Acting on Data

While decision-makers, researchers, and clinicians around the globe regularly use Global Burden of Disease (GBD) estimates to inform their work and set policy, educators are also finding value in incorporating this research and IHME resources into their curricula. 

Over the past few years, the Global Burden of Disease (GBD) study has grown a network of expert collaborators with an array of experience, competencies, and disciplines, and it is this diversity of perspective that makes GBD the most comprehensive view of global health burden in the world. One collaborator, Dr. Jayaraman, discussed her unique vantage point as a clinician in October during the GBD 2015 launch event, and we had the opportunity to learn more about Dr. Jayaraman’s experiences after the event.

Adolescence is often overlooked in health policy and planning, despite the fact that it represents a crucial period of life for addressing risks and preventing health problems in later life. Guided by insights from the Global Burden of Disease (GBD) study, the Government of India has prioritized the needs of adolescents in a comprehensive strategy to address the determinants of poor health for women, children, and young people.  

For World Diabetes Day (WDD), IHME showcased a variety of diabetes-related resources that can be used by decision-makers. IHME’s WDD social media campaign demonstrated how IHME’s online data visualization tool GBD Compare can be used to compare trends across countries, ages, sexes, and time periods.

Public Health England (PHE) just wrapped up the fifth year of their “Stoptober” challenge, a campaign to get 7 million people in England to stop smoking. This campaign reflects one of the seven priorities outlined in PHE’s plan of action, “From evidence into action: opportunities to protect and improve the nation’s health,” which was crafted using data from the Global Burden of Disease Study. 

Thomas J. Bollyky and Eric Goosby use IHME research to make the case for continued U.S. leadership and investment in global health.

To provide Namibia with actionable evidence to guide the country’s universal health coverage agenda,  the Institute for Health Metrics and Evaluation (IHME), in partnership with the World Health Organization (WHO), Namibia, recently published the report “Namibia: State of the Nation’s Health: Findings from the Global Burden of Disease.”

In New Zealand, the Ministry of Health is using Global Burden of Disease (GBD) data to guide the country’s health strategy for the next 10 years and beyond. An extensive new report, entitled Health Loss in New Zealand 1990-2013: A report from the New Zealand Burden of Diseases, Injuries, and Risk Factors, provides a big-picture look at New Zealand’s health landscape. By outlining the major causes of health loss in the country over the past two decades, it aims to guide policymakers, funders, researchers, and front-line providers in their efforts to ensure that all New Zealanders are “living well, staying well, and getting well.”

The world’s most comprehensive tool for measuring disease burden and guiding government health agendas just got better. Last Friday, the Global Burden of Disease (GBD) study enterprise – a collaboration among more than 1,800 health experts in 125 countries – launched updated estimates through 2015 for an expanded set of causes and risk factors for health loss in 195 countries and territories. To celebrate this update, IHME co-sponsored an event with The Lancet and the World Bank. The Washington, DC launch of GBD 2015 featured panels of experts and decision-makers who were convened to discuss the key findings of the study, and how GBD 2015 results may be used to identify and act on health issues around the globe. Here are a few great insights from experts who attended the launch on using data to improve health: “The study’s observations are important in the context of achieving the Sustainable Development Goals. Policy-makers need the best available evidence to make informed health policy decisions and to determine how to allocate resources. Some countries in sub-Saharan Africa face significant health challenges despite improvements in income and education, while other countries further behind in terms of development are seeing strong progress. Policymakers in all nations – from Senegal to South Africa and Equatorial Guinea to Eritrea – need to align spending to target the things that will make their communities healthier faster.” -Charles Shey Wiysonge, Deputy Director of the Centre for Evidence-based Health Care at Stellenbosch University and Chief Specialist Scientist of the South African Medical Research Council. Dr. Wiysonge is also a GBD collaborator. Read Dr. Wiysonge’s full post on the GBD 2015 study on the World Economic Forum’s website here. … “As a clinician, it’s important to be at this table. That is the army that is out there. That is the army that has the relationships with the patients and the communities. There is a real human being under these numbers, and our goal is to advance health. That means engaging clinicians around the world, partnering them effectively with ministries of health.” - Sudha Jayaraman, a practicing surgeon and Assistant Professor of Acute Care Surgical Services at Virginia Commonwealth University. Dr. Jayaraman is also a longtime GBD collaborator. … “We try to get as close to the truth as we possibly can by writing the story of health amongst the people on our planet. As we do so, we recognize progress, but we also see the huge challenges ahead. As we look at those challenges, we refuse to allow ourselves to be saddened by them. Indeed, we turn that around and make ourselves excited by the potential and the prize we have before us.” -Richard Horton, Editor-in-Chief of The Lancet … “This linking of disease, geospatial mapping, and impact on programing is really extraordinarily important, and it allows us to model out the counterfactuals and factuals by different interventions … The more geospatial relevance and the more age and sex disaggregated data we have, the more we are able to see not only where we are, but model where we could be and make sure our policy decisions have impact.” -Deborah Birx, Ambassador-at-Large and United States Global AIDS Coordinator  

In Mexico, evidence from the Global Burden of Disease study plays a central role in guiding health policy. As Secretary of Health of Mexico from 2000 to 2006, Dr. Julio Frenk was the first leader in the country to use Global Burden of Disease (GBD) findings to guide health policy. Burden of Disease research helped shape the package of health services provided to all Mexicans.

According to a new report from the World Bank and the Institute for Health Metrics and Evaluation (IHME), air pollution – which can lead to lung cancer, stroke, and heart disease – cost the global economy roughly $225 billion in 2013. Air pollution, per the Global Burden of Disease Study 2013, was the fourth-leading risk factor for premature death in 2013.

In June of 1981, the CDC reported five cases of Pneumocystis carinii pneumonia among previously healthy young men in Los Angeles. Thirty-five years later, and millions of words, thousands of scientific papers, and countless celebrities’ speeches later, AIDS has evolved from an obscure disease to a movement crossing medical, social, political, and economic boundaries. Last month, Durban, South Africa was at the center of that movement. And the Institute for Health Metrics and Evaluation (IHME) was recognized among many of the nearly 20,000 delegates as an important and invaluable source of data and analysis influencing the movement. On July 19, IHME Associate Professor Dr. Haidong Wang presented at a press conference on the paper, “HIV 1980–2015: The Global Burden of Disease Study 2015,” which was published simultaneously in The Lancet HIV. Dr. Wang was the first author of the paper, which is the first Global Burden of Disease Study 2015 publication to be released. The paper finds that while AIDS deaths are falling in most countries worldwide, the rate of new infections increased in several nations over the past decade, thereby threatening to undermine efforts to end the AIDS epidemic by 2030. Moreover, 74 countries saw increases in the age-standardized rate of new infections between 2005 and 2015, including Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico, and Russia. In addition, new infections of HIV fell by an average of only 0.7 percent per year between 2005 and 2015, compared to the 2.7 percent drop per year between 1997 and 2005. Professor Peter Piot, who is the director of the London School of Hygiene and Tropical Medicine and was the founding executive director of UNAIDS, also spoke at the press conference, sponsored by Lancet HIV. “This study shows that the AIDS epidemic is not over by any means and that HIV/AIDS remains one of the biggest public health threats of our time,” Professor Piot said. “The continuing high rate of over 2 million new HIV infections represents a collective failure which must be addressed through intensified prevention efforts and continued investment in HIV vaccine research.” Another panelist at the press conference, Nduku Kilonzo, director of the National AIDS Control Council of Kenya, spoke the following day at a special session, “Accelerating the Decline of the Burden and Incidence of HIV in Sub-Saharan Africa.” Bill Gates, co-chair of the Bill & Melinda Gates Foundation, gave the keynote address at that session. He remarked that if the goal to treat twice as many people with HIV is to be achieved, efficiency also must be doubled, since funding likely will not be doubled. Efficiency in health facilities is the subject of a separate paper released July 20 and co-authored by IHME and collaborators from Action Africa Help-International in Kenya, the Infectious Diseases Research Collaboration in Uganda, and the University of Zambia in Zambia. That paper, published in BMC Medicine, concludes that health facilities in Kenya, Uganda, and Zambia could extend antiretroviral therapy (ART) to hundreds of thousands of people living with HIV if facilities improved the efficiency of service delivery. “Improving efficiency can support major gains in expanding ART to people who need treatment, especially when funding is limited,” says IHME Assistant Professor Abraham Flaxman, senior author of the study. “Now we, as a global health community, need to figure out how.” Indeed, figuring out how to meet the needs of those infected with and affected by HIV was the subject of discussions, debates, and protests at the conference in Durban. “There are a lot of distractions – the economic turmoil, the Syrian crisis – to keep us from achieving our goal of an AIDS-free world,” Mr. Gates said according to the South African news service Health e-News. “Research funding has remained at the same level for the past eight or nine years … but funding will determine when we get [to an AIDS-free world].” Sixteen years ago, Durban hosted the International AIDS Conference, seven years before IHME was established. And while some at the conference last month were hopeful the world truly will see the end of AIDS by 2030, it was apparent the world faces significant challenges in reaching that goal, especially as funding for research, medications, and services grows increasing competitive. What was also apparent is that IHME will play an increasingly prominent role in educating, enlightening, and inspiring policy-makers and other leaders pursuing that goal.

This week, India’s Prime Minister Narendra Modi visited Nairobi, announcing that his country would help the Kenyan government build a high-tech cancer treatment center in the capital. At the same time, 65 health practitioners gathered in another part of the city to plan for an even bigger project: tackling all non-communicable diseases (NCDs). As a first step toward this goal, the International Center for Humanitarian Affairs (ICHA) at the Kenya Red Cross and the Institute for Health Metrics and Evaluation (IHME), in collaboration with the Kenya Ministry of Health, produced a report that examines health progress over the past 23 years, as well as the challenges the country faces as its population grows and Kenya’s health landscape shifts.

In the midst of a contentious Congressional battle over funding for Zika prevention and research, IHME is providing Congressional staff with objective information to guide decision-making. With Congress returning from its Fourth of July recess, the Washington Global Health Alliance, in collaboration with Representatives Adam Smith, Sheila Jackson-Lee, and Raul Ruiz, MD, recently invited a panel of experts to participate in a briefing on the Zika virus for Congressional staff. The panel discussion (video available here), which included Dr. David Pigott, Assistant Professor at IHME, focused on Zika transmission and prevention in the US. Zika can be transmitted in several ways, among them mosquito bites, sexual contact, and blood transfusions. So far, the Centers for Disease Control has counted 2,961 cases of Zika in the United States and its territories, but looking separately at cases in states and territories is revealing: almost all of the Zika cases in US territories (Puerto Rico, American Samoa, and the US Virgin Islands) arose locally through mosquito-to-human or human-to-human transmission, while cases in the continental US came from travelers who entered the US with an existing Zika infection. It does not appear that Zika has gained a local foothold in the continental US. But according to Dr. Pigott, that may be about to change. He pointed to two overlapping conditions that may result in outbreaks of locally acquired Zika virus in the US: summer weather and the oncoming mosquito season. In previous work, IHME researchers, including Dr. Pigott, demonstrated that Zika transmission is exacerbated by higher temperatures, humidity, and precipitation. In addition, noted Dr. Pigott, “We’re coming to the critical period in terms of mosquito abundance across the country. In the next couple of months, we’re going to see an uptick in the population numbers” of both Aedes aegypti, a known Zika carrier, and Aedes albopictus, a suspected carrier. Both species live in the United States. Experts like Dr. Pigott worry that this summer’s mosquitos will bite infected travelers returning to the US and then infect others, causing local outbreaks. Since areas of the US (as discussed in a previous post, Getting ahead of Zika’s spread) are suitable for local Zika transmission, said Dr. Pigott, “The chance that a local transmission could occur through mosquitos is going to be increasing as the summer goes by.” Prevention efforts will be key in limiting the spread of the disease. Baylor College’s Dr. Joseph Gathe, Jr., noted that his hometown of Houston, Texas – which matches the hot, humid, and rainy profile identified by IHME researchers as particularly conducive to Zika’s spread – will need to work at prevention if it wants to limit Zika. It will be vital to remove standing water (including that left from this spring’s floods), adhere to a robust insecticide spraying schedule, and to teach people to prevent mosquito bites. Dr. Gathe worried particularly about Zika risk among poor people in the US South whose homes may not be mosquito-proofed and who may lack access to up-to-date information about Zika prevention. The panel also discussed diagnostic and medical responses to Zika. “We have to be able to screen the blood supply for potential Zika virus infection and we also have to invest in technologies that can inactivate the Zika virus if it is in donated blood,” said Dr. Rick Bright of the Biomedical Advanced Research and Development Authority, adding, “and then most important, I think, is the need for vaccines.” While Dr. Bright thinks the chances of developing an effective vaccine are favorable, the earliest date that one could possibly be available is 2018. Since a Zika vaccine may be years away, public health experts will be watching the next few mosquito seasons closely for signs of local Zika transmissions in the US. It may be ­– even with increased funding for diagnostic testing and vaccine development – that surveillance and prevention will be necessary to contain Zika in the US. 

The estimation of global health outcomes just became much more transparent. On June 28, the Guidelines for Accurate and Transparent Health Estimates Reporting, also known as GATHER, were officially launched after two years of hard work and collaboration by a group of population health experts convened by the World Health Organization (WHO). The aim of the guidelines: to improve the accuracy and candor of population health research. Health estimates, which can fill gaps when data are incomplete or unavailable for a particular population or time, are important tools for decision-makers and policymakers seeking to prioritize health agendas. This is why it is crucial that estimates are as precise as possible, and that the methods used to obtain them are accessible and open for scrutiny. In part because the Institute for Health Metrics and Evaluation (IHME) believes in open health data (for example, making our results freely available), IHME’s Drs. Chris Murray and Theo Vos participated in the working group that drew up the guidelines. Other collaborating organizations included WHO, the Bill & Melinda Gates Foundation, the Harvard T.H. Chan School of Public Health, the London School of Hygiene and Tropical Medicine, the University of Ottawa, the University of Edinburgh, PLOS Medicine, and The Lancet, among others. “The world is now being shaped by numbers,” explained Dr. Richard Horton, Editor of The Lancet, during a recent trip to IHME in Seattle. “Reliable data are now informing decisions at the highest political level across all nations of the world. It is crucial that we can be sure about what those numbers are telling us.” In anticipation of the GATHER launch, the worldwide network of collaborators who contribute to the Global Burden of Disease study (for which IHME serves as the coordinating center) made the choice to become compliant with the new guidelines, and they hope to see other groups and organizations follow their lead. The Lancet and PLOS Medicine, which both published the GATHER statement upon its launch, plan to make the GATHER guidelines a requirement for groups submitting papers exhibiting health estimates, setting a new standard that will lead to higher-quality publications. Dr. Murray describes the GATHER guidelines as, “an important step in the direction of transparency and replicability of findings.” If the aim is to produce truly accurate health estimates, researchers must allow others to dig deeper into their methods and invite scrutiny and debate. The GATHER guidelines should also be used by policymakers when looking for the best health estimates of which to base important decisions for their communities. If a group is compliant with GATHER, policymakers can rest assured that any reports that a group releases are rigorous and reviewable, which in turn will lead to better decisions and more impactful policy action. The 18 GATHER best practices range from listing funding sources to making the computer code used to obtain findings publicly available and useable. The full GATHER statement and checklist can be found on its new website: www.gather-statement.org.