Effort to Chart Global Deaths Draws Backlash

It would be an enormous challenge to figure out what people suffer and die from in every part of the world. But Christopher Murray decided he would try.

The Rhodes Scholar and Harvard-trained doctor led a 20-year effort involving hundreds of scientists and $100 million. Murray believed concrete data from his initiative would help donors better channel their aid dollars, and thus improve global health. But controversy sparked among some aid groups and institutions like the World Health Organization when the Global Burden of Disease findings were released.

book jacketsmall

Author Jeremy Smith is out with a new book about Murray’s unprecedented undertaking called Epic Measures: One Doctor. Seven Billion Patients.

In an interview with Tiny Spark, Smith describes the challenges Murray’s team faced trying to tabulate global deaths. He says most people around the world don’t have death records. “If we don’t know what people are dying from, how do we save lives? Essentially what [Murray] found is it’s all a guess. And when he tried to fill in the numbers more reliably, he found that they contradicted basically all the figures produced by all the advocacy groups,” Smith says.

Take maternal mortality figures. For decades, it was said that 500,000 women died each year during childbirth. But the Global Burden of Disease concluded that one-third fewer women were dying. “The initial response from some advocates for mothers was panic,” Smith says. “They felt that this meant they would have a third less funding. There is this scarcity mentality that advocacy groups are competing with one another.”

At one point, Smith says the World Health Organization decided that Murray’s work was “too controversial” and expensive to continue. So the Global Burden of Disease no longer had an institutional home. Microsoft founder Bill Gates stepped in and gave Murray more than $100 million to revive the work. Smith explains that the philanthropist was partly motivated by self-interest: “If Gates is going to give away billions of dollars a year, and he has no way of knowing what’s working without the Global Burden of Disease study, that’s a big problem for him.”

Christopher Murray in Tanzania. (Credit: University of Washington)

Dr. Christopher Murray in Tanzania (Credit: University of Washington)

Smith’s book details how a lack of data produces both shortfalls and excesses in global health spending. For example, he says that HIV/AIDS has received about a quarter of all international health funding, but Murray’s study estimates that it produces just three percent of deaths in the developing world. Meanwhile, chronic diseases like diabetes, heart disease and stroke account for more than 60 percent of deaths in developing nations but get less than two percent of global health aid money, Smith explains.

Another revelation from Murray’s work is what it reveals about the Millennium Development Goals. Smith says the MDGs are important but incomplete, and fail to address 70 percent of the Global Burden of Disease. “We’ve succeeded in making a lot of progress against HIV, against malaria, against child mortality. And that means that children aren’t dying before their fifth birthday. That’s wonderful but that means that they’re susceptible to all these other causes of death.”

Smith calls Epic Measures a mystery, adventure and thriller. “The mystery is what do people really die from and what really makes them sick? The adventure is how do you find the answers to that, how do you pull together an international team around the world to get the answers? And the thriller is once you get those answers, how do you get people in power to listen?”

Christopher Murray with Jeremy N. Smith at the launch event for 'Epic Measures' at Town Hall Seattle. (Photo courtesy of Jeremy N. Smith)

Christopher Murray with Jeremy N. Smith at the launch event for ‘Epic Measures’ at Town Hall Seattle. (Photo courtesy of Jeremy N. Smith)

Additional Resources

Transcript of Smith’s interview with Tiny Spark

Institute for Health Metrics and Evaluations houses the most current Global Burden of Disease data

WIRED: One Doctor’s Quest to Save the World with Data

Montana Public Radio: Big Data Shows How We Live And Die

Smith’s recent articles:

The Atlantic: Mystery Killers: The unknown causes of mortality around the globe

New York Times: Fatal Accidents as a Global Health Crisis

New York Times: When ‘Moneyball’ Meets Medicine


  1. As thought-provoking as ever, if not more. Wishing Tiny Spark became a more integral part of the curriculum. Tried getting learners to listen to it, but it’s been rather difficult, maybe because they have to peel through layers of misconceptions before they get the core points.

    Really taken by the backlash aspect, addressed in that 2010 NYT piece that Smith mentioned. This one will surely become a “classic” in my classes, even without the connections to health or aid.

    There’s this useful concept in sociology about organisations trying to protect themselves instead of carrying this mission: “goal displacement.” Examples of this abound, and solutions to this kind of dysfunction are difficult to find. Advocacy groups asking The Lancet to delay the publication of an article showing the effectiveness of their work demonstrate this concept so powerfully. Groups depending on WHO funding for their work know that their numbers need to be striking. Cutting funding for maternal care could reverse the trend and cause a large number of deaths. From the outside though, it sounds really absurd that these groups would not celebrate the improvement, which most likely comes from their work. Who wouldn’t enjoy showing that they’re making a difference? With all the talk about accountability, being able to show such data sounds like the kind of thing advocates and donors really want.

  2. Jordan Owen

    One of the points that stood out to me the most was the need for advocates for patients rather than diseases. My paternal grandfather was a physician who was very active in social issues and saw immense change in the way we treat the ill in this country. It used to be that private practice doctors would follow their patients into hospitals if the need arose, both for the individual’s comfort and to be more efficient. Even after that was no longer the norm, he continued to visit his lifelong patients. He believed a holistic approach to health and consistency are critical to maintaining quality of life. I personally have had the privilege of receiving care from and having a relationship with my pediatrician since the day I was born. She is better able to address my needs and anticipate problems I might encounter later on. In the developing world, or at least where aid groups are the preeminent healthcare providers, most people do not have this luxury.

    Though I have studied global health for several years, Epic Measures was forced me to rethink much of what I thought I knew. It is wonderfully written and contains fascinating quantitative information about the way the world actually works.

  3. Ellie McWilliam-Grench

    I thought that it was fascinating what Jeremy said about how we think of women carrying water on their heads for many miles as a clean water issue, not a back pain issue, perhaps because lack of access to clean water affects everyone, whereas the back pain only, on the outside, affects the woman — until we realize that if a woman is so disabled due to her pain that she can’t work, there might be no one to collect water for the family at all. I wonder what other diseases we might look at through the wrong lens.

  4. Luis Funes

    It’s surprising that there’s so much data that still has not been collected. I admire Christopher Murray’s commitment to stepping into the unknown and uncovering the true numbers that show what really causes death and suffering in the world.

    I spoke to representatives of the Center for Global Development, and they emphasized the importance of collecting data. Reflecting on the experience, I’m curious about the credibility of that data. It makes me also think of the UN’s decisions on what they are funding because they might not have the correct information.

  5. Student from Carrboro High School

    This year in my Global Issues class, we had the opportunity to fly to Illinois for dinner with Howard Buffett. After reading Epic Measures , I gained a new appreciation that he doesn’t have to ask others for funding. Howard was more likely to be able to be transparent about his failures and report good numbers because he didn’t need other people to think the causes he was trying to combat were important or widespread. Hopefully the GBD project will help provide accurate data even to people who do rely on others for funding, so the international community can put aid dollars toward what impacts the most people.

  6. Katie Caruso

    I found it fascinating when Jeremy discussed how little collaboration there is in the nonprofit world; NGOs are infamous for making duplicate efforts. This has been a common theme through the Global Issues class I have been taking. We watched “Fatal Assistance,” a documentary about NGOs’ response to the earthquake in Haiti. One of the anecdotes in the movie was about several NGOs who worked (separately) to clean trash from a river in Haiti and place it on the river’s banks. Given the lack of coordination between NGOs, the trash washed back into the river.

  7. Lucia Lozano

    My class met with Jim Kim at the World Bank earlier this year, and he said we should build strong health systems that include treatments for multiple illnesses, including those that aren’t immediately intuitive. By getting donors to invest in health systems using big issues (e.g., Ebola), we can address many issues that are harder to get donors hyped up about. In this vein, Jeremy made a very important point that we need to be treating patients and not diseases.

  8. Jonas

    Epic Measures changed almost every perspective I had of aid. I thought that focusing on HIV/AIDs was a huge priority in the developing world. It gets 25% of aid donations. However, when looking at the Global Burden report, it only kills 3% of the population. This made me think about what should be funded more and what should be funded less.

  9. Max Mahadevan

    I thought it was crazy how AIDS gets so much funding but affects 3% of the people in developing countries, while back pain and other terminal illnesses get less than 7% funding yet affect over 60% of the people there and cause more deaths. I’m curious to see what will happen in the future in terms of creating solutions for funding.

  10. Anna Knotek

    I had thought the Millennium Development Goals were the best way to tackle poverty, and that the issues they were advocating for had to be the most important or have the greatest impact. Learning about the Global Burden of Disease study showed me that the most well-known diseases don’t always have the biggest impact.

  11. Mia Bennett

    I recently met with World Bank President Jim Kim, and he emphasized the importance of strong health. While reading “Epic Measures,” I concluded that Chris Murray and Jim Kim’s viewpoints go hand in hand. To build those health systems, we need accurate data and an objective assessment of what people are really dying from.

  12. Dylan Reed

    The fact that many groups’ numbers are adjusted for political reasons and monetary reasons is astounding. It is almost like the gatherers of data don’t actually care, and even though there are competitions for funding, it’s still not justified. It reminded me of when our class read Epic Measures, and he spoke of how data is taken from a country bordering another to be used for that country, but the data is actually extremely different.

    I never would have thought that the pictures of the woman with the water on her head could be used to represent neck pain and lower back problems. Personally I never would have made that connection unless I had read Epic Measures or Skyped with Chris and Jeremy.

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