Recent controversies about maternal mortality rates mask a bigger need to improve the process of global health estimation, and they deflect attention away from the need for action to improve the health of the most vulnerable. These are some of the strong conclusions of a group of articles in this week's PLoS Medicine, authored by leading experts who provide insights and opinion on what estimates mean for global health and how to move forward with better data, measurement, coordination, and leadership.
Global health estimates—such as rates of maternal and child mortality, progress toward the Millennium Development Goals, and other indicators of international health and development—are often a source of controversy among academic researchers and international agencies, especially when different estimates come to different conclusions. Recent controversies about the "true" rates of maternal deaths around the world afford an opportunity to reflect and debate the way forward.
The cluster of articles in PLoS Medicine includes an introductory article by Peter Byass (Umeå University, Sweden) laying out the main issues, as well as the perspectives of Ties Boerma and colleagues at WHO—once the main agency generating global health estimates— and academics Christopher Murray and Alan Lopez from the Institute for Health Metrics and Evaluation (IHME) in Seattle USA, which are now involved in global health estimation.
The cluster also includes the perspectives of the often forgotten "users" of global health estimates at the country level including Osman Sankoh (INDEPTH Network, Ghana) who argues that estimation work should draw on collaborations with researchers and planners in low- and middle-income countries. Wendy Graham (University of Aberdeen, UK) and Sam Adjei (Centre for Health and Social Services, Ghana) call for more "responsible estimation."
Accompanying the cluster is an editorial by the PLoS Medicine Editors that argues that "contentiousness about health indicator estimates operates too much at the level of the global, and not enough at levels where real data are generated and interpreted."
The Imperfect World of Global Health Estimates by Peter Byass
Funding: This work was undertaken within the Umeå Centre for Global Health Research, with support from FAS, the Swedish Council for Working Life and Social Research (grant no. 2006-1512). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The author is a member of the Editorial board of PLoS Medicine, deputy editor of Global Health Action, a member of the editorial board of Population Health Metrics (a journal based at the Institute for Health Metrics and Evaluation), and a member of the UN Maternal Mortality Estimation Inter-Agency Technical Advisory Group, hosted by WHO, Geneva. He has visited the Institute for Health Metrics and Evaluation, Seattle, at their expense.
Citation: Byass P (2010) The Imperfect World of Global Health Estimates. PLoS Med 7(11): e1001006.doi:10.1371/journal.pmed.1001006
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WHO and Global Health Monitoring: The Way Forward by Ties Boerma and colleagues
Funding: No specific funding was received for this article.
Competing Interests: While working at WHO, CAZ was involved in the development of global estimates. Disclaimer: The authors are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the World Health Organization.
Citation: Boerma JT, Mathers C, Abou-Zahr C (2010) WHO and Global Health Monitoring: The Way Forward. PLoS Med 7(11): e1000373. doi:10.1371/journal.pmed.1000373
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Production and Analysis of Health Indicators: The Role of Academia by Christopher Murray and colleagues
Funding: No specific funding was received for this study; however, the Institute for Health Metrics and Evaluation is funded by a grant from the Bill & Melinda Gates Foundation. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: CJLM works in academia generating health indicator estimates; is the Director of the Institute for Health Metrics and Evaluation; is a Professor of Global Health at the University of Washington; and from 1998 to 2003 worked at the World Health Organization in Geneva, Switzerland. ADL works in academia generating health indicator estimates; is a member of the editorial board for PLoS Medicine; is Head of the School of Population Health and Professor of Global Health at the University of Queensland; is an Affiliate Professor of Global Health at the Institute for Health Metrics and Evaluation; and from 1980 to 2002 worked at the World Health Organization in Geneva, Switzerland in a series of technical and senior managerial posts.
Citation: Murray CJL, Lopez AD (2010) Production and Analysis of Health Indicators: The Role of Academia. PLoS Med 7(11): e1001004. doi:10.1371/journal.pmed.1001004
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Global Health Estimates: Stronger Collaboration Needed with Low- and Middle-Income Countries by Osman Sankoh
Funding: OS is funded by core support grants from the Hewlett Foundation, Wellcome Trust, Rockefeller Foundation, Sida/GLOBFORSK, and the Gates Foundation. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: Osman Sankoh is the executive director of INDEPTH Network.
Citation: Sankoh O (2010) Global Health Estimates: Stronger Collaboration Needed with Low- and Middle-Income Countries. PLoS Med 7(11): e1001005. doi:10.1371/journal.pmed.1001005
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A Call for Responsible Estimation of Global Health by Wendy Graham and Sam Adjei
Funding: WJG is funded primarily by the University of Aberdeen. She also has a seconded position at the Department for International Development, but DFID played no role in the preparation of this article. SA is funded by the Rockefeller Foundation, which had no hand in this article. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: WJG declares that she is the principal scientist for a research group (Immpact) that undertakes the measurement of population health, including maternal mortality. WJG was one of the peer reviewers for an article in The Lancet by Hogan et al. that reported the IHME maternal mortality estimates, and was a member of the external Technical Advisory Group for the Inter-agency Group for maternal mortality. SA is a former Board member of the Health Metrics Network, former Deputy Director-General of the Ghana Health Service, former chairman of the country coordinating group of Immpact in Ghana, and former visiting Professor at the University of Aberdeen. He has provided consultancy services to the African Program of Onchocerciasis Control.
Citation: Graham WJ, Adjei S (2010) A Call for Responsible Estimation of Global Health. PLoS Med 7(11):e1001003. doi:10.1371/journal.pmed.1001003
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Can We Count on Global Health Estimates? by the PLoS Medicine Editors
Funding: The authors are each paid a salary by the Public Library of Science, and they wrote this editorial during their salaried time.
Competing Interests: The authors' individual competing interests are at http://www.plosmedicine.org/static/editorsInterests.action. PLoS is funded partly through manuscript publication charges, but the PLoS Medicine Editors are paid a fixed salary (their salary is not linked to the number of papers published in the journal).
Citation: The PLoS Medicine Editors (2010) Can We Count on Global Health Estimates? PLoS Med 7(11):e1001002. doi:10.1371/journal.pmed.1001002
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