Global health statistics: living longer, living better, reducing inequalities

Colin Mathers

World Statistics Day, 20 October 2010

Global health observatory | April 18, 20232 |

Global health statisticsGlobal health statistics

WHO is constitutionally mandated to

"establish and maintain ….. epidemiological and statistical services" and

"assist in developing an informed public opinion among all peoples on matters of health"

(WHO Constitution 1947)

DataGeneration

DataCompilation

Analysis and synthesisof data

Dissemination and use

Norms and standards

Information & Evidence work at WHO

Multi-country data collection

Country system and capacity building

Classifications and terminology

Methods and tools for data collection (including ethics)

Population health surveys, vital registration

Health research

Health information systems (including population surveys)

Vital registration systems

Databases

Disease registers

Surveillance

Data archive (surveys)

Core indicators and statistics

Disease-specific: eg. HIV, TB, malaria

Life expectancy etc

Health related MDGs

Systematic reviews of evidence and meta-analyses

Flagship publications

World Health Statistics

Global Health Observatory

Registration data

Health and health-related statistics

Comprehensive estimates

Deaths by cause, age, sex

Burden of disease (overall summary of lost healthy years)

Comparative risk assessment

WHO website

Health metrics network

Global health observatory | April 18, 20234 |

Inputs & processes Outputs Outcomes Impact

WHO Core Indicators

(DRAFT October 4, 2010)

WHO Core Indicators

(DRAFT October 4, 2010)

Health financing

1Total health expenditure per capita

2Government expenditure on health as % of total government expenditure

Health workforce

3Health workers per 10,000 population

Information

4% deaths registered

Governance

5National health strategy having the main attributes

Infrastructure

6Health facilities per 10,000 population

Service access and readiness

7Tracer medicines availability in health facilities

8Median price ratio for tracer medicines

9Outpatient visits per person per year

Service quality and safety

10TB treatment success rate (DOTS)

1130 day hospital case fatality rate acute myocardial infarction

12Waiting time to elective surgeries: cataract

13Surgical wound infection rate (% of all surgical operations)

Coverage of interventions

14Antenatal care (4+)

15Skilled birth attendance

16DPT3 Immunization coverage

17% need of family planning satisfied

18Children with ARI taken to health facility

19Children with diarrhoea receiving ORT

20ITN use among children

21ARV therapy

22ARV prophylaxis among HIV+ women

23Cervical cancer screening (20-64 years)

Risk factors and behaviours

24Condom use at last higher risk sex

25Access to safe water

26Access to improved sanitation

27Tobacco use (adults)

28Low birth weight among newborns

29Exclusive breastfeeding for 6 mths

30Obesity in adults (over 15)

31

32

Children under 5 who are stunted

Alcohol consumption (adults)

Health status

33Life expectancy at birth

34Child mortality (under-5)

35Maternal mortality ratio

36Deaths by cause,age,sex

37TB prevalence in adult population

38HIV prevalence

39Notifiable diseases (IHR)

Financial risk protection

40Out of pocket as % of total health expenditure

Global health observatory | April 18, 20235 |

Global Health Observatorywww.who/gho

Global Health Observatorywww.who/gho

WHO's portal to data and analyses for monitoring global health.

Direct access to major databases

World Health Statistics online tables

Critical data and analyses for key health themes and indicators

Country profiles by theme: core health indicators, MDGs etc

Interactive data tables and visualisations

Indicator and Metadata Registry; standards for metadata

Topical reports: Women and Health, Africa

Resource inventory; web-based registry of country data reports

Global health observatory | April 18, 20236 |

•Data are reported on an annual basis by country, year, sex, age and cause of death from civil registries

• Causes of death are coded according to the International Statistical Classification of Diseases and Related Health Problems (ICD)

•Historical data since 1950 with data coded to ICD 6, 7, 8, 9 and 10th revision

•ICD 11th revision currently in alpha draft (release 2011)

Database example: the WHO Mortality Database http://www.who.int/healthinfo/morttables/en/

Global health observatory | April 18, 20237 |

Coverage of the WHO Mortality DatabaseCoverage of the WHO Mortality Database

Of the reporting countries, half are developed providing 75% of the deaths included, but only 33% of estimated global deaths

Coverage90+75-8950-74<50 (sample)<50na

WHO Region

No of Member

States

Data reported for at least one of the years 2004-2008

% Member

States reporting

Afr 46 4 9Amr 35 32 91Emr 21 6 29Eur 53 46 87Sear 11 3 27Wpr 27 8 30TOTAL 193 99 51

Global health observatory | April 18, 20238 |

Age standardized death rates (per 100 000)All CVDs - Male - 60 years and over

0

1000

2000

3000

4000

5000

6000

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

Australia/New Zealand Central Europe Eastern Europe Latin AmericaNorthern America Western Europe Eastern Asia and Mauritius

Cardiovascular disease mortality trends

Analysis and synthesis: maternal mortalityAnalysis and synthesis: maternal mortality

SourcesNumber of surveys

Number of country-years

Civil Registration18911891

Surveys with Sibling Histories105819

Population Censuses1819

Other (eg special surveys, verbal autopsies, surveillance)

80113

Total20942842

24 countries had no nationally representative data that met inclusion criteria

Trends for 172 countries 1990-2009 estimated by an interagency working group

- input data sets, analysis programs, estimates and report on WHO website

Maternal mortality ratios at country level Maternal mortality ratios at country level www.who.int/maternal_health/enwww.who.int/maternal_health/en

Malaria: 38 countries on track to reduce the malaria-related burden of disease 9 African countries; 29 outside Africa

Is the pace of change sufficient?MDG 6: Combat AIDS, malaria and other diseases

Is the pace of change sufficient?MDG 6: Combat AIDS, malaria and other diseases

0

50

100

150

200

250

300

350

per 1

00 0

00 p

opula

tion

Prevalence of TB

0

0.5

1

1.5

2

2.5

3

3.5

4

Num

ber o

f peo

ple

(in m

illio

ns)

Incidence of HIV infection

The poorest are least likely to use health care:especially use of skilled care during childbirthThe poorest are least likely to use health care:especially use of skilled care during childbirth

0

20

40

60

80

100

Poorest 20% Middle 20% Least poor20%

Per

cen

tag

e

Measles immunization coverage Skilled birth attendants

Data for 47 developing countries

Global health observatory | April 18, 202313 |

Types of health statisticsTypes of health statistics

Unadjusted health statistics derived directly from primary data collection with no adjustments or corrections.

Adjusted health statistics corrected to deal with known biases, use of indirect techniques.

Predicted health statistics based on a model relating the quantity of interest to covariates.

– Forecasting: past relationships to predict future– Farcasting: missing primary data

Adult mortality rates by major cause group and region, 2004

0 2 4 6 8 10 12

Africa

Europe

South East Asia

Eastern Mediterranean

Americas

Western Pacific

High income

Death rate per 1000 adults aged 15–59 years

Cardiovascular diseases

Cancers

Other noncommunicable diseases

Injuries

HIVAIDS

Other infectious and parasitic diseases

Maternal and nutritional conditions

Comprehensive estimates: deaths by cause, age, sexComprehensive estimates: deaths by cause, age, sex

Percentage of disability-adjusted life years (DALYs)attributed to 19 leading risk factors, by country income level, 2004

Comparative risk assessmentComparative risk assessment

Assist Member States to build sound information systems that can generate high frequency data to monitor change

Promote and assist countries to implement and scale up vital registration systems

Work with research partners to develop innovative methods to collect information on mortality and cause of death in populations without vital registration (MOVE-IT)

Develop improved methods for dealing with incomplete and biased health data to generate comparable estimates of core indicators across countries

Improve transparency and replicability of statistics

Improve dissemination and access (Global Health Observatory)

Addressing the challenges Addressing the challenges