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The Revolution Will Be Analyzed
The Institute for Health Metrics and Evaluation
Forty-some years ago, crusaders for social justice were armed with signs, banners, and conviction. They marched, they protested, and they won victories that changed society.
Today’s crusaders at the Institute for Health Metrics and Evaluation rely on data rather than protest, but they have a similar hope: to change global health — and peoples’ lives — for the better.
Global health is an increasingly prominent topic in medical circles. At UW Medicine and other research institutions, more attention is being paid to diseases, such as tuberculosis, malaria, and AIDS, that are particularly deadly in the developing world. But disease is only one facet of global health. Other issues of interest to researchers include much broader themes, such as the availability of clean water or the risks posed by climate change. As the name implies, global health is a large topic.
It’s a topic that Christopher J. Murray, M.D., D.Phil. — professor in the Department of Global Health, director of the institute, and former head of the Evidence and Information for Policy Cluster at the World Health Organization — and his colleagues are subjecting to rigorous, objective testing.
The problem with many global health efforts, says Murray, is that the organizations most involved in health programs “have been monitoring themselves.” That process doesn’t yield objective data, and there’s no forum to disseminate research findings.
“I think our existence,” says Murray, “is changing the discourse on analysis.”
Investing in facts
In 2007, the Bill & Melinda Gates Foundation made a multi-year and multi-million-dollar commitment to create the Institute for Health Metrics and Evaluation. Recruiting Chris Murray, a world-renowned health economist, was an investment they were eager to make.
“One of the Gates Foundation’s priorities is to help ensure that decisions about global health policy and funding are based on high-quality data and evidence,” says Kathy Cahill, the foundation’s deputy director of integrated health solutions and development. “There has been a significant increase in funding for global health in recent years, and it’s critical to evaluate the impact of these investments.”
The institute will assess the investments made by foundations, governments, universities, and other groups in a variety of ways. First, the institute is analyzing data on adult and child mortality and functional impairment — what Murray calls “the global burden of disease.” Their intent is to create a single, comprehensive currency to measure global health.
The Institute for Health Metrics and Evaluation also will collect data on how and where public health and medical institutions treat patients. Researchers will track resources, to see how much governments, foreign aid agencies, and individuals pay for health care. They also will analyze the effectiveness of interventions and evaluate major health programs.
“The institute fills a very important niche in the institutional architecture of global health,” says Julio Frenk, M.D., MPH, Ph.D., the chair of IHME’s board of directors. Frenk, Mexico’s former Minister of Health, the new dean of the Harvard School of Public Health, and a senior fellow at the Gates Foundation, has a career-long interest in evidence-based medicine and social justice.
“Science is this force that allows us to transform reality in an enlightened way,” says Frenk. In an ideal world, he says, we’d have more data about the burden of disease and the cost-effectiveness of interventions, and we’d know what health issues to prioritize. In today’s world, he says, global health is still subject to the forces of ideology, short-term political gain, or economic interests.
Having independent objective data to inform public policy — “That’s why the IHME is so important,” says Frenk.
Shaping public policy
Like Frenk, Kathy Cahill believes in the Institute for Health Metrics and Evaluation’s ability to use data in powerful and effective ways.
“The institute’s analyses will help identify which health interventions are the most cost effective and have the highest effective coverage,” says Cahill. “That’s incredibly useful information to, say, an African health minister, who has to make tough decisions every day about how to allocate resources.”
Although the institute has been in existence for only one year, Chris Murray notes that he and his colleagues already have formed connections with organizations like the World Health Organization and the World Bank, and with federal and state government contacts in the U.S. And, he says, they’ve launched a number of studies.
Many of these studies are still in process, says Murray — such as projects that focus on new methods for measuring adult mortality, government health spending and international resources for health, progress toward universal childhood immunization, and the impact of global initiatives. But one study has returned results — unfortunately, surprisingly negative results. Despite global efforts to keep children healthy, evidence shows that, globally, we are doing no better at reducing child mortality now than we were 30 years ago. Murray doesn’t speculate as to why.
“What we largely do,” says Murray, “is try to stick to the evidence.” It’s an ethic that will change the practice and effectiveness of global health efforts.
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