Making deaths count

Abstract

Death has always been an overriding concern: two of the Millennium Development Goals express targets in terms of mortality and one out of three components of the Human Development Index is a mortality measure. It is therefore surprising that the systematic measurement of mortality is relatively recent: rudimentary life tables to summarize mortality from the 17th century, the use of systematically collected data on vital events to examine mortality differentials and cause of death from the 19th century, and systematic explorations of behavioural risk factors only in the 20th. Today, routinely collected data on vital events provide complete and representative information for only about 40% of the world's countries and a quarter of its population. (1) The planning, implementation and evaluation of health programmes at national and international levels require valid, comparable and timely information on the nature and magnitude of health problems. Information on deaths by cause is the key: the Global Burden of Disease 2000 (2) estimates that 63% of healthy life lost in 2000 resulted from premature deaths. Yet Mathers et al., (3) reviewing cause of death recording among Member States supplying data to WHO for 1990 or later, conclude that quality is high for countries with only 12% of the world's population, medium for 17% and poor for 5%; no data are supplied for the remaining 66%. Only two countries from sub-Saharan Africa, the region with the highest mortality, report causes for 50% or more of their deaths. Global health progress requires action to improve the availability of valid statistics: broader collection and timely dissemination of health statistics, and new methodologies that make better use of existing data or that can collect substitutes for vital statistics records quickly and inexpensively. The articles in this issue address both. Information on child mortality in the 1990s is now available for a large majority of countries. Coordinated programmes such as the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys have provided information on patterns, levels and trends of child mortality in many developing countries. Population censuses have added indirect observations and small area estimates for local health authorities. The major international agencies have coordinated their efforts, developing a common database and working on methodological improvements, but there is still much we do not know. Existing estimates are not timely: relatively few developing countries provide estimates of child mortality for 2000 or later. Information on cause of death is weak, and existing verbal autopsy approaches identify few causes well. Countries affected by civil strife, with perhaps the greatest problems of elevated child mortality, rarely have recent indicators of child mortality. The situation is worse for adult mortality. …