Elsevier

The Lancet

Volume 369, Issue 9565, 17–23 March 2007, Pages 956-963
The Lancet

Series
Interpreting health statistics for policymaking: the story behind the headlines

https://doi.org/10.1016/S0140-6736(07)60454-1Get rights and content

Summary

Politicians, policymakers, and public-health professionals make complex decisions on the basis of estimates of disease burden from different sources, many of which are “marketed” by skilled advocates. To help people who rely on such statistics make more informed decisions, we explain how health estimates are developed, and offer basic guidance on how to assess and interpret them. We describe the different levels of estimates used to quantify disease burden and its correlates; understanding how closely linked a type of statistic is to disease and death rates is crucial in designing health policies and programmes. We also suggest questions that people using such statistics should ask and offer tips to help separate advocacy from evidence-based positions. Global health agencies have a key role in communicating robust estimates of disease, as do policymakers at national and subnational levels where key public-health decisions are made. A common framework and standardised methods, building on the work of Child Health Epidemiology Reference Group (CHERG) and others, are urgently needed.

Section snippets

Levels of estimation

In public health, different levels of estimate correspond to different relations to a disease or other cause of illness or death. Panel 1 shows the hierarchy of these levels, based on the relation of the indices to mortality or morbidity. Understanding how closely linked a type of statistic is to disease and death rates is crucial in designing health policies and programmes.

Five questions decisionmakers should ask about estimates

A complete methodological discussion of estimates in public health is beyond the scope of this paper. Instead, we suggest questions to help users of disease burden estimates assess and understand their strengths and limitations.

Conclusion

Estimates of disease burden, along with considerations of feasibility and cost, should be central to decisions about public-health interventions. Even if the role of evidence in public-health decision-making is balanced by strong political, social, and other contextual factors,54, 55 estimates provided to decision-makers should be based on sound and transparent methods, applied in comprehensive and systematic ways to the various levels of disease burden assessment, and to diseases and

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