Emmanuela Gakidou, Murray’s wife and colleague, was crucial to the effort, helping to hire faculty and overseeing a fellowship program where recent college graduates can earn a master’s degree in public health. Today the institute employs 139 people, including 24 faculty, 35 fellows and 14 data analysts.
Staff members are interdisciplinary and international. The director of data development is a former media executive from Germany. An American mathematician designed the software program to model levels of impairment from each illness or injury. Rafael Lozano, lead author of the original Mexican burden of disease study, leads the global cause of death analysis group.
Official “Global Burden” results began appearing in the British medical journal The Lancet late last year in an unprecedented triple issue of the weekly publication, the first in its 190-year history. “In total, there are 650 million individual results to be reported,” Editor-in-Chief Richard Horton, not exaggerating, told Twitter followers. If he tried to run them all, he joked, “that would be six years of The Lancet with nothing but the Global Burden of Disease.”
The publication was celebrated with a daylong scientific symposium at the Royal Society in London, open to the public and attended by many of the study’s 486 co-authors from 302 institutions in 50 countries. The audience included Christine Kaseba-Sata, the first lady of Zambia; Jane Halton, secretary of the Department of Health and Ageing in Australia; Mickey Chopra, chief of health for UNICEF; and Mark Dybul, executive director of the Global Fund to Fight AIDS, TB and Malaria. Murray and colleagues discussed a few of the startling findings filling the global burden ocean.
Around the world, for example, chronic obstructive pulmonary disease claimed roughly twice the number of lives as HIV/AIDS in 2010, but HIV/AIDS was much more fatal to young people, and therefore appears higher in the DALY ranking. Likewise, as risk factors, not eating enough fruit out-rivals illicit drug use. For years, experts have said that most of the world’s major childhood diseases could be eliminated with clean water. What global burden suggests is that while lack of access to water and sanitation is a concern, five times worse for the world is indoor smoke from cookstoves, a major contributor to respiratory illnesses, communicable diseases, cardiovascular problems and cancers.
The concept of global burden upsets entire categories of thought, not the least of which is the old distinction between “developing” and “developed” nations around the world. For example, high blood pressure is the top risk factor in nations as diverse as Germany, Brazil, Indonesia, Egypt, China and Russia. Conversely, the No. 1 cause of ill health varies widely, even among close neighbors. “In Venezuela, it’s homicide. In Mexico, it’s diabetes,” says Murray. “Tuberculosis is big in Indonesia; in Malaysia and Thailand, it’s ischemic heart disease, same as in Western Europe.”
“What is exciting about this is that it’s the most up-to-date information,” says Lisa Cohen, executive director of the Washington Global Health Alliance, representing many of the world’s leading global health nonprofit organizations, including the Bill and Melinda Gates Foundation. “Where should we put our program resources?” In some nations, health spending may be as little as $2 or $3 per person. “That is infinitely precious money,” says Cohen. And with guidance from global burden data, government officials can allocate money to save and improve the most lives.
Simple comparisons suggest tomorrow’s priorities. Back pain costs men more years of healthy life than malnutrition; depression and suicide hurt women more than tuberculosis and cirrhosis; glaucoma was one of the fastest-growing contributors to health loss between 1990 and 2010. While Swiss males outlive even the Japanese, life expectancy in the United States has slipped by comparison with other nations of wealth.
Depending on the county, men and women may have the same average life expectancy in Indiana and Panama, Nevada and Vietnam, Michigan and Syria. “What we have found is that America has wonderful health care services for those who enjoy them,” says Lopez, today an IHME affiliate professor and the Rowden-White Chair of Global Health and Burden of Disease Measurement at the Melbourne School of Population and Global Health at the University of Melbourne in Australia. “But you have large proportions of the population who don’t have access to those services.”
What countries do with the data is up to political leaders, not IHME. But Murray is committed to making global burden datasets a constantly updated, freely available public resource rather than a once-every-other-decade publication. In January and February of 2012, even as he and his team raced with collaborators to ready the entirety of their research for publication, Murray traveled to Washington, D.C., Brasilia, Dhaka and Beijing to share preliminary findings and demonstrate interactive visualizations. And this year, IHME has put the same tools online for use by anyone in the world. Murray’s energy and impatience to measure life and death just may prove infectious.
Back in Murray’s office, we click again at the computer, and the display shifts to a series of nested rectangles showing the top global causes of DALYs in 2010. The bigger the rectangle, the worse the problem; the darker the rectangle, the more it has changed recently in percentage terms. Especially dark is “exposure to forces of nature.”
Murray swivels in his chair to face me. “That’s Haiti,” he says.
I ask if numbers can tell the whole story.
We already fit vast human tragedies into little rectangles, Murray responds. “People walk around with a mental map that’s different for every one of us. A real map has got to be a better guide.”