We Don't Actually Know Cause of Death for Millions of Humans

About 60 million humans will die this year, but 40 million of them will die without having a death certificate filled out for them in which a cause of death is listed. We can make some pretty good guesses about why they died, of course, but we could make better health progress if we knew for sure. This is the situation laid out by Dr. Alan Lopez, Director of the Global Burden of Disease Group at the Melbourne School of Population and Global Health, University of Melbourne and a long-time associate of Dr. Chris Murray and his Global Burden of Disease Group at the University of Washington. The story came to us via Ozy.com, and it made even my head turn.

“Policy is very weak because countries don’t have any evidence” for what’s killing populations, says Alan Lopez, one of the studies’ lead authors and laureate professor at the University of Melbourne’s school of population and global health. Without a cause of death and other basic demographic information, aka civil registration and vital statistics, it makes trying to prevent premature death a Goliath task. The series of studies, published in The Lancet, also found that another 40 million births a year, approximately one-third of the world’s total, also go unrecorded.

The births that go unrecorded are perhaps less important from a health perspective, but they do matter to the people who don't have a birth certificate because in modern society that means that you don't "count" in any official way. Your presence on the planet is estimated, but not officially acknowledged.

Our estimates of the causes of death come from limited sets of questions in surveys and censuses, as well as what are known as "verbal autopsies", in which a respondent tells an official what they think was the causes of death for a family member who died recently (typically in the past year). Lopez and others are trying to kickstart a movement to improve the registration of births and deaths.

Lopez and his team say they are starting to gain traction in making the recording of basic death and birth statistics a priority for global health movers and shakers. In partnership with Bloomberg Philanthropies, which is putting in $100 million, and a number of other groups, Lopez is leading a four-year push to improve death and birth registration systems in 20 countries. The initiative, called Data for Health, will look to use mobile and other technology to collect data faster and more efficiently.

A regular system of civil registration is very expensive, so there is almost no point in trying to move in that direction. On the other hand, cell phone penetration is now so deep in most developing countries, that verbal autopsies via cell phone text message makes a lot of sense.