Dear HIFA and CHIFA colleagues,
I was interested to read this article by Bill Gates. Extracts below and a comment from me. Full text here: https://www.gatesnotes.com/work/save-lives/reader/how-to-cut-child-morta...
'This year marks 25 years since we started the Gates Foundation. Back then, we had a simple but ambitious goal: help more children survive and thrive. But at the time, even the most basic question—why are so many children dying?—didn’t have a clear answer...
'That’s why I believe our most transformative breakthrough from the past two-and-a-half decades wasn’t a single vaccine or invention. It was better data...
'So the foundation helped create the Institute for Health Metrics and Evaluation at the University of Washington, to give a permanent home to the Global Burden of Disease study...
'With better knowledge of what was killing children, and where, one more fundamental question remained: Why might one child die from a disease while another—who lives in the same place, faces the same risks, and gets the same treatment—survives? This was our third big challenge...'
'In theory, traditional autopsies would provide the answer. But in the places where most childhood deaths still occur, these invasive procedures are often impossible to perform—too costly, and sometimes opposed for religious, cultural, or personal reasons. So in 2015, the foundation launched the Child Health and Mortality Prevention Surveillance network, or CHAMPS, which now operates in nine countries across Africa and South Asia. Working with in-country partners, CHAMPS pioneered a new autopsy alternative—using minimally invasive tissue sampling—that can determine causes of death quickly and accurately while respecting local customs and beliefs.'
COMMENT (NPW): In a linked article, Bill Gates asks 'Why do children die?' https://www.gatesnotes.com/work/save-lives/reader/why-do-children-die
He writes: 'My introduction to the subject came 25 years ago, when I read a New York Times article about the health problems caused by unsafe drinking water in low- and middle-income countries. I was shocked to learn that every year, 3.1 million people — nearly all of them children — died of diarrhea, often because they had drunk contaminated water. Diarrhea kills 3.1 million children?, I thought. That can’t be true, can it? But it was.'
My own introduction came in 1987. I was working as a volunteer doctor in rural Peru. One day a woman came to my hut with a bundle in her arms. When I opened the bundle I saw the dehydrated, lifeless body of a small girl child. The mother told me the child had died in her arms as she carried her to my post. With the help of an interpreter I learned that the child was suffering from diarrhoea in the past few days. The parents believed they should withhold fluids to a child with diarrhoea, so this is what they did. Tragically the parents contributed to the child's death because of a lack of basic healthcare information. I subsequently learned that this false belief is still common today worldwide. In A national survey in India, for example, found that more than half of children with acute diarrhoea receive less to drink than normal (and one in 20 receive no fluids at all).
https://www.hifa.org/about-hifa/why-hifa-needed
Lack of basic healthcare information as a major contributor to poor health care is a phenomenon that applies to almost every area of health, not just diarrhoea. Furthermore it applies not only to parents and the general public, but also to health workers. In the early days of HIFA I coauthored a review with HIFA co-founder Fred Bukachi, which concluded there is 'a gross lack of knowledge about the basics on how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices'.
In 2006, the year HIFA was launched, global health leaders wrote in The Lancet: 'The Gates Foundation identified fourteen challenges but a fifteenth challenge stares us plainly in the face: The 15th challenge is to ensure that everyone in the world can have access to clean, clear, knowledge — a basic human right, and a public health need as important as access to clean, clear, water, and much more easily achievable.'
A 15th grand challenge for global public health. Pang, Tikki et al. The Lancet, Volume 367, Issue 9507, 284 - 286
I understand from one of the authors that the Gates Foundation did not reply.
My dream would be that WHO provides the political leadership and steps up to champion universal access to reliable healthcare information, while Gates (or any other major funder) provides financial support.
Our recent global consultation indicates that this is what most of us in the global evidence ecosystem want to see: political and financial commitment to universal access to reliable healthcare information.
And my message to Bill Gates would be: Even more important than 'better data' is better access to basic lifesaving information and knowledge. And the key question is not "Why might one child die from a disease while another — who lives in the same place, faces the same risks, and gets the same treatment — survives?". It is "Why might one child survive, and another child dies, simply because the parent or health worker did not have access to the basic healthcare knowledge they needed to save them?" The tragedy is that so many children - and adults - are continuing to die due simply to a lack of basic healthcare information. The surest way to cut child mortality in half again is to ensure that every child, every parent and every health worker has access to the reliable healthcare information they need to protect their own health and the health of those for whom they are responsible.
Join HIFA: www.hifa.org/join
Join CHIFA (child health and rights): https://www.hifa.org/join/join-chifa-child-health-and-rights
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org