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The Joy of Facts and Figures News The joy of facts and figures Hans Rosling tells Fiona Fleck why it’s easy to make health statistics interesting but difficult to persuade people to accept a fact-based view of the world. Q: Are people using health statistics in the best way? Hans Rosling is a world-known public speaker A: Very few of them. The old on global health and demographic trends using concept of a world divided between innovative, animated software. He has been a professor developed and developing countries, of international health at the Karolinska Institute in is still perpetuated by the United Na- Stockholm, Sweden, since 1997 and is chairman of tions (UN) – although the UN´s own the Gapminder Foundation, which he set up in 2007 statistics show that such a division no with his son and daughter-in-law. They developed the longer exists. For example, in 2012 Trendalyzer software that converts time series data into WHO published together with the Courtesy of Hans Rosling United Nations Children’s Fund and Hans Rosling interactive moving bubble-graphs. Rosling studied the World Bank the report Levels and statistics and medicine at Uppsala University, Sweden trends in child mortality. I always carry from 1967 to 1974 and public health at St Johns Medical College in Bangalore, it in my backpack. Here, the world is still India in 1972. From 1979 to 1981 he served as district medical officer in northern divided into developed and developing Mozambique and in 1981, with his research team, identified a new paralytic regions. The developing ones include disease and named it konzo. In 2010, his filmThe Joy of Stats won the Grierson Singapore, the country with the lowest Award for the best science documentary film. child mortality, Qatar, the world’s rich- est country, and the Republic of Korea, the fastest developing country. What is the criterion for these classifications? average global life expectancy was 50 of respondents knew that the number A 1963 fertility rate of five or more live or 60 years, but the correct answer is 70 of children in the world has stopped births per woman, which will forever years. Only about 10–15% of respondents increasing. This is the biggest event in label a country as developing. (It took knew that [and, so the majority of these the history of mankind that was ever me months to find that out!) respondents have a seriously distorted completely missed by the media. world view]. Had we asked chimpanzees, Q: What is needed to counter such mis- twice as many of them would have picked Q: The public needs access to reliable conceptions? the right answer just at random. health statistics to be able to embrace A: We need to divide the countries a fact-based world view. You have of the world into three or more groups: criticized WHO in the past for failing to two groups is just not enough to reflect make its data more accessible, has this This is the biggest the widely divergent socioeconomic re- situation improved? alities. The situation in the very poorest “event in the history of A: Many WHO programmes used countries should not be portrayed as mankind that was ever to publish their data on separate web the general situation for “the develop- completely missed by pages to present the success of their pro- ing world”. Especially when it comes the media. gramme to donors. Access to WHO data to health, Brazil and the Democratic has improved with the Global Health Republic of the Congo (DRC) just do not ” Observatory [a statistics portal for fit in the same group any longer. WHO technical departments established in 2010] and, for example, statistics can Q: Is this view of the world widely held? Q: Why did so few know this? now be downloaded for people to print. A: Yes. The Gapminder Foundation A: In the richest countries global I admire this central statistical work decided to take a fact-based approach. health is still largely perceived as cata- of WHO, but there are still problems, This year we started to do surveys on strophic and so is the growth of the such as with merged cells at the top of the public’s knowledge about the world, world population. I try to erase those excel sheets, which you must “unmerge” asking the people in Sweden and the concepts by telling simple facts. When when you want to use them. I would also United Kingdom questions like “what I was born in 1948, we were fewer than like to have more straightforward data, is the average global life expectancy, or 1 billion children in the world (aged for example, the number of cigarettes literacy rate?” We found that people in 0–14 years). Up to the turn of the smoked per person and lung cancer Sweden and the United Kingdom had 20th century, this number more than cases in countries to compare. These heard about the tragedy in Afghanistan, doubled to almost two billion. What data are often not complete and the age the high mortality from AIDS in Zambia does the UN project for the end of the distributions are different. and the civil war in the DRC and that 21st century: continuous growth to four they think deaths are very common in billion children, slower growth to three Q: What is the solution? the developing world as a whole. Given billion or has the number of children A: More power and funding for three options, most respondents said already stopped increasing? Only 10% the people who do statistics centrally at 904 Bull World Health Organ 2013;91:904–905 | doi: http://dx.doi.org/10.2471/BLT.13.031213 News WHO. Of course their work is supported financial crisis: they processed them to what we did in Sweden to establish civil by Director-General Margaret Chan, the degree that no one understood the registration in 1750. It is unlikely to be when she says that she will never change result. When very few people under- repeated in other countries because civil the numbers that WHO experts have stand your methods, your work cannot registration requires a deeper cultural concluded. WHO needs more authority be independently verified or replicated and social transformation than many and integrity and that can only come easily. I asked: “What would be better? experts realize. I certainly don’t think with a higher proportion of core budget That you process all the child mortality it will be swiftly implemented in the than the current 25–75 split between core data existing for the DRC using these countries where we need the data most. budget (assessed contributions) and vol- new methods instead of the one used untary contributions. Countries should by the UN, or do you do another de- Q: Successor development goals to re-organize the way they finance their mographic and health survey (DHS)?” the Millennium Development Goals international organizations, WHO, for Obviously it’s better to do another DHS (MDGs) are currently being discussed one, needs to be given more core budget. because it produces more empirical data. and proposals for new goals are being At the inauguration of the IHME, I said hammered out. Do you think health Q: International statistics experts gath- in my speech as one of the evaluators: statistics receive enough attention from ered at WHO in February reviewed the “Let the Institute challenge the UN, but these campaigns? way global health estimates are reached, don’t let it try to replace it.” Now I hear A: The MDG campaign has a prob- including those in the latest Global Bur- that the UN is going to try to model lematic relationship with data, partly den of Disease study by the Institute for more advanced data. I am not convinced because it didn’t add one dollar to ex- Health Metrics and Evaluation (IHME). this is the right approach, but time will panding and improving data collection. Why was data sharing an issue? tell. We must be open to new methods It just relies on existing data much of A: When the institute received its in public health, and IHME forces us to which has very wide uncertainty inter- grant from the Bill & Melinda Gates consider many new methods. vals. Now people are stating that there Foundation to work on this Global are x number of days left before the 2015 Burden of Disease study, it said it would Q: So what is needed to improve global deadline. In doing so they disregard the make its methods transparent and its health statistics? fact that for most MDGs we won’t know data freely available. But since its publi- A: The main challenge for global whether they have been achieved or not cation, I have not been able to get all the health data is that we need sub-national until 2018 or 2019. The reason for this is data. At the meeting in February, Chris data for the poorest countries and not that data are based on surveys done with Murray, the director of IHME, explained only national estimates from national three- to five-year intervals. WHO has that, for example, the Chinese authori- surveys. Quintile calculations (broken done well with its estimates of maternal ties allow the Institute to use their data down by fifths of the population) can mortality, given the recent reported drop for their calculations but forbid it to be made based on data from national in the deaths of women related to preg- share them. If anyone else wants the health services, but these are not as nancy and childbirth, but some activists data, they must ask the Chinese authori- useful as estimates based on data from got furious about this as they perceived ties.
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