Can better health statistics save lives

Abstract

One of the central themes of this year's International AIDS Conference, held in Toronto, Canada in August, was a renewed call for universal access to treatment for HIV/AIDS. For Dr Peter Ghys this was all the more reason to pursue one of his main assignments at UNAIDS--improving the quality of data that measure the epidemic. Faced with discrepancies in published statistics and demands from donors for better information, Ghys and his counterparts at WHO have been charged with producing more accurate numbers in a more timely way. All diseases should have accurate figures, and our numbers form the basis of a lot of important actions related to the fight against AIDS, says Ghys, Manager of Epidemic and Impact Monitoring at UNAIDS. They are useful to try to quantify what universal access would mean, so it becomes very important. These efforts have produced important results. In the 2006 Report on the global AIDS epidemic, released in New York City in May, UNAIDS said that the epidemic is smaller than previously thought and changed its estimate of the number of people living with HIV infection to 38.6 million, down from the 40.3 million it had estimated six months earlier. Most of the decrease was due to better information, and not an overall decline. The efforts of UNAIDS to improve figures represent just one of several initiatives designed to gather more accurate data and harmonize health statistics. One such initiative is the Health Metrics Network, which aims to help developing countries improve health information systems and make timely and accurate information available around the world. Another example is the Mortality Coordination Group, made up of WHO, UNICEF, the World Bank and the UN Population Division that aims to harmonize under-five mortality estimates. WHO has also implemented new systems to harmonize data and make results universally accessible. Discrepancies in public health data have often led to controversy and raised questions about how health policy is formulated and where health dollars should go. The issue was highlighted this spring, when Greenpeace estimated that a much higher number of people were directly affected by the Chernobyl nuclear disaster than had been estimated by the International Atomic Energy Agency (IAEA) and WHO. Researchers have also had difficulty producing accurate figures for many causes of death, from tuberculosis and malaria to injuries and neglected tropical diseases, because of the lack of data, especially from countries where mortality is high. Dr Kenji Shibuya, Coordinator of the WHO Health Statistics and Evidence unit, says the push to produce better information, and to come up with one number that everyone agrees on, is fuelled partly by the demands of donors, who are increasingly concerned about whether their money is being well-spent. Developing countries have also recognized that they need better information as they struggle with multiple demands for data to monitor progress towards the Millennium Development Goals and the performance of their health systems. In order to improve the detection and response to public health emergencies around the world, WHO's Member States have committed themselves from June 2007 to report cases of certain diseases under the revised International Health Regulations. Researchers hope that accurate statistics will lead to better outcomes. It is actually difficult to prove this, but good statistics should contribute to good decision-making based on evidence, which will eventually lead to improved health status in a population, says Shibuya. The harmonization efforts to improve health statistics already in place are based on two principles. First, there should be an independent peer-review process of the figures generated. And second, all the information should be publicly available as soon as it is produced. For example, the Mortality Coordination Group meets at least once a year to share information, discuss what is known about how the numbers were gathered, and agree on which data to accept. …