Date Published: November 20, 2007
Publisher: Public Library of Science
Author(s): Peter Byass
Abstract: The author discusses two studies that report important methodological advances in determining cause of death, which is crucial for health planning and prioritization.
Partial Text: More than half of the world’s deaths pass by undocumented as to cause . Whilst the appropriate focus of health services may well be the care of the living, consistent and reliable cause-of-death data also constitute a crucial and major resource for health planning and prioritisation, and their lack in many settings is a major concern. Two new papers from Christopher Murray and colleagues in this issue of PLoS Medicine [2,3] report important methodological advances which should go some way towards filling these data gaps.
To paraphrase George Orwell, all deaths are equal, but some are more equal than others. In particular, the chance of a death being registered and documented as to cause depends strongly on the socioeconomic status of the community and nation in which it occurs, and this is a major obstacle in coming to a meaningful global overview of mortality patterns.
Methodological advances in cause-of-death determination have not always been explicit about which gaps in the global data they seek to fill, and this has sometimes led to a confused overall picture. There are different levels at which data on mortality patterns are needed (i.e., from the local to the global) and various ways of meeting these needs, as shown in Table 1.
Realistically, there will not be universal vital registration and individually based cause-of-death data on a worldwide basis anytime soon, no matter how useful such information might be in public health terms. Therefore a mixed-methods approach will continue to be used, combining data sources that are most appropriate to their particular settings, and meeting needs at different levels.
Today’s world is a long way from having the comprehensive picture of mortality patterns needed for effective health planning. Murray and colleagues’ new methods make important contributions to filling some gaps at the global level, but further methodological development and wider support for implementing cause-of-death surveillance are still needed at all levels in the world’s poorest nations.