Importance OF CAUSE OF DEATH DATA MEDICAL CERTIFICATION OF Cause of death, TONGA November, 2018

International Reality check

Discussion point Do you know where to get cause of death data from in your country? Have you used any information on cause of death in the last couple of months? What sort of information on cause of death would you like to have? Why?

Cod data In summary… #1 Medical certificates of cause of death provide the most timely and complete sources of information about: which people are dying, where the deaths are occurring, what diseases or conditions are responsible for the deaths

Cod data In summary…#2 COD statistics are used for essential mortality surveillance COD information provides evidence for development of relevant national health policies COD data supports planning and resource allocation to decrease the burden of disease identify and reduce risk factors target interventions to improve population health.

Discussion point Which individuals or groups or organisations do you think need to access causes of death data? Why do you think they need it? What is it used for?

Who needs causes of death data? #1 Who: World Health Organization, other national and international bodies; governments What: ICD coded data, global and national cause specific mortality estimates Why: Standardised and comparable estimates over time and place, informing multisector policy and planning decisions, monitoring SDGs

Causes of death data is required for this type of analysis

Sustainable development goals and health SDG 3 is the main SDG with an explicit focus on health, but at least 10 other goals are also concerned with health issues. In total, more than 50 SDG indicators agreed internationally to measure health outcomes, proximal determinants of health or health-service provision health-related indicators grouped into seven thematic areas: reproductive, maternal, newborn and child health infectious diseases noncommunicable diseases (NCDs) and mental health injuries and violence universal health coverage (UHC) and health systems environmental risks health risks and disease outbreaks

Health SDG targets – which of these rely on cod data? 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births. 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

Health SDG targets – which of these rely on cod data? 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents. 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Health SDG targets – which of these rely on cod data? 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

Policy Level uses Cause of death information is important to: Determine what issues need to be addressed to help the population live longer and healthier lives Advocate for funding and resources for key health priorities Determine whether the health policies and programs that have been implemented in response to these priorities have been effective Cause of death is also more responsive for monitoring than morbidity in many instances We need this information by AGE and SEX in order to be useful We also need to know the UNDERLYING cause of death

Who needs causes of death data? #2 Who: Local public health officers What: Top ranking causes of death and details about local public health priorities Why: Assessment of community health status, Monitoring trends over time, implementing and evaluating public health interventions, providing an early warning function for public health safety

Who needs causes of death data? #3 Who: Epidemiologists, public health researchers What: COD data relating to specific population groups and specific areas Why: Understanding current health problems, suggesting patterns of risk in specific communities, understanding of patterns of disease (disease progression, risk factors, common co-morbidities, survival times and outcomes)

Who needs causes of death data? #4 Who: Institutional managers and clinical auditors What: Patterns of deaths in hospitals and other health care institutions, across the health care system Why: Monitoring trends over time in institutions and within departments, safety and quality of care assessment; management of caseloads and resources

Who needs causes of death data? #5 Who: Medical and legal practitioners What: Individual causes for particular cases Why: Understanding and preventing specific causes of death, following up consequences of individual deaths, improving quality of care

Who needs causes of death data? #6 Who: Families What: Death certificates, cause of death details Why: Help the family understand what happened; determine if there were circumstances that need further review; potentially provide family members with information about their own health risks; permit burial, support settlement of estate, act as a medico-legal document

Certifier's important role Certifiers are responsible for contributing important data to a country’s health information system in the form of accurate medical death certificates Note the important link between what is written on the death certificate and the mortality data reported by a country – and the international statistics reported by the World Health Organization

Reporting Cause of Death Top 10 leading causes can be misleading – if these include all ages More useful to examine causes by age group Children Adults 15-64 years Adults 65 years plus Everyone must die of something - including older adults Deaths in the elderly may bias the causes toward ‘non- specific’, ‘senility’, ‘cardiovascular disease’, ‘cancer’ Hard to base policy/ intervention decisions on these

MEASURING Cause of death many ways to look at the distribution of causes of death in a population data must be comparable over time and between countries need to be able to disaggregate data sufficiently to identify vulnerable populations  Common measures used for COD include: Numbers, Rates, Proportional mortality the ICD provides a framework that allows comparisons to be made at different levels: from broad chapters to more specific causes

If there is no local data If there is no local data ...or if local data cannot be compared internationally over the past century, there has been a notable transition in deaths from communicable and infectious diseases such as tuberculosis, pneumonia and influenza towards non-communicable diseases (NCDs) such as heart disease, cancers, diabetes and respiratory disease causes of death vary significantly by country and income levels across the world if a country doesn’t produce its own cause of death data (of sufficient quality), mortality burden ends up represented by estimates based on what is happening in other countries decision making is done elsewhere.....