Better Death Records Can Lead to Longer Life

Here’s a morbid thought atop a morbid thought: Two in three deaths worldwide -- some 35 million a year -- go unregistered. And in many cases when deaths are recorded, reliable information on what caused them is lacking.

Why does this matter? Without such records, public-health authorities can’t tell enough about what’s killing people to minimize the dangers they face.

How, in 2013, can so many people leave the world without notice? Many poor countries still lack the government systems and trained workforce to do the job. Doctors, who might best be counted on to ensure that deaths are recorded, don’t always have incentive to do so, particularly in the developing world.

The Global Burden of Disease, a collaboration of researchers worldwide, estimates cause-of-death statistics for all countries, but these measurements aren’t perfectly accurate, because in many countries they can’t be based on actual death records. Health Metrics Network, a partner with the World Health Organization that has been largely funded by the Bill & Melinda Gates Foundation, has helped countries use new tools to assess and strengthen their record-keeping systems. In recent years, Brazil and South Africa have improved to the point where they register more than 95 percent of adult deaths and 80 percent or more of child deaths.

It’s no time to give up the effort. However, the Health Metrics Network is being disbanded, a victim of leadership problems and its own lack of success. And 120 countries are still not keeping adequate death records.

The costs are high. Today, two-thirds of the world’s people die of lifestyle-related causes: heart disease, diabetes, liver disease and road accidents. Fatal traffic crashes alone have risen 46 percent since 1990.

There are plenty of ways to steer people away from the activities that lead to such deaths: smoking, overeating, alcohol abuse and unsafe driving, to name a few. But it’s impossible to create targeted public-health policies if you don’t know exactly what and where the targets should be.

Even those countries that have begun to keep simple track of deaths have had trouble pinpointing the cause for each person, because, whether or not a doctor is present, no diagnosis is made. New “verbal autopsy” tools can do the job; they allow people who have witnessed a death to report symptoms, which can then be used to determine a cause of death. Studies have found that this approach can be as accurate as a doctor’s assessment.

What’s needed now is a new organization -- perhaps a consortium of international public-health experts, but independent of the WHO and the United Nations -- to drive a global effort to help all countries keep better track of their people. The technological capability is there; all that’s missing is leadership to make full record keeping a priority.

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