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Canadian Epidemiologist Called “Thoughtful Pioneer” For His Million
Death Study
Prabhat Jha,
an Indian-Canadian epidemiologist, was profiled recently by 52
Insights. The online magazine publishes weekly interviews with
leaders, innovators and pioneers in a variety of fields ranging from
science and politics to popular culture. Prabhat Jha was chosen for
his work on the Million Death Study. According to magazine founder
Ari Stein, “We like thoughtful pioneers such as Prabhat Jha and
hugely disruptive projects such as the Million Death Study.”
Sobering Statistics
The interview leads with a pair of sobering statistics.
“Only 3% of individuals that die worldwide have an official cause of
death certificate. More specifically, in India, a country of over a
billion people, 80% of deaths take place outside the healthcare
system.” Without information on causes of death, countries are
hindered in developing strategies to address premature mortality or in
assuring the appropriateness of existing strategies.
Grandmother Interview
In the most revealing moment of the interview, Jha
recounts a visit to his grandmother’s village shortly after his
grandfather’s passing. A medical student at the time, he asked her to
tell him how his grandfather had died. “From her description, I could
tell that he probably had a stroke. I was able to convey that to my
mother and grandmother and it brought them a bit of closure. Only
later did I look back and realize that listening to my grandmother was
something that had worked, and it might work on a larger level.”
Million Death Study
That realization led Jha to initiate the ambitious
Million Death Study. The study, conducted from 1998 – 2014, sought to
quantify the causes of premature mortality in more than a million
previously undocumented deaths in India. “India is an amazing
laboratory of understanding major patterns of diseases and their risk
factors,” Jha said in the interview.
Methods
Partnering with the Registrar General of India’s
existing Sample Registration System, the Million Death Study monitored
deaths occurring in nationally representative Indian households.
Trained surveyors visited the households twice a year. After noting a
death, an in-person interview was conducted with a close family member
using the verbal autopsy method. Two trained physicians then used the
written information to assign a cause of death. In the event of a
disagreement of diagnosis, a senior physician was brought in.
Impact
In the interview, Jha asserts the study demonstrated
the need for the Indian government to take tobacco more seriously and
prompted an increase in taxes on tobacco. Additionally, the work
estimated that nearly 200,000 deaths occur annually from malaria, an
increase by more than an order of magnitude from the 15,000 estimated
by the WHO. Conversely, HIV deaths were only a quarter of what was
predicted. These differences have also triggered changes in funding.
Criticism
The study has received criticism that verbal autopsy
cannot diagnose the cause of death with complete certainty. However,
in the case of malaria, Jha and his colleagues look for additional
factors such as seasonality and the degree to which malaria is
reported in the area to bolster the diagnoses.
Global Idea
Jha goes on to explain in the interview how India is
just one example of how this problem plays out globally, and that a
future where everyone dies in hospital is a long way off. In the
meantime, his “diagnosis for the world’s problems on mortality is very
simple. Collect a random sample of all the deaths in every major
population, enumerated through verbal autopsy.”
The biggest obstacle to this? Sustained funding.
“Anything really important in global health is never a matter of doing
things in the next year or two. You have to think in terms of a
decade. And that’s where you see progress.”
Prabhat Jha is the founding director of the Centre for Global Health
Research, the Inaugural University of Toronto Endowed Professor in
Disease Control, Canada Research Chair at the Dalla Lana School of
Public Health, co-investigator of the Disease Control Priorities
Network, and a Bill and Melinda Gates Foundation advisor on HIV/AIDS
control in India.
To read the interview in more detail, visit:
https://tinyurl.com/zabndse
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