What’s being measured?
The Institute for Health Metrics and Evaluation at the University of Washington has collected an enormous amount of data on global health. This snapshot of the world (above) in 2010, released in 2013, shows the toll taken by communicable, maternal, neonatal and nutritional disorders by country. The DALY (or disability-adjusted life year), a time-based measurement that combines years of life lost due to premature mortality and years lived in less than ideal health. The countries on the blue end of the spectrum have the fewest DALYs per 100,000; the countries on the warmer (red) end of the spectrum have the most.

Health trends in global populations are in constant flux. This may be the most basic lesson drawn from the Global Burden of Disease (GBD) Study 2010, an in-depth and unprecedentedly thorough look at the way people around the world live and die.

Led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and involving collaborating institutions and researchers worldwide, the GBD offers a plethora of relatable and highly detailed data on everything from cervical cancer, heart disease and childhood obesity to tuberculosis, automobile fatalities and gun violence. This wealth of information, organized and presented as a free and searchable online tool, reveals significant and surprising changes in global health trends since 1990.

Take, for instance, positive change shown by the data on the global stage. Great strides have been made in minimizing fatal illnesses, especially deadly infectious diseases, for people of all ages. As infectious diseases and child illnesses related to malnutrition lose their hold, child mortality is trending downward in many parts of the world.

However, while people are living longer, many live with more chronic pain, limited mobility, and impairment in hearing, sight and cognitive function. Chronic disabilities, such as mental and behavioral disorders, musculoskeletal problems and neurological conditions, now account for nearly half of all health loss in the U.S.

The purpose of gathering all this data? “We need objective evidence to show policymakers what works and what does not work in order to improve people’s lives,” says Christopher J. L. Murray, M.D., D. Phil., IHME’s director and UW professor in the Department of Global Health.

An ambitious and independent agenda

An independent global health research center and part of the University of Washington, IHME’s mission is to provide rigorous and comparable measurement of the world’s most pressing health issues and evaluate the strategies used to address them. IHME was founded in 2007 through a generous gift to the University of Washington from the Bill & Melinda Gates Foundation.

Murray notes that the foundation and the university have been instrumental to IHME’s and the GBD’s success. “Their support has allowed us to set an ambitious agenda to provide comprehensive information on population health,” he says. “Having support from organizations that value research, science and measurement has helped us to ensure that our work in Seattle is recognized globally.”

The gift — and the collaboration with researchers worldwide on the GBD — also have given IHME the freedom to serve as a trusted resource for policymakers, health organizations and others.

“By harnessing all sources of available data, we’re not dependent on any single measurement or any single source, and we remain independent from official intergovernmental agencies,” says Murray.

The GBD: Power in Collaboration
In undertaking the GBD, IHME enlisted a large group of collaborators and amassed an enormous amount of data to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex and geography over time.

Collaborators: 488 researchers,
303 institutions, 50 countries
Countries Examined: 187
Epidemiological Regions: 21
Diseases and Injuries Reviewed: 291
Risk Factors Evaluated: 67
Age Groups Assessed: 20

Accomplishments
• Set the stage for policy
decisions worldwide related
to healthcare and resource
allocation.
• Developed metrics that quantify disability-adjusted life years (DALYs), a time-based measure that combines years lived with a disability and years of life lost due to premature mortality.
• Strengthened statistical
methods used for estimation.
• Created a system capable of integrating new data sources.
• Published data from 2010
(and 1990 and 2005).

Use the tools
IHME’s superb visualization tools allow even casual users to compare and contrast data.

Using the GBD: from China to King County, Wash.

First unveiled at the Royal Society in London in December 2012, and published shortly thereafter in a first-ever triple issue of The Lancet, the GBD’s seven scientific papers and accompanying commentaries and tables provide a powerful new platform for assessing the world’s biggest health challenges and finding the best ways to address them.

The world has been taking notice — in part because the information, presented in an accessible format in online visualizations, is free and available to everyone: researchers, policymakers, the public.

Paul G. Ramsey, M.D., CEO of UW Medicine and dean of the UW School of Medicine, is not surprised by the activity generated by the GBD. “At a time when world economies are struggling, health systems and global health funders must know where best to allocate resources,” he says. “I see the GBD as a management tool for ministers of health and leaders of health systems to prepare for the specific health challenges coming their way.”

Murray says it’s been gratifying to see how the GBD is being used throughout the world.

“Several countries, including Australia, the U.K. and China, have worked with us to undertake studies focused on local health challenges using the GBD model,” Murray says. “The World Bank has been very supportive of our GBD analysis, and we’ve worked with them to create a series of reports on health issues in a group of World Bank regions.”

The GBD also is being used significantly closer to home, according to David Fleming, M.D., director and health officer for Public Health-Seattle & King County. The agency uses GBD data to compare how communities in King County fare against those in developed and developing countries.

In addition to nutritional and physical activity programs, Fleming and his staff have an array of other healthcare issues to consider, including prenatal care and child healthcare, immunizations, diabetes screenings, HIV/AIDS epidemiology and breast, cervical and colon cancer prevention. IHME research data have been eye-opening resources.

“If we examine King County at the census-tract level and ask how each census tract is doing relative to the best-performing countries — it turns out that the county’s overall ‘good’ average hides huge underlying disparities,” Fleming explains.

Fleming, former director of the Bill & Melinda Gates Foundation’s Global Health Strategies Program, says his staff is working with IHME to replicate the GBD’s work — especially the data visualizations — at the county level.

“By creating the visualizations, we will have a powerful tool that can help people better understand the nature of health disparities here in King County,” says Fleming. And when leaders understand health disparities more fully, they have the resources to make better decisions about healthcare funding.

Global health: now in our hands

Results from the 2010 GBD are very much in the public eye, garnering attention and calls for action. And research to compile the GBD 2013 is already under way — the product of an advanced computing platform the IHME created during their work on the 2010 report. The platform is designed to accommodate frequent updates and expansions.

And expand it will. IHME is reaching out to experts who are advancing the field of health metrics in countries around the world — the goal being not just to increase the number of collaborators and countries included in the GBD, but also to expand the list of diseases, injuries and risk factors included in the study. GBD 2013 is due out in 2014.

“The GBD platform and these powerful visual tools allow us to ask questions about the state of the world’s health that we didn’t even know to ask before,” says Murray. “They also allow us to engage everyone — from the highest levels of government to people on the street with their smart phones — in seeking understanding on how to improve people’s health.”

“Health measurement is no longer controlled by the specialists,” Murray says. “It is now in your hands.”

See the full-size visualizations

Christopher Murray goes to Washington, D.C.

Photo: Steve Korn

According to GBD statistics, diet was the top risk factor for health loss in the U.S. in 2010. It may not be surprising, then, to learn that First Lady Michelle Obama invited IHME’s director, Christopher J. L. Murray, M.D., D. Phil., to speak at a gathering of community leaders in July that celebrated the anniversary of Let’s Move! Cities, Towns and Counties. Let’s Move is an initiative to end childhood obesity.

“First Lady Michelle Obama and the team working on the Let’s Move campaign have been enthusiastic about using the Global Burden of Disease to explore trends related to physical activity and obesity at the county level, and the critical role that diet plays in good health,” Murray says.

The First Lady cited IHME research during her address to the group. Dietary risks contributed to more health loss in 2010 than smoking, high blood pressure and high blood sugar. “Poor nutrition is the single greatest cause of preventable diseases and ailments in this country,” Obama said. And while emphasizing the importance of communities’ advocacy for healthier eating and increased physical activity, she pointed out how data from the GBD could be used to change public policy.

“The key here is that the data from this report goes all the way down to the county level, which means that you’ll be able to see which issues are affecting your communities the most,” she said. “And once you have all this information, you’ll be able to make more effective decisions to really focus your resources and programming to find solutions that fit the needs of your community.”

Following the First Lady’s remarks, Murray presented GBD results on U.S. life expectancy, obesity and physical activity from three papers published in the Journal of the American Medical Association and Population Health Metrics.

For further reading. The IHME offers numerous policy recommendations in The State of US Health: Innovations, Insights and Recommendations from the Global Burden of Disease Study, available on the IHME website. Among the recommendations that focus on diet: maximize the ability of primary-care providers to help patients modify behaviors with regard to food, alcohol and high blood pressure; use taxes and subsidies to incentivize diets that focus on food such as vegetables, seafood and whole grains; and create environments, both physical and social, that reward physical activity.

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