Colin Mathers World Statistics Day, 20 October 2010 Global health statistics: living longer, living better, reducing inequalities Colin Mathers World Statistics Day, 20 October 2010

Global 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)

Analysis and synthesis Health metrics network Information & Evidence work at WHO Data Generation Data Compilation Analysis and synthesis of data Dissemination and use Norms and standards Core indicators and statistics Databases Flagship publications Classifications and terminology Surveillance World Health Statistics Disease-specific: eg. HIV, TB, malaria Methods and tools for data collection (including ethics) Disease registers Life expectancy etc Global Health Observatory Registration data Multi-country data collection Data archive (surveys) Health related MDGs Comprehensive estimates WHO website Health and health-related statistics Population health surveys, vital registration Health research Deaths by cause, age, sex Burden of disease (overall summary of lost healthy years) Country system and capacity building Health metrics network Comparative risk assessment Health information systems (including population surveys) Systematic reviews of evidence and meta-analyses Vital registration systems

WHO Core Indicators (DRAFT October 4, 2010) Inputs & processes Outputs Outcomes Impact Health financing 1 Total health expenditure per capita 2 Government expenditure on health as % of total government expenditure Health workforce 3 Health workers per 10,000 population Information 4 % deaths registered Governance 5 National health strategy having the main attributes Infrastructure 6 Health facilities per 10,000 population Service access and readiness 7 Tracer medicines availability in health facilities 8 Median price ratio for tracer medicines 9 Outpatient visits per person per year Service quality and safety 10 TB treatment success rate (DOTS) 11 30 day hospital case fatality rate acute myocardial infarction 12 Waiting time to elective surgeries: cataract 13 Surgical wound infection rate (% of all surgical operations) Coverage of interventions 14 Antenatal care (4+) 15 Skilled birth attendance 16 DPT3 Immunization coverage 17 % need of family planning satisfied 18 Children with ARI taken to health facility 19 Children with diarrhoea receiving ORT 20 ITN use among children 21 ARV therapy 22 ARV prophylaxis among HIV+ women 23 Cervical cancer screening (20-64 years) Risk factors and behaviours 24 Condom use at last higher risk sex 25 Access to safe water 26 Access to improved sanitation 27 Tobacco use (adults) 28 Low birth weight among newborns 29 Exclusive breastfeeding for 6 mths 30 Obesity in adults (over 15) 31 32 Children under 5 who are stunted Alcohol consumption (adults) Health status 33 Life expectancy at birth 34 Child mortality (under-5) 35 Maternal mortality ratio 36 Deaths by cause,age,sex 37 TB prevalence in adult population 38 HIV prevalence 39 Notifiable diseases (IHR) Financial risk protection 40 Out of pocket as % of total health expenditure

Global Health Observatory www.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

Database example: the WHO Mortality Database http://www. who 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)

Coverage 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

Cardiovascular disease mortality trends

Analysis and synthesis: maternal mortality Sources Number of surveys Number of country-years Civil Registration 1891 Surveys with Sibling Histories 105 819 Population Censuses 18 19 Other (eg special surveys, verbal autopsies, surveillance) 80 113 Total 2094 2842 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 www. who Maternal mortality ratios at country level www.who.int/maternal_health/en

Incidence of HIV infection Is the pace of change sufficient? MDG 6: Combat AIDS, malaria and other diseases Incidence of HIV infection Prevalence of TB Malaria: 38 countries on track to reduce the malaria-related burden of disease 9 African countries; 29 outside Africa

Data for 47 developing countries The poorest are least likely to use health care: especially use of skilled care during childbirth Data for 47 developing countries

Types 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

Comprehensive estimates: deaths by cause, age, sex Adult mortality rates by major cause group and region, 2004

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

Addressing the challenges 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)