1. 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

2. 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)

3. 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

4. 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

5. 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

6. 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)

7. 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

8. Cardiovascular disease mortality trends

9. 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 estimated by an interagency working group
- input data sets, analysis programs, estimates and report on WHO website

10. Maternal mortality ratios at country level www. who
Maternal mortality ratios at country level

11. 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

12. 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

13. 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

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

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

16. 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)