updates to the committee on GBD 2015, scenario forecasting, risk factors, the Indian State-level Burden of Disease Initiative and the GBD collaborator network. Ongoing GBD sense-making and policy translation activities, initial geospatial mapping workplans and a comparison of MCEE/CHERG and GBD 2013 child death estimates were also reviewed. Additionally a discussion was held about potential opportunities to align GBD’s work with health-related SDGs.
IAC comments and recommendations
- The IAC commends IHME for the growing maturity of the GBD endeavor and the successful delivery of the first GBD annual update. The IAC also appreciates IHME’s constructive engagement with the committee.
- Following its earlier recommendation the committee commends the publication of the GBD methodology [Flaxman AD, Vos T, and Murray CJL. 2015. An Integrative Metaregression Framework for Descriptive Epidemiology. Seattle: University of Washington Press.] which serves to disseminate the GBD methodology more widely and helps further the scientific discourse in the rapidly evolving field of descriptive epidemiology.
- The Committee notes the resource implications of the annual updates for IHME staffing and computational needs. As the GBD endeavor continues to grow, a clearer separation of production and methodological development remains a critical goal in terms of ensuring (organizational) sustainability. The IAC notes progress made in this area and recommends a review of IHME staffing with this goal in mind.
- The IAC recommends that IHME develop a comprehensive risk management strategy incorporating quality control and other issues related to annual GBD production.
- The IAC was pleased with the presentation of IHME’s top-level goals for GBD 2015 and recommends this be published more widely in the public domain.
- In response to IHME’s observations about increased uncertainty leading to problems with calculation of incidence, the committee suggests that IHME prepare a technical paper on HIV incidence measurement, including a call for better (greater) data collection.
- The IAC praises IHME for achieving good progress in GBD scenario work and recommends that IHME:
- Carry out a consultation on its scenario forecasting work to inform its direction;
- Produce scenario forecasts on HIV/AIDS to 2030 and;
- Develop a strong communications plan around scenarios.
- The IAC recommends that IHME launch its GBD scenario work with an initial focus on the SDGs, producing initial baseline as well as future SDG scenarios.
- The committee welcomes the inclusion of geospatial mapping into GBD and stresses the need to develop a strong communications plan and key messages in relation to geospatial mapping.
- The IAC does not currently recommend that all GBD data be geo-located as the availability of sufficient data is not yet clear, nor whether demand for this exists and what benefits this would deliver. This will be reviewed in future when GBD geospatial mapping work matures.
- The committee welcomes the inclusion of distal risk factors in GBD comparative risk factors work and recommends developing assessment criteria for risk factors.
- The IAC recommends that IHME, as a major independent voice in global health metrics, actively monitor global progress against the SDGs.
- The committee welcomes the increasingly constructive dialogue between IHME and MCEE/CHERG on child death estimates.
- The committee welcomes the expanding GBD collaborator network and:
- Commends IHME for its increasingly systematic approach to managing the GBD collaborative network and resulting prioritization of collaborator engagement. A strategy for network engagement will become increasingly important as the size of the network continues to grow.
- Urges caution about resource implications associated with the expanding number of MoUs, and encourages IHME to manage expectations carefully.
- Recommends that IHME consider Nigeria for network expansion.
- Commends IHME, PHFI and ICMR on their breakthrough collaborations and the successful launch of the state-level burden of disease study in India. The IAC also notes the importance of continued engagement with various Indian stakeholders to ensure the long-term success of the initiative.
- Highlights the issue of the ongoing (financial) sustainability of subnational burden of disease studies and suggests active engagement with local funding partners, as is already the case in a number of countries such as the UK and Japan.
- The IAC stresses the need to develop a robust GBD publication and dissemination strategy which addresses tensions between prioritization of publication in high-citation journals vs. policy impact. Non-English language versions are critical for policy impact in certain countries.
- The recent work on sense-making and policy translation of GBD is critical for IHME’s mission and should be further expanded. The IAC recommends that a systematic approach to measuring impact be adopted.
SEATTLE, MAY 4-5, 2015
The fourth meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) was convened May 4-5, 2015, at the Institute for Health Metrics and Evaluation (IHME) in Seattle.
A delegation from IHME, led by Christopher Murray, presented updates on GBD 2013 and GBD 2015, risk factors, HIV estimate methodology for GBD 2013, the India subnational estimation, and scenario-based disease burden forecasting. Additionally, IHME funding sources, GBD production timeline and publication strategy, and GBD’s policy and impact conceptual framework were presented to the committee.
IAC comments and recommendations
- The Committee welcomed IHME’s strong commitment to improving GBD methodology in response to IAC recommendations from previous meetings. Most notable were the convening of the risk factor consultation in January 2015, reintroduction of unsafe sexual practices as a risk factor, the new Data Representativeness Index, separation of development and production, and the revision of HIV/AIDS estimation for GBD 2013.
- The IAC commended IHME’s ongoing expansion of collaborations, particularly collaborations with WHO, the World Bank, and the Russian Bureau of Statistics, which serve to improve the quality of global health estimates.
- There was strong support for integrating geospatial disease mapping and surveillance into the core of GBD. The IAC urged IHME to ensure that sufficient consideration would be given to data confidentiality, ethics, and individuals’ privacy.
- There was support for a release calendar of GBD results to help maximize potential impact and media coverage. The IAC encourages diversity of publication outlets.
- In light of the planned expansion of work on risk factors, the IAC suggested putting out an open call inviting proposals for additional risk-outcome pairs to incorporate into GBD. Some suggestions were given by IAC members for screening proposals.
- The IAC strongly recommends that IHME publish GBD methodology as well as the process of conducting burden of disease studies. Buy-in from the wider research community was recognized as crucial to the success of GBD.
- There was strong support for the development of scenario-based forecasts. IHME should engage in stakeholder dialogue as early as possible in order to ensure that the forecasting tool is relevant to users and grounded in reality. Some concern was expressed about plans to forecast GBD’s own population growth and GDP. IHME was cautioned about the importance of using appropriate language in any messaging. Being clear with the purpose and sense-checking of the proposed scenarios and resultant forecasts will be key to the success of this endeavor. As such, the committee recommends that a new member with expertise in this area be invited to join the IAC.
- IAC discussions also highlighted a need to identify key IHME communications audiences for research uptake purposes. Pursuing a targeted approach and feeding tailored and digestible information to groups or individuals (such as technical advisors to ministries) was likely to achieve greater impact/influence on policy.
- There was support for improving collaborations with ministries and NGOs in existing partner countries. However, due primarily to the foreseeable difficulties associated with scaling up such efforts in multiple countries, increasing IHME’s presence in other countries was not supported.
Future agenda items
Agenda items for future meetings include the following:
- Guidelines for access to and use of GBD data at different geographic levels (including data governance and protection)
- Forecasting and scenario-building with special focuses on:
- Population growth modeling
- Difference between forecasting and evaluation
- Sense-making of any proposed scenarios and forecasts
- Health expenditures and interventions update (into future GBD studies)
- Risk factor estimation update
- Sense-making/policy translation
- Collaborations update
LONDON, OCTOBER 23-24, 2014
The third meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) was convened October 23-24, 2014, at the Wellcome Trust in London.
A delegation from IHME, led by Christopher Murray, presented on GBD analysis, risk estimates, national burden of disease work, subnational estimation for China, and plans to incorporate health expenditures and interventions as well as forecasting into future GBD work. Other agenda items included a Brazilian national burden of disease case study, the SEED cross-pathogen surveillance network, and WHO’s latest health estimates.
IAC comments and recommendations
- The Committee welcomed IHME’s new cause-level maps of data availability and agreed that this visualization tool will provide helpful context on overall data availability as well as being a very useful addition to the GBD work. The difficulties around the communication of uncertainty were highlighted, and it was recognized that this is a critical part of the planned forecasting work. Traffic light/star rating systems were suggested as a way of enhancing users’ understanding of the quality of the estimates. It was also suggested that IHME create a GBD application for smart phones/tablets.
- The IAC was receptive to IHME’s improvements to the presentation of risk factors in GBD in three categories: behavioral, environmental, and metabolic. The new Venn diagram presentation is a valuable addition, but it was also noted that it is still important to retain the original comprehensive list of risk factors as in past GBD studies.
- On the subject of identifying potential target audience for GBD outputs, the IAC suggested targeting policymakers’ staffers who are likely to be in charge of putting together policy briefs. They could also be targeted for future GBD trainings and apps.
- There was strong support for IHME’s national Burden of Disease work, using Brazil as a case study. National burden of disease projects are recognized as being crucial for the sustainability of GBD, and this type of country-based approach strengthens the work of GBD as a whole.
- The IAC commended IHME’s expansion of collaborations in relation to subnational estimation for China but highlighted the issue of the variable quality of Chinese provincial data on childhood mortality.
- In response to the Foundation’s proposed SEED network, the IAC noted that there are already a huge number of surveillance sites in operation across Africa. The committee identified a critical need to engage with public health leaders in country to ensure the program’s fit within the existing environment. It will also be important to build links with policy/decision-makers in order for this surveillance program to have (the desired) impact.
- There was strong support for the increased collaboration between IHME and WHO in recent years, particularly the draft MoU now under development. IAC members agreed that competition between WHO and IHME is healthy and, provided there is a forum for the discussion of differences between estimates, should lead to better-quality estimates.
- The IAC commended IHME for preliminary work on incorporating health expenditures and interventions into future GBD studies. The enormous scope of this work was recognized, in particular the challenges of capturing indirect costs/expenditure for poor health and the duration of time it might take to set up this project framework.
- The IAC noted that efforts at incorporating forecasting and scenario-building into future GBD work were in early stages but agreed that this could add great value to the GBD work and would be of great interest to policymakers and GBD users. The IAC recommended connecting with forecasting researchers in governmental or industry sectors who specialize in forecasting and scenario-building over long periods of time.
SEATTLE, JUNE 17-18, 2014
The second meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) project was held June 17-18, 2014, at the Bill & Melinda Gates Foundation in Seattle. A delegation from the Institute for Health Metrics and Evaluation (IHME), led by GBD study principal investigator Christopher Murray, presented on the GBD 2013 updates, plans for future studies, GBD uptake and collaboration, and the GBD risk factor assessment. Other agenda items included the working methods of the IAC and the garbage code methodology. Eleven GBD IAC members joined the meeting, including two new members and two observers from the World Bank and WHO.
IAC comments and recommendations
1. The Committee commended IHME again on its impressive work in generating global health estimates, which have become genuine global public goods for which there is currently no alternative. The IAC noted that the GBD efforts expose the urgent and critical need for global improvements and investments in better primary health data.
2. The Committee welcomes the Bill & Melinda Gates Foundation’s planned investments in surveillance sites and networks. The IAC strongly recommends the inclusion of risk determinants in the surveillance sites and networks (in addition to disease estimates) as well as continued advocacy at the country level to ensure greater country buy-in on data collection improvements.
3. The challenges in conveying and communicating the extent of uncertainty in GBD estimates was raised as an issue that requires further exploration. One IAC recommendation was to develop a simple grading system for the presentation of GBD estimates.
4. The IAC stressed the need for IHME to invest more in sense-making and policy dialogue, in addition to the publication of its work.
5. The IAC recommends commissioning an independent report on the use of GBD.
6. GBD Work Plan. The IAC supports the proposed new schedule of work and annual publication plan presented by IHME, which specifically separates different work flows in the GBD process, such as the development and production phase of estimates. This more “staggered schedule” was seen as a better means of working within IHME’s current scope and resources.
7. The IAC prioritized the following special topics for future analysis, from a list proposed by IHME:
- Forecasting and scenarios (often of most interest to policymakers)
- Health/disease expenditure
- Generating subnational estimates
- Specific health issues such as water and sanitation
- Resolving discrepancies in major health issues such as maternal mortality
8. The IAC reviewed the current garbage code correction technique and recommended a change in the terminology (noting the sensitivity of the “garbage” term). There was also support for garbage-coding visualization tools and in making the code available.
9. The IAC welcomed the fact that IHME is revisiting its approach to estimates of risk determinants. The area of risk factor estimates had already been noted in the first GBD IAC meeting as a topic that needed improvements. The IAC recommended the following:
- To incorporate three levels (physiological, behavioral/exposure, and distal) and recognized the complexities of trying to capture these effectively.
- To adapt the evidence criteria for each layer of risk.
- The focus for the global estimates should still be on the theoretical minimum risk.
- Detailed case studies or pilot studies in data-rich settings could also look at the affordable minimum risk.
- The IAC welcomes the risk factor consultation later in the year, which IAC members will join.
10. The IAC noted improvements in collaboration and consultation with the World Bank, WHO (particularly some regional offices), UNAIDS, and UNICEF, and encouraged IHME to continue the dialogue. The IAC agreed that there is value in differences between the estimates, and that as long as the data are poor there will continue to be uncertainty in all estimates.
11. The IAC will work in different sub-groups for the following particular areas of interest:
- Reviewing the risk factor methodology
- Data management issues for IHME
- Sense-making/policy translation/policy engagement
12. The IAC will publish an article articulating the role of the IAC (stressing its independent nature), its terms of reference, and the meaning of health estimates. On the role of the IAC, it was agreed that the IAC has a role in raising concerns that other groups/external audiences have about GBD to IHME. The IAC also recommends commissioning an independent report on the use of GBD.
Future agenda items
Agenda items for future meetings include the following:
- Risk estimates
- Forecasting and scenario-building that IHME is keen to develop
- Incorporating health expenditures and interventions into future GBD studies
- Discrepancies on specific estimates
- The long-term strategy for the GBD
BRUSSELS, NOVEMBER 15-16, 2013
The first meeting of the Independent Advisory Committee (IAC) of the Global Burden of Disease (GBD) project was convened November 15-16, 2013, at the King Baudouin Foundation in Brussels. A delegation from the Institute for Health Metrics and Evaluation (IHME), led by the GBD study’s principal investigator, Christopher Murray, presented on their work to date and objectives for future GBD studies. The Bill & Melinda Gates Foundation (the project funders) had representatives present at the meeting, including the president of its Global Health Program, Trevor Mundel. Peter Piot (London School of Hygiene & Tropical Medicine) chaired the proceedings.
The two-day meeting was attended by 10 of the current committee members. Two further committee members are being sought to join the GBD-IAC for future meetings, and IAC members are asked to propose potential candidates to Peter Piot.
Over the course of the discussions, the IAC members noted the major improvements in the GBD estimates and models, the worldwide attention that the project has received, and the increasing use of the GBD by countries to improve their own disease estimates and inform health policy. Proposed new areas for future GBD studies, such as forecasting capabilities and the inclusion of health expenditure data, were very much welcomed by the Committee. Comments to IHME raised by the IAC members included suggestions to improve the project’s communications strategy to combat some of the criticisms over transparency; ensuring that the new plans for GBD work remain within the scope of the project and the IHME team; the need to address potential vulnerabilities with the organizational structure and the GBD business model; and the need for a methodological rethinking of the GBD risk factors.
For more information, please contact GBD-IAC Program Manager Sarah Curran.