The story begins with the Murray's: two physicians from New Zealand living in Minnesota. With a shared passion for global health they take their children to Africa every summer during their childhood. The four children all go on to have important jobs in the health field, however the most precocious was the youngest, Chris. His journey takes him from Harvard College to Oxford University and back to Harvard Medical School for his M.D. and PhD. Throughout his career he works at Harvard, the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME). Murray would ultimately team up with the Bill and Melinda Gates Foundation to produce reputable Global Health Statistics.
While at Harvard Medical School he worked and learned beside two influential figures in the Global Health world: Jim Kim (12th President of the World Bank) and Paul Farmer (Co-founder of Partners in Health). It is amazing to think of their conversations during medical school
One of Murray's greatest contributions to global health is integrating disability into our perception of health.
Taken from the book:
"Murray reviewed various attempts since the 1960's to create a combined measure of impairment, illness, and death. Look at a life span alone and the devoted gardener who never has so much as a cough and dies at age eighty seems the same as a neighbor who also lives to age eighty, but is blind, bedridden, or paralyzed by anxiety attacks. Simply count deaths, on the other hand, and the pneumonia that kills a one-year-old is no different than the stoke that kills a seventy-year old."
Murray formed a concept called Disability Adjusted Life years (DALY's). He concluded that it was not enough to know how long people lived and died, but also the years of healthy life lost. He came up with a formula to give different conditions disability weights. For example:
| Condition | Disability Weight | Years Lost per Decade with Condition |
| Mild Neck Pain | 0.1 | 1 |
| Deafness | 0.2 | 2 |
| Severe Depression | 0.6 | 6 |
Creating a new formula was quite controversial. It took several decades to standardize DALY's working with other experts and professionals. in the 1993 World Development Report over 700 disabilities were weighted and published.
As Murray continued his studies he found that there were major gaps in Global Health statistical reporting. Averages for one country seemed to be created out of thin air. " Only a handful of countries in the developing world had complete vital registration systems--that is, they had birth, death, and census records for at least 90 percent of their population. Murray counted at least five separate models for estimating life expectancy used by UN agencies and four by independent demographers. Their results varied by as much as fifteen years!"
Importance of Global Health Statistics:
"Global Health estimates help determine where billions of dollars in health funding goes. Campaigners use them to justify public health spending on certain causes, such as measles immunization campaigns or AIDS prevention. The numbers also help measure whether a campaign had made any difference, and they are one of the ways policymakers determine whether they are spending their money wisely."Science Journal, June 2012
Murray and his team published multiple studies in The Lancet, one of the most reputable medical journals on the world.
Key Individuals that worked alongside Chris Murray:
- Alan Lopez-associate professor at IHME
- Julio Frenk- Dean at Harvard School of Public Health
- Gro Harlem Brundtland-Former Director of the WHO
- Peter Piot- Professor of Hygiene and Tropical Medicine
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| Under 5 Mortality Rate in GAVI eligible countries (per 1,000 live births |
Other links of interest from the book:
- Harvard Pop Center-Global Health demographic center at Harvard University where Chris Murray worked.
- UNAIDS-Joint UN program focused on HIV and AIDS
- GAVI-The Vaccine Alliance created by the Bill and Melinda Gates Foundation
| Top 10 Causes of Years of Healthy Life Lost to Disability Worldwide: |
| 1. Low Back Pain |
| 2. Major Depressive Disorder |
| 3. Iron-Deficiency Anemia |
| 4. Neck Pain |
| 5. COPD (Chronic Obstructive Pulmonary Disorders |
| 6. Other musculoskeletal disorders |
| 7. Anxiety Disorders |
| 8. Migraine |
| 9. Diabetes |
| 10. Falls |
| Top 10 Risk Factors for Years of Healthy Life Lost Worldwide |
| 1. High Blood Pressure |
| 2. Tobacco Smoking |
| 3. Alcohol Abuse |
| 4. Household Air Pollution |
| 5. Diet Low in Fruits |
| 6. High Body Mass Index |
| 7. High Blood Sugar |
| 8. Childhood underweight |
| 9. Ambient particulate matter pollution |
| 10. Physical Inactivity |
How to live a longer, healthier life: According to the Global Burden of Disease:
1. Beat the Reaper: Eat Better (Ideal Diet) this will lead to an 87% decrease in YLL to heart disease. Increase physical activity or lower body weight (cuts into diabetes toll by 30-75%). Put out cigarettes completely and more than 80% of the health loss due to lung cancer and COPD would be eliminated.2. Stay Strong to the End: Prevent neck and back pain by taking regular stretch breaks, exercise with a focus on core strength, and consult guides to improve your posture.
3. Change What Risks you Can: Consume the optimal amount of fruits, nuts and seeds foods. Fruit: 300 gr/day, Nuts and seed foods: 114 gr/day. Avoid Processed meats: bacon, salami, sausages, and deli ham, turkey, and pastrami to prevent colon and rectum cancers, diabetes and ischemic heart disease. If you can, try and get 250mg of omega-3 fatty acids a day. Cut out sugar-sweetened beverages!
4. Support Public Action: Individuals in New York have increased the life expectancy by 13 years through political action including HIV prevention efforts, smoke-free public spaces, increased cigerrette taxes, restaurant calorie counts, and a trans fat ingredient ban. Most recently they enacted an action plan to eliminate traffic deaths entirely by 2024.
5. Get Smart (even if you can't get rich): Education is a wiser investment in terms of mortality than any other statistic. Educating women is an especially wise health investment on two fronts: first, it makes them better advocates and decision makers and second, it leads women to delay the onset of motherhood and have fewer life-risking pregnancies overall.
6. Stay Tuned: Check out www.healthdata.org for the latest on risk factor rankings by region, country, age group, sex and time period for death and disability.
Other Sources:
http://www.npr.org/sections/goatsandsoda/2015/09/18/441435120/the-good-news-and-bad-news-about-how-people-die
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00128-2/abstract
I think it is interesting that of the 10 risk factors for a healthy life, 9 of them are pretty much within our own control, the exception possibly being ambient particulate matter.
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