Measuring and Fostering the Progress of Societies Second OECD World Forum on Statistics, Knowledge and Policy Istanbul

Meeting the World’s Health Challenges Day 3: Friday 29 June 2007 Chairperson’s Summary

Chairperson: Harvey V. Fineberg Speaker: Margaret Chan, Director General, world Health Organization Speaker: Julio Frenk, Senior Fellow, Bill and Melinda Gates Foundation; Chair of the Board, Institute for Health Metrics and Measurement, University of Washington; and former Minister of Health, Mexico Speaker: Denise Lievesley, Chief Executive, the Information Centre, National Health Service, UK and President-elect, International Statistical Institute; and Michael Wolfson, Assistant Chief Statistician, Analysis and Development, Statistics Canada

Health is a universal human aspiration that is valued in its own right and serves as an indicator of broader social progress. The case of health illustrates how social indicators can function both as reflections of society’s progress and as measures of the success of programs and policy. This session explored some of the requirements to advance global health, the role of measurement to promote health reform, and the selection of measures that indicate individual and population health and the performance of health systems.

Margaret Chan reflected on three themes that are central to making progress in health, particularly among the world’s poor. These are (1) health care financing, (2) equity, and (3) prevention of disease. In 47 of the world’s poorest countries, per capita health expenditures are less than 20USD, roughly half the minimum estimated as needed to attain essential health services. Residents of the poorest countries tend to pay a higher fraction of personal health costs out-of-pocket, and every year an estimated 150 million persons in the world suffer financial catastrophe because of health expenses. Two ideas that hold promise as partial remedies are micro-insurance for health, now introduced in 32 countries, and conditional cash transfers, where receipt of public support is conditioned on such desired behavior as school attendance, immunization, and maternal care. Also important will be a shift in emphasis and resources to increase prevention of disease and to extend primary care as the best path to efficient, appropriate, and affordable care.

Julio Frenk drew on his experience as Minister of Health of Mexico to demonstrate the real possibility of evidence-based policy. He noted a new consensus that health is both a result of and a determinant of economic growth and that increasing scientific knowledge is a key foundation to advance health. In Mexico, studies showed that more than half of all personal and family health expenditures were out-of-pocket, and these costs fell especially heavily on the poor. This evidence opened a new perspective on health financing among policy makers. A commitment to increase public funding through a national risk pool was coupled with an explicit package of personal health benefits and management reforms in such areas as health facilities, training, and quality assurance. Mexico demonstrates how to use evidence to drive reform, and reform efforts themselves should be viewed as experiments that offer learning opportunities to guide future progress.

In a joint presentation, Demise Lievesley and Michael Wolfson commented on measures of the health of individuals and populations and of the performance of health systems. The two most frequently used measures, life expectancy and health spending as a fraction of GNP, are severely deficient. The former omits the quality of life and the latter relies on inputs rather than outcomes. A superior measure of population health is Health Adjusted Life Expectancy (HALE) which incorporates impairment to quality of life along with survival. Measures such as HALE can indicate the relatively heavy burden of conditions such as arthritis and mental illness, which may impair function without necessarily shortening lives. A system of national health accounts, which measures health expenditures, will not reflect system performance as it does not differentiate useless from useful health interventions. A valuable step forward will come from improved measures of functional health in individuals (such as the “Budapest Initiative”) that are parsimonious, reliable, and revealing.

The discussion raised a number of salient points, including the challenge of coping with vested interests in health care, the merits of locating measurement systems within or outside official agencies, the extent of adoption of measures such as HALE, and lessons from the comparative experience in health reform in countries such as Mexico and Turkey.