Measuring Global Health Issues, Seven Billion Times

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Dr. Murray and his associates say that we need a single measure of what particular diseases cost us in quantity and quality of life. Such a single measure might prove to be a ‘useful policy tool,’ but it does not address the key issue underlying Dr. Murray’s data: the impact of poverty.


Title: Epic Measures: One Doctor. Seven Billion Patients
Author: Jeremy N. Smith
Publisher: Harper Wave
Publication date: April 7, 2015
Price: $26.99; hardcover, 352 pages

Health measures are essential tools in assessing public health and safety. Collecting large amounts of data is a laborious task, requiring a certain kind of relentless stamina and sense of purpose. Christopher Murray, MD, who is also an economist, began one of the largest scientific data-collection undertakings in history when he initiated the Global Burden of Disease study to gain a truer understanding of how humans across the globe live and die. This monumental undertaking is described in lively prose by journalist Jeremy N. Smith in his new book, Epic Measures: One Doctor. Seven Billion Patients.

The book is based primarily on a dozen reporting trips and more than 100 interviews. As the author explains, “Everyone wants the world to move in a healthier direction. But what we need is a map. And if no accurate, sufficiently extensive map exists, someone needs to create one.” Enter Dr. Murray, whose central argument is that until we can accurately measure global health issues, we cannot understand what makes humans sick or do much to improve the conditions that cause disease.

From his early days at Harvard University, Dr. Murray was a save-the-world crusader. Now, he’s a trained physician who no longer practices medicine but is trying to treat the world’s 7 billion inhabitants. His life’s work, the Global Burden of Disease project, is a concept, a quantity, an ongoing project, and its numbers can be broken down person-by-person by place, ailment, and consequence—what kills us, what makes us sick, and what shortens our pain-free years of life. According to the author, after all of these metadata are collected, “the question then becomes not what stops us from living better, but how far and how fast are we willing to improve?”

Informative Journey

What kind of person devotes his career to dissecting the health outcomes of 7 billion people? The author writes, “Murray himself was fascinating: blunt, often abrasive, hyper-energetic, supremely confident, yet fiercely collaborative…. [He] likes to argue, and he seemed to operate on the assumption that scientific progress relies on picking fights.” No doubt, Dr. Murray has a big personality, which one would expect for anyone undertaking a project of this dimension, and following Dr. Murray through the ups and downs of the Global Burden of Disease project is, at times, a thrilling and informative journey.

It took Mr. Smith 3 years to write his book. He introduces the main character, Dr. Murray, by returning to his childhood, which by all accounts was enthralling. His parents had wanderlust, and he and his siblings saw much of the world. But these family jaunts to far-flung places were not of the Disneyworld variety; they were adventurous learning trips that became the foundation of Dr. Murray’s later work in global health care.

Mr. Smith begins the book, “March 1973. The Sahara. There was no road, and certainly no GPS. Forward motion meant following a dusty track. Occasionally, through the haze, the family had seen a lone gazelle or a few people on camels. Every now and then they had discovered a village. For the last three days, however, they had encountered no one but themselves.”

This makes for good adventurous travel writing, but the book is ostensibly about a game-changing public health project, and the author takes four chapters introducing Dr. Murray, which is a tad too much. It feels, at times, as if he needed filler to make his publisher’s word count.

Setting Things Right

Chapter 5, called “The Big Picture,” begins, “Everyone on Earth should have the chance to live a long life in full health. But statistics we [use] to measure progress toward that goal [have been] not only inaccurate, but also irrelevant.” According to Dr. Murray, the World Health Organization (WHO), the United Nations, the Centers for Disease Control and Prevention, and others have botched the business of collecting health outcomes, and he’s here to set things right. To that end, he does have some weighty supporters, such as Bill Gates, who kicked in $100 million for the project.

While some of the global health-care content is informative enough to rate as an interesting read, the author still needs to develop a compelling storyline to keep readers engaged. Health policy books generally don’t achieve best-seller status often because most people, with the exception of policy wonks, find discussions of data points and health measure metrics tiresome. So Mr. Smith juices up the narrative, for example, with anecdotal snapshots about how Dr. Murray reinvented the program midstream and how Dr. Murray met Bill Gates. A tangential homage to Bill Gates’ father is particularly long-winded.

Collecting data for data’s sake, no matter how well crafted the project might be, is sort of like building the Great Pyramid of Giza. Yes, it was an incredible feat that took tens of thousands of laborers decades to construct; to boot, it is one of the Seven Wonders of the Ancient World. But what purpose does it serve other than being a colossal tomb in the desert for the pharaoh who commissioned it? Therein lies the danger of the potentially fruitless grandiosity that Dr. Murray’s Global Burden of Disease project faces.

Politics and Sacrifices

When Dr. Murray finally released the first installment of reports stemming from his work, he was broadsided by global health agencies such as WHO, claiming that his “complex statistical models and computer analyses were a ‘black box step’ other researchers would find very hard to reproduce.” The reader gets an up-close and personal view of the politics involved in the huge world of nonprofit, nongovernmental organizations. And when these supersized egos and billionaires start squabbling over who is on the right side of an issue, it gets nasty.

Moreover, like many save-the-world dreamers, Dr. Murray was more concerned with kids in the developing world than his own. “Those who couldn’t stand his intense style left, or became very estranged, especially if they were family. Following fifteen years of litigation, Murray had lost all visitation rights to his three children from his first marriage.”

That’s quite a sacrifice. Was it worth it? Can this massive collection of health-care data be used to increase health standards across the globe, enough to justify its cost and scope, or is it another pyramid—a glorious but useless monument to its creator? Time will tell. However, if the afterword detailing the suggested solutions that Dr. Murray derived from his work is any indication, he hasn’t yet offered enough to move the needle on these issues.

Key Issue

Among Dr. Murray’s findings: If you were a male born in Sierra Leone, you could expect to live for about 39 years, whereas if you were born in Japan, you could expect to live for about 84 years. People living in countries with stable governments, high literacy rates, high per capita income, and good health-care systems live much longer, disease-free lives than those in poor countries with dysfunctional governments.

Dr. Murray and his associates say that we need a single measure of what particular diseases cost us in quantity and quality of life. Such a single measure might prove to be a “useful policy tool,” but it does not address the key issue underlying Dr. Murray’s data: the impact of poverty. His work, well intentioned as it is, does not offer a solution to that. ■