Vital statistics: not vital enough

The authors look at sources of this data worldwide, and say that few developing countries have been able to improve their civil registration and vital statistics systems in the past 50 years. They say: “International efforts to improve comparability of vital statistics seem to be effective, and there is reasonable progress in collection and publication of data. However, worldwide efforts to improve data have been limited to sporadic and short-term measures.”

On cause of death data sent to WHO, for example, countries providing the highest quality (90-100% complete) include, not surprisingly, developed countries like the UK, USA, and Iceland, and also several Latin American countries such as Venezuela and Chile. Those providing no data at all include many African countries, North Korea, Andorra and East Timor in a total of 68 countries. The authors say two points from the data stand out: “First, the absence of data reported to WHO from sub-Saharan African countries and second, the mixed quality cause-of-death reporting from Europe, Asia, and Latin America. In particular, not all developed countries seem to have high quality data.”

They add: “Our collective inability to make or sustain improvements in vital statistics is due to two principal failures; first, national governments have not made civil registration systems a priority, and second, development partners do not yet recognise such systems as crucially important in the development infrastructure.”

Whilst over the last half century, the world has become healthier despite the absence of vital statistics, the authors propose: “Surely that development would have been widespread and much more equitable if people had access to intelligence about regional and local differences in disease burden?”

They conclude: “Sustainable civil registration systems that yield reliable information about the state of a population’s health should be a key development goal for all countries. It is unacceptable for us to be as ignorant about the state of a nation’s health in 50 years time as we are today.”