Institute for Health Metrics and Evaluation

Stanford attack of UW/Seattle study on global health funding itself under attack

Okay, this is a bit convoluted but see if you can follow.

The gist here is about how best to fund improvements in global health.

In 2010, Seattle researchers at the University of Washington’s Institute for Health Metrics and Evaluation published an analysis of global health spending and found a significant amount of ‘displacement’ – meaning foreign donations to fight HIV, malaria, TB or other scourges were allowing governments in poor countries to cut their own spending on health.

This is a problem because one of the primary goals in global health is to support local investment in health services and infrastructure.

Some used (arguably, misinterpreted) the UW study as evidence a lot of global health spending is misused or wasted. The Seattle number-crunchers weren’t actually saying that, of course. They were just pointing out that donors and aid organizations may need to build in better incentives to programs to avoid this counter-productive phenomenon.

But perhaps based on the concern that some were using the IHME study as evidence foreign health aid is a waste, some experts at Stanford University recently published their own analysis of the UW analysis and decided that there is “no evidence that international health is wasted.” Writing in PLoS Medicine, two experts with Stanford contend of the Seattle study:

(The) conclusions drawn from these data are unstable and driven by outliers…. While government spending may be displaced by development assistance for health in some settings, the evidence is not robust and is highly variable across countries. We recommend that current evidence about aid displacement cannot be used to guide policy.

Them’s fighting words for number crunchers. Continue reading →

FILED UNDER: Basics, Science, global health spending, Institute for Health Metrics and Evaluation

May 16, 2012 | 11:35 AM | By Tom Paulson

WHO report highlights chronic diseases & lack of global health strategy

Flickr, Erebos

Analysis

The World Health Organization has published its annual health report for 2012 and this year decided to “put the spotlight on the growing problem of non-communicable diseases.”

Here are some of the news stories spawned by the WHO report:

Reuters/MSNBC Heart disease, diabetes spreading to poor regions

AP/Washington Post Diseases of affluence are spreading worldwide

Voice of America Non-communicable diseases cause most deaths worldwide

UN Dispatch The Good, Bad and Mixed News in World Health Statistics

This focus on the NCDs, (non-communicable diseases) is certainly legitimate since they are, as a general category, major contributors to the global burden of disease. But another way to look at this, of course, is that the WHO report has turned the spotlight away from other diseases.

Why the focus this year on diabetes, heart disease and other chronic illnesses? Why has the attention been shifted away from the still-expanding HIV-AIDS pandemic, the threat of drug-resistant tuberculosis or malaria?

One easy answer is that the WHO annual statistics report always picks a theme and this year’s flavor is chronic disease.

Before, it was AIDS. Another year, it was TB or malaria. To WHO’s credit, one year the organization focused the attention on the much-neglected problem of mental illness worldwide. Another time, the spotlight was on deaths from accidents (which is a much bigger contributor to global mortality than you might think).

All of these are legitimate health concerns. But the nagging suspicion — or perhaps just inkling — you get from all this is that the shifting spotlight indicates no real strategy for global health.

I’ve long been disturbed by the lack of a clear, comprehensive strategy in global health — as well as the lack of a clear definition of what the hell we even mean by global health. Many tell me to lighten up, that the diversity of opinion and a de-centralized approach to the fight against disease is actually a good thing.

I’m not so sure, and I’m not alone in my uncertainty. See this post from the Center for Global Development’s Amanda Glassman and Kate McQueston Making Priority Setting a Priority for Global Health, which offers links to other related posts.

Update: Here is Amanda’s more recent perspective published in the British Medical Journal.

Kate Kelland of Reuters earlier this week also did a great report on the ‘squishiness’ of the WHO health statistics and the debate over how best to measure the burden of disease globally. It’s worth a read and mentions a group of Seattle number-crunchers, at the UW’s Institute for Health Metrics and Evaluation (e.g. a recent report on malaria) who are trying to bring more reliability and perhaps order to all this.

But, clearly, it’s not just a matter of improving the numbers. The international community has no consensus on what we mean by global health, let alone consensus on which problems deserve the most attention and resources.

FILED UNDER: Health, annual report, Institute for Health Metrics and Evaluation, non-communicable diseases, World Health Organization

February 2, 2012 | 3:30 PM | By Tom Paulson

Study: Malaria death toll nearly twice the official count, kills many adults

Flickr, ACJ1

A new global estimate of malaria deaths by researchers in Seattle has revealed the death toll is much greater than most experts had thought — and is not, as had been universally assumed, mostly a killer of children.

The study found more than 1.2 million people died from malaria in 2010, nearly twice the official estimate put out by the World Health Organization, and more than a third of the deaths were in adults.

The common wisdom has been that 99 percent of malaria deaths are in young children because adults develop immunity.

“This radically changes the picture,” said Dr. Christopher Murray, lead author of the study and director of the University of Washington’s Institute for Health Metrics and Evaluation (IHME).

Continue reading →

FILED UNDER: Health, Science, Chris Murray, Institute for Health Metrics and Evaluation, malaria, mortality, World Health Organization

December 15, 2011 | 9:35 AM | By Tom Paulson

Global health funding still growing, but slowing

Despite the global economic downturn, funding for projects aimed at fighting the diseases of poverty around the world continued to increase — but at a slower pace — throughout 2011, according to a report from Seattle researchers.

IHME

Chris Murray

“Even though we continue to see growth in global health funding through 2011, it is troubling to see so many funders pulling back,” said Dr. Christopher Murray, director of the UW’s Institute for Health Metrics and Evaluation and one of the report’s authors. “We are just now beginning to see the impact from the extraordinary growth in global health funding over the past decade. If we give up now, we may lose that momentum.”

The massive increase in global health spending over the past decade has produced significant improvements in maternal and child mortality, reductions in malaria incidence as well as preventing and treating HIV infections worldwide, Murray noted. The IHME report is published online in Health Affairs.

But now, say the Seattle number crunchers, major international health initiatives like the Global Fund to Fight AIDS, TB and Malaria are seeing donations decline (to the Global Fund, a 16 percent decline last year).

On the upside, given everything else going on, it is good news that global health funding has continued to increase overall. On the downside, the increase in 2011 was about 4 percent — the slowest rate of growth for this sector over the past decade. Continue reading →

FILED UNDER: Health, Chris Murray, funding, global health, Institute for Health Metrics and Evaluation

November 1, 2011 | 12:56 PM | By Tom Paulson

If 7 billion people are living on Earth, how many are dying?

Flickr, aldinegirl87

One of the big news items this week was that the global human population was expected to reach 7 billion with a baby born on Halloween, according to a gang of UN statisticians.

That was yesterday. Today is Day of the Dead, or Día de los Muertos in Mexico.

So let’s talk about dying.

No, this is not a Malthusian strategy for popluation control. What we will examine is how death actually causes population growth — and how little we know about why people die.

This will lead us into a discussion about a technique known as “verbal autopsies,” which some Seattle scientists are working to refine, and a new phone app that could help reduce the global birth/death burden on the planet.

It is truly a killer app.

First, it needs to be said that we can’t really know when the global population will have precisely crossed the 7 billion person threshold. In fact, as the BBC notes, we may be off by many months — or even years — in either direction with this estimate.

Secondly, we are equally in the dark about how and why people die, about 50 million per year. Most countries around the world have very poor mortality statistics.

But one thing we do know for certain is that those countries with the highest mortality rates are also the countries with highest population growth.

Huh? Yes, you read that right. Continue reading →

FILED UNDER: Basics, Health, Abraham Flaxman, Alan Lopez, Chris Murray, Gaetano Boriello, Institute for Health Metrics and Evaluation, mortality, population, verbal autopsy

October 11, 2011 | 11:45 AM | By Tom Paulson

Gates-backed AIDS project in India prevented 100,000 HIV infections, study says

Mike Urban, 2003

Nisha visits her son Allwyn's grave in Delhi. He died from AIDS, unknowingly transmitted to her by her husband.

A $258 million initiative sponsored by the Bill & Melinda Gates Foundation aimed at preventing AIDS in India appears to have paid off overall, researchers say, resulting in more than 100,000 fewer new HIV infections over five years.

Many aren’t quite ready to judge this project, Avahan, a success, however.

The project failed in three of the six Indian states where it was tested. And many are concerned that the amount of money spent to achieve these mixed results makes the approach highly impractical for poor countries.

The analysis of this project’s impact was done by the University of Washington’s Institute for Health Metrics and Evaluation, also sponsored by the Gates Foundation. This awkward situation is hardly unusual, as the Seattle philanthropy is now one of the primary funding sources for all things global health.

But before anyone gets too excited about the potential conflict of interest, which is real but which I can also attest has been repeatedly and vigorously debated within the UW Institute, it should be emphasized that the analysis was peer-reviewed by editors at The Lancet before publication.

The UW authors admit that their study results are preliminary and incomplete. Even with all the caveats, lead author Marie Ng says:

“The take-home message here is that prevention programs can be effective. Despite the heterogeneity of these results, it is clearly significant that we found more than 100,000 HIV infections were prevented.”

Continue reading →

FILED UNDER: Health, Science, Avahan, Bill & Melinda Gates Foundation, HIV-AIDS, Institute for Health Metrics and Evaluation, Marie Ng

September 15, 2011 | 9:53 AM | By Tom Paulson

More women in poor countries dying from breast cancer

www.joaquinjara.net

African woman by Joaquin Jara

The number of young women with breast cancer has more than doubled worldwide since 1980, say researchers at Seattle’s Institute for Health Metrics and Evaluation.

Most of this, say the University of Washington global health number crunchers, is in the developing world where women lack access to screening, prevention and treatment programs that have reduced the overall risk of breast cancer for women in the rich world.

“Women in high-income countries like the United States and the United Kingdom are benefiting from early cancer screenings, drug therapies, and vaccines,” said Dr. Rafael Lozano, a UW professor of global Health at IHME and co-author of the paper published today in The Lancet.

The findings are almost certainly going to be fodder for those advocating giving cancer more attention on the global health agenda at next week’s UN High-Level Meeting on Non-Communicable Diseases.

The study, which reviewed health data of 187 countries from 1980 to 2010, looked at both breast and cervical cancer death rates.

Over three decades, the researchers determined that breast cancer cases increased from 641,000 cases in 1980 to 1.6 million cases in 2010 (which far exceeds what would happen from population growth). Cervical cancer cases increased from 378,000 in 1980 to 425,000 in 2010, not as dramatically as breast cancer cases, and the cervical death rate (though 200,000) actually declined.

IHME UW

Breast cancer rates worldwide, 1980-2010

But it is the shift in the disease burden globally that is of perhaps more interest than the overall numbers. Continue reading →

FILED UNDER: Health, cancer, Institute for Health Metrics and Evaluation, non-communicable diseases, Rafael Lozano, United Nations

September 6, 2011 | 9:00 AM | By Tom Paulson

Nets protect against malaria, scientists say (but you already knew that)

Global health number crunchers, led by Seattle’s Institute for Health Metrics and Evaluation, have determined after an exhaustive survey of medical and demographic records in 22 sub-Saharan African countries that treated bed nets do protect against malaria.

Duh, you say.

Flickr, 4Cheungs

You might well think it’s a no-brainer to ask if handing out hundreds of millions of insecticide-treated bed nets in sub-Saharan Africa helps to reduce malaria.

But it’s not.

To begin with, there are lots of things that can — and do — reduce the incidence of malaria deaths and illnesses. There is the practice of indoor household spraying of insecticide, which has been increased along with the massive campaign to distribute insecticide-treated nets (ITNs).

There also seems to be a routine ebb-and-flow of malaria severity in the tropics. The disease, like many things in nature, tends to alternate between severe and mild cycles. It’s not clear why.

Flickr, Aya Rosen

And there was this confusing report recently, about the unexplained decline in mosquito populations in parts of Africa. This happened even in places where nobody was spraying or using bed nets.

There’s changes in rainfall patterns and land use that affect mosquito breeding. There are changes in access to malaria drugs (which has also been increased in recent years). And there’s a chronic problem of misdiagnosis of malaria in poor communities lacking labs. Continue reading →