Portugal joins Global Burden of Disease enterprise to improve community health

In the historic city of Porto, famous for being a critical center of trade, health organizations from across Portugal have come together to celebrate a new partnership between Portugal and the Institute for Health Metrics and Evaluation to advance the work of the Global Burden of Disease enterprise and provide insight to guide policymaking in the country.

At the biannual National Congress on Public Health on February 16, the country’s Director General for Health, Dr. Francisco George, signed a memorandum of understanding with IHME to improve national-level GBD estimates and, over time, develop local-level estimates.

“This MOU with IHME is so important because it will allow us to improve the health information going into our policy and planning, to improve our health systems, and ultimately to improve the health of our people,” Dr. George told the audience, gathered for two days of debate and discussion about how to strengthen Portugal’s public health work.

The fact that more than 1,000 people registered to attend the congress underscores how public health is being elevated in Portugal’s national dialogue. The Portuguese parliament is considering public health reform. In addition, the government is looking to address both a growing aging population and – in contrast to many countries in Europe – a rising fertility rate. Moreover, for the first time, a sitting president addressed a national public health congress.

After thanking IHME for entering into a collaboration with Portugal, President Marcelo Rebelo de Sousa remarked, “We have a challenge to advance knowledge, to improve information, and to raise a spirit of cooperation so that people may have the same vision and goal despite their backgrounds or political beliefs: to improve the health of our communities.”

National Minister of Health Dr. Adalberto Campos Fernandes said, “2017 will be the year of public health,” and that the MOU with IHME comes at an opportune time.

“With this collaboration on the Global Burden of Disease we can make advances to evaluate the health of the population of Portugal,” Dr. Fernandes said. “We also can realize the theme of this National Congress on Public Health: that public health services are the arms that build columns and bridges.”

The health reform being considered would, among other things, create a central health data repository to pull together millions of data records being created both by public health programs and in clinical settings.

“Our problem isn’t that we have too much data. We can never have too much data. But it’s difficult to integrate all of the data that we have,” said Dr. Paulo Nogueira, Director of Services for the Directorate General of Health’s information and analysis section.

One way to make sense of all that data will be the Global Burden of Disease collaboration, he said.

“It’s important to have an institute as a partner that already has the tools and the methods in place to measure health indicators,” Dr. George said. “With the DALYs (disability-adjusted life years), we can measure not just premature mortality, but also years lived in poor health and total years of healthy life lost.”

Nogueira elaborated, saying, “One of the most powerful things about the GBD is how it shows uncertainty levels around all the estimates. So you can identify data gaps and look for ways to improve the estimates over time.”

An uncertainty interval is the numeric range above and below an estimate that is likely (usually with a probability of 95%) to contain the correct value.

IHME will work with a growing set of partners in Portugal, including several who have participated in IHME’s annual Global Burden of Disease methods workshop in Greece. Among them is Dr. Carla Farinha, who is now the focal point for the Directorate General of Health on the GBD.

“When I first read about the GBD, I became deeply interested in it as a way to make sense of the health of the world,” said Dr. Farinha, chief of the Division of Health Statistics and Monitoring within the Directorate General of Health’s Office. “When I came back from Greece, I was able to sit down with my colleagues and explain some of the powerful machinery that goes into making these estimates so useful for planning and policy setting.”

The collaboration with IHME and the Global Burden of Disease enterprise began with ARS Norte, the primary public health agency for the northern region of Portugal. The agency produced a burden of disease report about the region in April 2011, which built on work by IHME Director Dr. Christopher Murray and IHME faculty, including Dr. Theo Vos. One of the goals for the new, nationwide collaboration will be to produce national-level burden of disease scientific papers and reports as well as regional and local analyses.

Local-level analyses will be key for meeting the challenge made by President de Sousa, who has been advocating for public health services to be increasingly responsive to the specific needs of local communities.

“The center of public health is the people in the community, not the institutions like the hospitals and health care centers,” de Sousa said. “And we must focus on the people in terms of communication, information, and proximity. Proximity might seem like an obsession of mine. The era of managing things at a distance is over. You cannot provide the service that the communities of Portugal need without proximity.”

IHME’s Director of Global Engagement, William Heisel, signed the MOU alongside Dr. George, and remarked to congress participants that IHME is ready to help the country “identify its most pressing health challenges through better measurement.”

Meghan Mooney, IHME’s Senior Engagement Manager, said Portugal is on the verge of becoming another GBD success story, following the examples set by the United Kingdom, Norway, Brazil, and other countries.

“The partnership between IHME and Portugal exemplifies the value of collaboration and cooperation built on a shared vision: to help all people to live long lives in full health,” Mooney said. “And as all of us here today recognize, turning this vision into reality requires public health data and analyses that are systematic, precise, and impartial.”