IHMEAccElErAtIng globAl HEAltH progrEss tHrougH sound MEAsurEMEnt And AccountAblE scIEncE

The Institute for Health Metrics and Evaluation (IHME) is a global research center at the University of Washington that provides independent, rigorous, and compa-rable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.

• Brings together a criticalmassofquantitative analystswhoseworkovertheircareershascreatedthefounda-tionforglobalhealthmeasurement, influencinghealthpolicyandreformindozensofcountries.

•Measures key characteristics of a country’s healthsystem to provide a comprehensive picture of healthsystemperformance.

• Conductsevaluationsofhealthprogramsandinitiativestoverifywhatis–andisnot–working,withtheultimategoalofimprovingpopulationhealth.

•Measureshealthdisparitiesamongdifferentgroupsandidentifieschallengestodeliveringhealthcare.

• Develops innovative methods and tools to identifytrendsandfillindatagaps.

• Examinesthebroadrangeoffactorsthataffecthealth,includingenvironment,income,andeducation.

•Negotiateswithgovernments,non-governmentalorga-nizations, and other institutions to gather data fromnearly200countries.

• Provides information that is comprehensible, timely,andrelevanttopolicymakersworldwide.

•Makes evidence freely and easily accessible, enablingthe public to better understand health trends andallowingresearcherstobuildonourwork.

• Trainstheglobalhealthleadersofthefuturebyteachingstudents, researchers, and policymakers how to useadvancedhealthmetricstools.

IHME…

Overthepasttwodecades,globalhealthhasbecomean increasingly urgent priority, with hundreds ofbillions spent to save lives and ease the burden ofdisease in developing countries. Individual successstories abound, but a lack of objective evidenceprevents policymakers from knowing whether theireffortsareactuallyimprovingpeople’slives.

TheInstituteforHealthMetricsandEvaluation(IHME)wascreatedat theUniversityofWashington tohelpfillthatinformationgap.

Webrokewithtraditiontobuildahybridorganizationlikenoother:anacademicresearchinstitutewiththeindependenceandspiritofanNGO.

By employing cutting-edge science — and standingapartfrompoliticalconsiderations—IHMEisworkingwith others to quantify themajor threats to healthandbuildthebaseofevidenceaboutwhatworksandwhatdoesnotworktoimprovehealthconditionsandhealthsystemsworldwide.Wedothisbyfocusingonthree critical questions:What are theworld’smajorhealthproblems?Howwellissocietyaddressingtheseproblems? How do we best dedicate resources tomaximizehealthimprovement?

Toanswerthesequestions,wemeasuretheextentofdisease,injury,anddeathworldwideaswellastheriskfactorsthatcancutlivesshort.Wetracktheperform-ance of health programs and initiatives, as well asother factors that influence health, such as educa-tion and income. We also analyze trends in health

financing to help understand the impact it is havingaroundtheworld.Andwelookforwaystohelpguidehealthpolicybyidentifyinghowtogetthemaximumhealth impact from scarce resources. By examiningtheseelementstogether,wecreateacomprehensivepictureofhowsocietiesarerespondingtohealthchal-lengesandthestepsneededtoimproveprogress.

Atthesametime,wearecommittedtoexpandingthefield of healthmetrics through collaboration and bytraining thenextgenerationofglobalhealth leadersinasciencethatisbothaccountableandtransparent.Tohelpresearchersreplicateourworkandtoinspirenew discoveries, IHME has created a Global HealthDataExchangewheremethodsandresultsaresharedandfreelyaccessibletoall.

Thankstolong-termfundingfromtheBill&MelindaGatesFoundationandsupportfromthestateofWash-ington,wehavebeenabletosetanambitiousagendafor the Institute. Throughour research,we strive toprovidethemostaccurateandcomprehensive infor-mationonpopulationhealththatwillinturncreateastrongerfoundationforstrategicdecision-makingand,ultimately,betterhealthforpeopleworldwide.

Christopher J.L. Murray, MD, DPhilInstitute Director

Measuring HealtH

tracking PerforMance

MaxiMizing iMPact

innovative MeasureMent systeMs

critical questions

•Whataretheworld’smajorhealthproblems?

•Howwellissocietyaddressingtheseproblems?

•Howdowebestdedicateresourcestomaximizehealthimprovement?

researcH areas

By EMployIng cUTTIng-EdgE scIEncE To qUanTIfy THE Major THrEaTs To HEalTH WorldWIdE, WE arE BUIldIng THE BasE of EvIdEncE aBoUT WHaT Works and WHaT doEs noT Work To IMprovE HEalTH condITIons and HEalTH sysTEM pErforMancE aroUnd THE World.

ApproAcH Answering the criticAl questions in globAl heAlth

key projects

Ourresearchteamsworkonthefollowingkeyprojectsinpursuitofanswerstothecriticalquestionsessentialtounderstandingthecurrentstateofpopulationhealth.

Global Burden of Diseases, Injuries, and Risk Factors Study 2010

Goal:Measuretheimpactofapproximately300healthconditionsand40healthriskfactors

Research:Incollaborationwith800researchers,IHMEisproducingestimatesin21regionsaroundtheworldofdiseaseburdenbyageandsexovertwodecades.This involvesconducting in-personsurveysinsomecountriesandgatheringhealthinformationthroughaninnovativeonlinesurvey.

Location:Worldwide

Disease Control Priorities Network Project at IHME

Goal:Producecost-effectivenessestimates

Research: IHMEisleadingateamofdemographers,statisticians,economists,andotherexpertsinastudyonhowtoimprovetheallocationofresourcesamonginterventions,technologies,hospitals,andotherservicedeliveryplatforms.

Location:Multiplecountries,includingIndia,Lebanon,SouthAfrica,SriLanka,theUnitedStates,Yemen,andZambia

Population Health Metrics Research Consortium Project

Goal:Createnewmethodsfortrackinghealthinterventioncoverageinlow-resourcesettings

Approach: IHME, working in close collaboration with research organizations in four countries, isdevelopingmethodstomeasuremortality,causesofdeath,andincidenceofmajorillnesseswheredataareincomplete.

Location:India,Mexico,thePhilippines,andTanzania

Malaria Control Policy Assessment Project

Goal:Evaluatetheeffectivenessofmalariacontrolinterventions

Research:IHMEisevaluatingtheeffectivenessofmalariainterventionsintwocountriesbyanalyzingtheireffectonchildmortalityandproducingestimatesatthenationalandlocallevels.

Location:Sub-SaharanAfrica

US Research

Goal:Estimatemortality,lifeexpectancy,riskfactors,healthdisparities,anddiseaseprevalence

Research:IHMEiscompilingnationalandlocalhealthtrendsandintegratingmultipledatasourcestomonitordisparitiesinchronicdiseases.ItalsoismeasuringeffectivecoverageinallWashingtonstatecountiesandconductingoneofthelargesthealthsurveyseverlaunchedinalocalpopulation,workthatwillprovideamodelforotherstates.

Location:TheUnitedStates

IHME’s work is organized around answering three criticalquestionsthatareessentialtounderstandingthecurrentstateofpopulationhealthandthestrategiesnecessarytoimproveit:

•Whataretheworld’smajorhealthproblems?

• Howwellissocietyaddressingtheseproblems?

• How do we best dedicate resources to maximize healthimprovement?

These questions provide the framework for IHME’s fourresearchareas:

Measuring Health. To better understand the current state ofpopulation health, IHME provides rigorous, comparable, andtimely scientific measurement of trends in diseases, injuries,riskfactors,anddeath,analyzingdataacrosscountriesandovertime.Decision-makersneedtoknowwhatismakingpeoplesickinordertodesignappropriatepreventionprogramsandtobesttargetthedeliveryofdrugs,vaccines,andotherinterventions.Research teams in this area also produce estimates of popu-lation characteristics and functional health status, which is agaugeoflifelimitationsfromdiseaseorinjury.Tohelpusgatherbetterdata,weareimprovingverbalautopsymethods,allowingustodeterminethecausesandcircumstancesofdeathsinareasthatlackstrongvitalregistrationsystems.

Tracking Performance.Weevaluatetheimpactofpoliciesandinterventionstounderstandtheprogressbeingmadeinhealth,always with an eye toward effective intervention coverage,whichisthemeasureofhowmuchofthepopulationinneedofahealthserviceactuallyreceivesit.Weanalyzehealthfinancingby studying development assistance for health, governmenthealth spending, privatehealth expenditures, and the cost ofservices, includinghospitalsandcommunityhealthclinics.We

alsogenerateestimatesforeducation,income,andothersocialdeterminants that can influence people’s health. Overall, weare attempting to track health system performance for everycountry,and,insomecases,suchastheUnitedStates,wealsoassesscounty-levelperformance.

Maximizing Impact. IHME provides decision-makers withtimely, comparable, and forward-looking information toinformchoicesaboutpoliciesandfunding–especiallyincoun-tries with scarce resources. We measure health disparitiesamong different groups and identify challenges to deliveringhealthcare.Wealsoestimatethecost-effectivenessofhealthprograms, analyze constraints on scaling up interventions,and examine the decision-making process to understand theimpactonequityandfairnesswithinhealthsystems.Knowingthebudget restrictionsofnationaland localgovernments,aswell as non-governmental organizations working in devel-opingcountries,weidentifyopportunitiesforoptimalresourceallocation.

Innovative Measurement Systems.AspartofIHME’scommit-ment to advance the science of health measurement andevaluation,weconstantlylookforwaystoremovethebarriersthat prevent accurate and comparable health measurement.We develop new analyticalmethods and computer softwarethat allow us to harness the value from existing health databycorrectingforerrorsandfillingingapsinthedata.Weuseexistingpatternsinthedatatoarriveatlocalestimatesofkeynational-level indicators. To improve the quality of the datacollected,wecreateanddisseminatenewsurveys,surveytech-niques,andhealthinformationsystemsthatcanbeadaptedtoanarrayofsettings.

at IHME, we are trying to identify the best strategies to build a healthier world. We believe the best way to achieve that goal is through better information about health trends and program performance. Better evidence disseminated broadly will lead to a higher level of public discourse, and an informed public debate can contribute to a change in how people think about health issues and solutions. Ultimately, we believe reliable health information will influence how the world addresses health challenges locally, nationally, and on a global scale.

IHME pUBlIsHEs an annUal polIcy rEporT, Financing global HealtH, WHIcH Tracks MorE THan $200 BIllIon In pUBlIc and prIvaTE conTrIBUTIons To gloBal HEalTH.

Through the Global Burden of Diseases, Injuries, and Risk FactorsStudy 2010, IHME is sharing new methodological tools and thelatest estimates for mortality and causes of death worldwidewith researchers in 73 countries. These researchers will use thenew techniques and data to develop detailed analyses of health conditionsbothwithintheircountriesandforthepopulationglobally.

IMpAct

Foundedin2007,theInstitutealreadyishavinganimpactonthe scienceofpopulationhealthmeasurement, globalhealthfunding,andhealthpolicyimplementation.

•IHME publishes an annual policy report, Financing Global Health, which tracks more than $200 billion in public andprivatecontributions toglobalhealth.Aspartof thatwork,IHMEhasadvisednon-governmentalorganizations, interna-tionalagencies,andnationalpolicymakersonaccountabilityin health funding, including Oxfam International, the Inter-national Aid Transparency Initiative, and the United Statesgovernment.

•For decades, the global health community lamented thata half-million women died every year from complicationsrelated topregnancyand childbirth, anumber thatdidnotappeartobedecliningdespite increasingamountsofpolicyattention and resources. IHME collaborated with otherresearcherstore-examinethetrends in maternal mortalitysince 1980 and found that there had been considerableprogress. An estimated 343,000women died in 2008 frommaternal causes – a significant drop that gives new reasonforoptimism.Tohelpcountriesbetterunderstandtheirowntrendsinmaternalmortality,wearetrainingpolicymakersinournewmethods,includingagenciesfromBrazil,Cambodia,India,thePhilippines,andSriLanka.

•In2010,justascountrieswerelookingforwaystoaccelerateprogresstowardtheMillenniumDevelopmentGoalforreducingchildmortality, published IHME research attributed 51% ofthedeclineinchildmortalitysince1990toincreased educa-tional attainmentinwomenofreproductiveage.TheWorldBank’seducationdirectorwrotethatthestudywas“powerfulevidence”oftheimportanceofachievinginternationalgoalsforbroadaccesstoeducation.“Agoodqualityeducationisthemostpowerfultoolwecangiveourchildrentohelpthemescapepovertyandleadhappier,healthier,andmoreproductivelives.”

•OneoftheInstitute’smaingoalsistocreatetoolsfordevel-opingcountriestobettermonitortheirpopulationhealthandidentifywaystoimproveit.Forexample,simplydevelopinganaccuratecountofthenumberofchildrenwhodieeveryyearin a low-resource country can be difficult and costly. IHMEcreatedalow-costwayforcountriestomoreaccurately track child mortalitythroughexistingsurveyandcensusprogramstohelpthembetterassesshealthpriorities.

•IHME, working with other researchers, developed a moredetailed and timely way of analyzing risk factors in small geographic areas,suchasUScounties.Theyfoundthatsaltaloneleadstomorethan100,000deathseveryyearintheUS.Asaresult,NewYorkCitycalledonIHMEtohelpitdeveloplocalestimatesforarangeofriskfactorsasitleadsanation-wideefforttolowertheamountofsaltinpreparedfoods.

guiding better heAlth policies locAlly And worldwide

Training IHME trains researchers from around the world in advancedmethodsandtoolscreatedtocapturethemostaccuratepicturepossibleofpopulationhealthandtoidentifywaystoimproveit.Throughworkshops,conferences,andregularseminars,wefosterarobustexchangeofideas.IHMEalsoworkscloselywithpolicymakers at the local, state, and national levels to teachthemkeyhealthmetricsconceptsandtoprovidetimelydatathathelpguideevidence-basedpolicydecisions.

innovationIHMEstrivestomakeitsdatafreelyandeasilyaccessible.Weproactivelydisseminateourdataandmethodstoresearchers,decision-makers, donors, United Nations agencies, NGOs,public health workers, and the media. IHME has createddynamicdatavisualizationstoallowanyonewhovisitsIHME’swebsite to clearly view complicatedhealth trends over time.Wealsodevisedageographicinformationsystemmappingtoolthatdisplaysinformationonhealthoutcomes,healthspending,intervention coverage, and other factors across countries.Thesetoolsbringdatatolifeinawaythatoffersnewinsightsintohowbesttofund,design,andimplementeffectivehealthpolicyprograms.IHMEalsoisgatheringasmuchglobalhealthdata as possible into aGlobal HealthData Exchange (GHDx).The GHDx mission is threefold. It aims to catalog all known

healthdatasources,encompassingmorethan10,000surveys,studies, and censuses. It provides all research results gener-atedbyIHME,extensivedocumentationforalldatasets,and,inselectedareas,thesourcedata.Inaddition,theGHDxwillserveasalibrarywhereglobalhealthresearchersandinstitutionswillbeencouragedtoposttheirdataforpublicuse.

collaborationIn addition to our research collaborations with universities,United Nations agencies, and other organizations, we alsoworkwithgovernments– suchasBrazil, India, Lebanon, andtheUnitedStates–aidagencies,andothergroupstoputourmethods and findings into action.We are part of a growingmovement in science to make research methods under-standable and applicable in both high-income countries andlow-resource settings. For a health minister in sub-SaharanAfrica investigating new approaches for improving the coun-try’s childmortality rate, IHMEprovides concrete techniquesfor weighing the differences between interventions. And foracountyhealthofficial in theUnitedStates trying to identifywho ismost at risk fordiabetes, IHMEprovides specificdatatohelptailor interventionandoutreachprograms.Fromlocaltonationaltointernationalsolutionsforimprovingpopulationhealth,weareputtingglobalhealth’sbestmindstothetask.

WE arE coMMITTEd To ExpandIng THE fIEld of HEalTH METrIcs By TraInIng THE nExT gEnEraTIon of gloBal HEalTH lEadErs In a scIEncE THaT Is BoTH accoUnTaBlE and TransparEnT.

educationIHMEisgrowingthefieldofhealthmetrics,notonlythroughthepublicationofourresearch,butbyeducatingandtrainingcurrentandfutureglobalhealthleaders.Wedothisthroughlectures,workshops,andtrainingprogramsforresearchers,policymakers,andjournalists,ultimatelyworkingtomakescientificmeasure-mentandevaluationthebasisforsounddecision-making.

CourseworkUndergraduate and graduate students at the University ofWashingtoncantakeclassesinanarrayofpopulationhealthtopics from IHME faculty members who are leading globalhealth experts. The demand for special training in IHMEmethods was so strong that the University ofWashington’sDepartment of Global Health now offers Master of PublicHealthstudentsaHealthMetricsandEvaluationtrack,thefirstprogramofitskindinthenation.

FellowshipsEvery year, IHME receivesmore than400 applications to fillfewerthan20openingsforPost-BachelorandPost-GraduateFellows. From backgrounds as diverse as economics, engi-neering,andcomputerscience,fellowshavetheopportunityto sharpen their quantitative skills in an open-minded andmultidisciplinary environment. Their work and discoverieshelpdrivetheInstitute’sresearch.

rEAcH building the heAlth metrics community through educAtion, innovAtion, And collAborAtion

TheseguidingprinciplespermeateeverythingIHMEdoes,fromourresearchinthefieldtoourdataanalysisandpublicoutreach.

Excellence:Wewillapplythebestscientificmethodstothechallengesofhealthmeasurementandevaluation.

Relevance:Wewillmeasurewhatisimportantforpopulationhealth,notjustwhatiseasytomeasure.

Independence:Wewillensure the independenceof the Instituteand its staff frompolitical influence,policyadvocacy,andotherconflictinginfluences.

Comparability:Wewillmakemeasurementscomparableacrosstimeandpopulations.

Comprehensibility: We will make measurements comprehensible by broad audiences, including the public,policymakers,healthprofessionals,andresearchers.

Coherence:Wewillbaseourmeasurementsonsystematicassessmentsofavailabledataandobjectivelyportraytheuncertaintyinmeasurements.

Transparency:Wewillfostertransparencyandaccountabilitybyprovidinganexplicitdataaudittrailthatprovidesenoughdetailforresultstobereplicatedbyothers.

Efficiency:WewillseektouseourresourceswheretheInstitutecanmakethegreatestcontribution.

Collaboration:Wewillworkwith other institutions tomake the greatest contribution to the field of healthmetricsandevaluation.

Consultation:Wewill consult with the global health community to better understandwhat is important tomeasureandevaluateandwillconsultwiththosewhoareaffectedbyananalysis.Werecognizethatconsulta-tiondoesnotnecessarilyleadtoconsensus.

Dialogue:Wewillfosteranopenandconstructivedebateanddialogueaboutallaspectsofhealthmetricsandevaluation,includingourownmethodsandresults.

prIncIplEs setting A new stAndArd for scientific integrity

our faculty

Christopher J.L. Murray,InstituteDirectorandProfessor

Jed Blore,Lecturer

Lalit Dandona,Professor

Majid Ezzati,AffiliateAssociateProfessor

Abraham Flaxman,AssistantProfessor

Emmanuela Gakidou,AssociateProfessor

Michael Hanlon,Lecturer

Santosh Kumar,Lecturer

Stephen Lim,AssociateProfessor

Alan Lopez,AffiliateProfessor

Rafael Lozano,Professor

Ali Mokdad,Professor

Mohsen Naghavi,AssociateProfessor

Julie Knoll Rajaratnam,AssistantProfessor

Haidong Wang,AssistantProfessor

our board

Julio Frenk,Dean,HarvardSchoolofPublicHealth

Lincoln Chen,President,ChinaMedicalBoard

Harvey Fineberg,President,InstituteofMedicine

Jane Halton,SecretaryoftheDepartmentofHealthandAgeing,Australia

Peter Piot, Director,LondonSchoolofHygiene&TropicalMedicine

K. Srinath Reddy,President,PublicHealthFoundationofIndia

David Roux,Co-FounderandChairman,SilverLake

Endang Rahayu Sedyaningsih,MinisterofHealth,RepublicofIndonesia

Tomris Türmen,President,InternationalChildren’sCenter,andHead,DepartmentofPediatrics/NewbornMedicine,UniversityofAnkaraMedicalSchool,Turkey

lEAdErsHIpour executive teaM

Christopher J.L. Murray, InstituteDirector

Kelly Campbell, Director,AdministrationandOperations

Emmanuela Gakidou, Director,EducationandTraining

Michael MacIntyre, Director,StrategyandSpecialProjects

Jill Oviatt, Director,Communications

Peter Speyer, Director,DataDevelopment

our scientific oversigHt grouP

George Alleyne,Chancellor,UniversityoftheWestIndies;DirectorEmeritus,PanAmericanHealthOrganization

Barry R. Bloom,DeanoftheFaculty,HarvardSchoolofPublicHealth

Alex Chika Ezeh,ExecutiveDirector,AfricanPopulationandHealthResearchCenter

Richard G.A. Feachem,DirectorofGlobalHealthGroup,UniversityofCalifornia,SanFrancisco

Roger I. Glass, Director,FogartyInternationalCenter

Gary King,Director,InstituteforQuantitativeSocialScience,HarvardUniversity

Ana Langer,Coordinator,Dean’sSpecialInitiativeonWomenandHealth,HarvardSchoolofPublicHealth

Nora C. Lustig,SamuelZ.StoneProfessorofLatinAmericanEconomics,TulaneUniversity

Anne Mills,HeadoftheDepartmentofPublicHealthandPolicy,LondonSchoolofHygiene&TropicalMedicine

Gideon Barak Agembo Okelo,SecretaryGeneralandExecutiveDirector,AfricanAcademyofSciences

Vikram Patel,ProfessorofInternationalMentalHealth,LondonSchoolofHygiene&TropicalMedicine

Christina Paxson,Dean,WoodrowWilsonSchoolofPublicandInternationalAffairs,PrincetonUniversity

Richard Peto,ProfessorofMedicalStatisticsandEpidemiology,UniversityofOxford

Samuel H. Preston,FredrickJ.WarrenProfessorofDemography,UniversityofPennsylvania

John-Arne Røttingen,DirectorGeneral,NorwegianKnowledgeCentreforHealthServices

Peter Smith,Professor,InstituteforGlobalHealth,ImperialCollegeLondon

opportunItIEsIHMEisdrawingtogetherpeoplewithapassionforaddressinghealthchallengesefficientlyandeffectively.Wearealwayslookingforopportunitiestofindnewdata,collaboratewithnewpartners,andimprovethescienceofhealthmeasurement.Weinviteyoutoexploretheseopportunitieswithus.

Please visit IHME’s website: www.healthmetricsandevaluation.org Contact us at: +1-206-897-2800 or comms@healthmetricsandevaluation.org

InstituteforHealthMetricsandEvaluation2301FifthAve.,Suite600Seattle,WA98121USAwww.healthmetricsandevaluation.org

Telephone:+1-206-897-2800Fax:+1-206-897-2899Email:comms@healthmetricsandevaluation.org