Less than 50% of deaths worldwide had a documented cause of death – how this is changing

What is responsible for most deaths in the world? For a long time, nobody really knew.

This is because, according to the World Health Organization, in 2005 only around a third of all deaths worldwide had an officially registered cause of death. By 2015, this figure had almost halved: 27 million of the 56 million deaths that year had a registered cause of death. But this proportion was still far below what it should be. Ultimately, it is important to know what the majority of people die of in order to develop the right measures and interventions to prevent such deaths in the future.

This was the impetus for the creation of Bloomberg Philanthropies' Data for Health Initiative, which has contributed to the collection of 12.2 million birth certificates and 16.2 million new or improved death certificates in 31 different countries since 2015. And in late July, Bloomberg Philanthropies announced a $150 million increase in funding for this initiative, plus a $40 million investment from the Gates Foundation, bringing the total amount invested in the Data for Health Initiative since its inception to $436 million.

“Countries were eager to better understand their birth and death situation,” said Dr. Kelly Henning, head of the Public Health Program at Bloomberg Philanthropies, emphasizing how enthusiastic governments of various countries were about this initiative. “We did not find any political problems [hampering countries’ interest in the initiative].” In addition to working with governments of low- and middle-income countries to collect birth and death data, the initiative has also helped set up cancer registries, collect data on risk factors for noncommunicable diseases (NCDs), and train people in collecting, analyzing and using data in general.

One example of progress Data for Health has helped drive and support was helping Colombia produce its first interactive population statistics report. Such a report helps people, well, give them more data about their health. Policymakers and others can now use the report to mine birth and death data in different ways, breaking it down by geographic area, year, gender and age. And that, in turn, can help determine whether death rates are higher for people in certain groups and backgrounds.

Another example is the Data to Policy (D2P) training program, developed in collaboration with Vital Strategies, the U.S. Centers for Disease Control and Prevention, and various national governments, and now implemented in 20 countries in Asia, Africa, and Latin America. According to the program description, the training program is designed to help participants better use data and evidence to assess health problems, develop and select policies that address the root causes of such problems, use methodologies such as stakeholder analysis, health impact assessments, and economic evaluations, and communicate policy recommendations to others. The program also aims to help organizations develop packages of “data-driven policy recommendations in priority areas,” provide staff with the skills and tools to analyze policy, systems to use data and evidence, and training programs and capacity to do all of this.

A third example is Rwanda, where the number of registered deaths has more than quadrupled. The initiative achieved this by, among other things, improving the networking of the country's health sector and registration authorities. The formalization of mortality reporting in communities and health facilities also contributed to this.

One approach is to increase the use and standardize verbal autopsies. In a verbal autopsy (VA), WHO interviews the next of kin and caregivers of a deceased person to gather information about the deceased person's symptoms, medical history and accompanying circumstances. This information can then be used either by healthcare professionals or by algorithms to determine the likely cause of death, particularly when formal medical certification of death is not routinely performed. WHO released a verbal autopsy tool in 2022—an update of a tool introduced in 2016—to guide and facilitate VAs.

Yes, data is damn important when you're trying to make decisions. Otherwise, it's more like making assumptions or saying, “let's try this and hope it's the right thing,” or even “let's do nothing.” Even if you can guess the causes of death of many people in a particular place based on what's happening in other places, that's still a guess. You can't always assume that what's happening in one community is also happening in other communities. Different people can face very different conditions and challenges because of things like discrimination against women and ethnic minorities and inequality in general.

Another big benefit of the initiative so far is that people who should be working together are now working together, for example different parts of the same government. “Before the initiative, the ministries within a state government often didn't meet or talk to each other. These are blockages that had to be overcome.” This is not really surprising to anyone who has ever worked in a large organization and experienced the classic situation where the right hand doesn't know what the left is doing. Sometimes the right hand doesn't even know it's a hand, a problem that can spiral out of control.

In a statement about the new investment in Data for Health, Michael R. Bloomberg, founder of Bloomberg LP and Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries, said: “When we launched the Data for Health initiative nearly a decade ago, we wanted to give nations the tools they needed to measure and address major public health challenges – and the results are encouraging.”

Bill Gates, co-chair of the Gates Foundation, added the following to the statement: “Today, children are twice as likely to live to see their fifth birthday as they were in 2000 – thanks in large part to data that helps us understand who is dying where and why.” He continued: “It's a simple idea, but it's hard to implement, particularly in remote communities. These investments will help improve data collection and, in turn, give us a more comprehensive picture of where and how disease affects people, so more children and families can live better, healthier lives.”

There's a saying that death can teach you something about life. And many deaths in the world still occur far too soon. Many people continue to face life-threatening injustices and conditions that could have been prevented. And collecting and using the right data can help ensure that those who have died as a result have not died in vain.