Dr. Christopher Murray, Director of the Institute for Health Metrics Evaluation

(Music)

Mark Masse ll i: This is Conversations on Health Care . I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, spring has sprung. Easter and Passover are
behind us and the m ercury has started to rise. R eally feels like the time of
renewal and new growth is upon us.

Margaret Flinter: And it couldn’t come a minute too soon, Mark. It is the special
time of y ear certainly. In the Northeast, people seem reenergized after the long
winter. And the debate a round Medicaid expansion and the Affordable Care Act
also seems to have been reenergized lately. A number of republican - led states
are refusing to expand Medicaid to cover more of the ir residents, even though it's
completely covered by the federal governm ent for the first three years.

Mark Masselli: The State of Arkansas approached Health and Human Services
and the Obama Administration with the new alternative to the Affordable Care
Act provisions on Medicaid expansion.

Margaret Flinter: Well that’s re ally interesting, Mark, because I think most would
agree that Arkansas is a state that has a fairly stringent Medicaid program , rather
minimal in terms of the benefits. And while the governor was in favor of
expanding Medicaid to cover more of his state ’ s uninsured population , his
legislature , republican - control led legislature , was clearly against it.

Mark Masselli: The governor’s office approach ed HHS with a proposal to use
those federal dollars that would have been used to expand Medicaid a nd instead
u se those federal dollars to subsidize buying insurance on the exchange. HHS is
considering the plan , saying it will work with officials there t o come up with a
formula that might work.

Margaret Flinter: So other states like Tennessee for instance, where the
governor is a strong opponent of the Affordable Care Act , I understand is hoping
for perhaps a similar deal. And HHS Secretary Kathleen Sebelius is warning
state officials who a re looking at this option that that’s going to be much more
expensive tha n simply expanding Medicaid. So we will see how this plays out.

Mark Masselli: We will. And one thing we do know Margaret is that when
children and families live near poverty and they gain access to health care, they
end up being much more healthy in t he long run primarily because they can
access preventative care and early screenings, avoiding more catastrophic
illnesses.

Margaret Flinter : And our guest today is one of the world’s leading experts on
global disease and how that’s impacting health and longevity all around the
world.

Mark Masselli: Dr. Christopher Murray is Founder and Director of the Institute for
Health Metrics and Evaluation at the University of Washington . He is author of
t he Global Burden of Disease 2010, the world’s first truly comprehensive analysis
of each nation’s disease burden by gender and age.

Margaret Flinter: It's the first real document allowing public health officials and
caregi vers a global health assessment. So that’s a very fascinating
conversation, Mark.

Mark M asselli: We look forward to that . And as always, we look forward to
hearing from FactCheck.org’s Lori Roberton. And you can hear all of our shows
by Googling CHC Radio.

Margaret Flinter : And of course , if you have comments, email us at
www.chcradio.com or find us on Facebook or Twitter because we love to hear
from you.
Mark Masselli : And we will get to interview with Dr. Murray in just a moment. But
first, here is our producer Marianne O'Hare with this week’s Headline News.
(Music) M arianne O'Hare: I am Marianne O'Hare with the se Health Care Headlines. The
Obama Administration announced an ambitious goal this week , one that thus far
eluded science . The $100 million project to map the working human brain w as
kicked off at the White House. The plan w ould galvanize support for scientist s
already in the throes of such research. The project will seek to invent new
research techniques that can catch your brain function as it's happening and refine the techniqu es already in existence. The program being like ned to the
mapping of the human genome seeks to find pathways to cures for a variety of brain diseases like Alzheimer’s , autism and other forms of mental illness.
The insurance exchanges aren’t supposed to b e up and running for consumers
until October but the State of Vermont is getting a jump on the competition. They
have already posted rates for medical procedures and insurance rates under the exchange plans , offering customers a chance to compare individu al insurance
rates under the Affordable Care Act . And it's a situation highly unlikely t o pla y
out similarly in other states. Vermont ’s rates for next year are expected to stay
relatively flat , whereas analyst s predict there will be sticker shock in insu rance
rates in other parts of the country.

Turns out, grandma was right ; fish oil is good for you. In the first longitudinal
study of the protective properties of fish oil, a recent study showed a decline in
cardiovascular disease in those who consumed h igh er amounts of Omega 3 fish
oils from fish. Several thousand randomly selected people were studied over a
14 year period and those who had higher presence of Omega 3 in their blood
were 27% less likely to suffer from heart disease or die from cardiovasc ular
illness than those with lower amounts. I am Marianne O'Hare with these Health
Care Headlines

(Music)

Mark Masselli: We are speaking today with Dr. Christopher Murray, Director of
the Institute of Health Metrics and Evaluation at the University of Washington ,
where he is also a professor of Global Health. A physician and health economist ,
Dr. Murray co - created the concept of t he global burden of disease which became
the foundation for numerous public health policies in countries around the world.
He served as the Executive Director of the World Health Organization ’ s Evidence
and Information for Policy Clusters , where he pioneered the groundbreaking
World Health Report 2000. He was the first director of the Harvard Institute for
Global Health. He also earned his undergraduate and medical degrees from
Harvard. Dr. Murray, welcome to Conversations on Health Care.

Dr. Christopher Murray: Thank you very much for having me on the show.

Mark Masselli: You know, you have been lauded as a pioneer in t he world of
global health data analytics. Your work, it's been compared to the race to map
the human genome and the race to the mo on . What was the genesis of this
groundbreaking work that you did with the global burden of disease ?

Dr. Christopher Murray : Well my own personal interest in this actually goes back
to my parents who did missionary work in different parts of Africa. And since
childhood, I wanted to know what are the major problems that different societies
have and sort of why some places hav e good health and other places don’t. And
that led me on a personal journey to try to get answers to that , and I have been
very lucky that my that personal interest has evolved into a series of br oa der
opportunities where institutions like the World Bank in the early ’ 90s wanted an
answer to this question . And as the drive to mo re evidence - based decision
making has come , there has been both a demand and a willingness from a broad
array of scientist s around the world to try to sort of come together and pro vide a
coherent answer to those sort of big picture questions.

Margaret Flinter: So , Dr. Murray , when you release d the most recent Global
Burden of Disease Report in 2012 , it looked like there were some pretty
remarkable changes in global health statisti cs in that relatively short period of
time since the release of the first re port in the mid 1990s . But you generated
about a billion different estimates , and I think billion is an accurate statement

here not an exaggeration , estimates of health levels and tr e n d s . And you noted
that there were five significant areas of change that signaled a shift in disease
burden around the globe. I wonder if you could highlight some of those
significant shifts in global health tr e n d s .

Dr. Christopher Murray: It is tr ue there area a billion results from the study , and I
think when you look at some of the ways of understanding the results , you do
see dramatic changes just in the two decade period. So first , we see that there
has been big decline in mortality rates in a lmost every age group and that led to
an aging of both population as well as profiled who is sick in the population , and
it's incredibly fast in place s like Latin America or East Asia.

The second big thing that we are seeing is there is a substantial shif t towards the
leading health problems being non - communicable diseases . The third big factor
which wa s real surprise to us all was how much of a shift towards chronic
disability there has been in the world where leading causes of ill health include
things like mental disorders , substance abuse , and very predominately , the
musculoskeletal disorders be it arthritis , low back pain, neck pain , conditions like
that . And then the fo urth of the set of factors that are driving change outside of
Africa is the shift in the underlying risk factors. Back in 1990 , malnutrition in
children was the number one global cause of ill health , and now we have things
at the top of the list like smoking , diet , obesity and physical inactivity. So it’s a
huge transition in the pro file of risk . But the fifth of the ( 8: 32 inaudible) t hemes is
the fact that in Sub - Saharan Africa , des pite a lot of progress in reducing the toll
of malaria and HIV , their health problems are still dominated by the infectious
diseases , diarrhea and pneumo nia in children ; HIV , TB, m alaria in adults.

Mark Masselli: You know I want to pull the thread a little on the amount of data
that you have collected . As Margaret said , you have generated about a billion
results from your research on everything about ho w long people live by gender
and region to what makes them sick and ultimately leads to mortality. Tell us
about the system s you have created to achieve the task of analyzing this so that
all the data could be easily coalesced and disseminated to global h ealth
practitioners and policy makers around the world.

Dr. Christopher Murray: So there are four components to try ing to put together a
coherent picture of health around the world . So the first component is we try very
hard with our broad network of co llaborators to find world ’ s data on health which
is no trivial task and is always incomplete because there is always data that is
still being collected . But we have looked across the entire publish ed scientific
literature ; we have gone through finding hos pital data , clinic data from around the
world , trying a s exhaustibly as we can to find data . And we have a thing called
the Global Health Data Exchange where we try to make much of that raw data
archived and available to the public. The second component , which the one that
I think is why this is such a labor - intensive task , is trying very hard to make all
these different data sets and measurements around the world comparable to

each to other. If you want to use data to make meaningful comparison which is
core to our view of the world , then we put a huge amount of effort into trying to
enhance the comparability of these data sets.

The third component to it is the whole sort of modern era of Bayesian statistic al
estimation where we try to take all the data and come up with a coheren t set of
estimate. And because of the cheap computational power now, you can develop
and apply a series of methods that weren’t there before or weren’t possibl e
be for e. And then the last component to our system , which is probab ly as
important as any of the rest , is trying to figure out ways to make the results
accessible to people , and we put a lot of effort into making findings that are sort
of complicated in terms of their number and dimensionality , available to people to
get some insight into them.

Margaret Flinter: I know you have partnered with Dr. Julio Frenk , now the Dean
of the Harvard School of Public Health , previously the Minister of Health in
Mexico , who credits your early wor k for giving him a framework he needed t o
build a case for universal health care in Mexico and was ultimately successful in
achieving that goal . Tell us about that connection with Dr. Frank , how that led to
a successful policy change in Mexico which would seem to offer some lessons
for how we d o this in other states and countries as well.

Dr. Christopher Murray: Well , Julio and I have been working together for nearly
20 years . We met after the first burden of disease work , and he was in Mexico at
the time and thinking about health reform as e arly as a round about 1993 . And
then what happened was that we worked together in the ‘90s and we both ended
up at the World Health Organization . And in that period of time , together we
came up with this framework for thinking about health system performa nce and
we then actually went around benchmarking the world ’ s health systems on
several dimensions , what they we re doing for health, what they were doing for
the sort of client - oriented aspects of health care, what we call responsiveness ,
and what they wer e doing about protecting households from financial catastrophe
in paying for health care. And that framework when Julio was asked to be on the
transition team , and then ultimately Minister of Health in Mexico , served a very
useful purpose to sort of say w here was Mexico . It was sort of doing okay on
health but doing really poorly on terms of financial risk protection or protecting
households from financial catastrophe. And I think that helped Julio launch the
universal health insurance efforts that he wa s a key architect of in Mexico. We
have kept working . Julio is the chair of our board at the institute and we have
kept this partnership going.

Mark Masselli: We are speaking today with Dr. Christopher Murray , Director of
t he Institute for Health Metri cs and Evaluation at the University of Washington , a
physician and health economist. Dr. Murray develop ed the Global Burden of
Disease, which became the foundation for numerous public health policies in
countries around the world. Dr. Murray , you have re ceived your initial funding

from the Gates Foundation , which has established a goal to help eradicate
disease around the globe . And Bill Gates stated that it's in the areas where good
measurement happens that progress is made , especially in health care . Tell us
about these visual measurement tools you have created that have been
deployed to assist global health workers and policy initiatives.

Dr. Christopher Murray: What happened is that I have always wanted them used
both in data quality and communicat ing to other people graphs . And one of our
young fellows from our post - bachelor in Global Health Program came up with the
first prototype of dynamic data visualization because he was tired of making so
many graphs. And when we saw this and started to use these visualization tools ,
a light bulb went off in everybody at the institute and everybody that we have
worked with . And we have invested a lot of effort now to build a set of intuitive
interesting fun to use ways to see patterns in the data. And sinc e one of our core
belie fs is it's the comparison across diseases and risk factors that gives you
insight , a lot of the tools are focused on helping you see those comparisons. So
th e lead tool is called GBD Compare because of the desire to get people to lo ok
how they are doing compare d to other settings. We have now recognized just
because of the response from ourselves and everybody that we work with that
there is as much importance in what we do around getting the science right on
the measurement as gett ing these visualizations out to everybody so that they
can explore the findings on their own.

Margaret Flinter: But you know , the Global Burden of Disease framework also
allows for ongoing data input on social determinants of health , things like income
a nd education , using real data from each countr y’ s unique perspective . And at a
presentation that you and your colleagues d id recently , you noted that the system
is also going to allow for comp ilation of genetic information to be added to the
data set . I don’t know if that’s a near or a little bit longer term step but it would
seem that would also be a huge boost t o researchers attempting to understand
variations in global health and then improve it. Tell us about some of those
collaborations and how do y ou envision that aspect moving forward .

Dr. Christopher Murray: The vision there is that we created this resource for
people to use for helping understand the world around them . But the world is
changing quickly a nd so we are now committed to keeping th at resource up - to -
date and using and building our collaboration of scientist s around the world
hopefully having scientist s who are interested in population health in every
country in the world participating to keep the basic description of health and its
r isk factors up - to - date and expand it as you mentioned . And the dimensions that
we hope to expand into include things like making forecast s for the disease in the
next 10 or 15 years for some type s of decision making . One vision would be to
capture geneti c information . I think that will come. Also, we want to try to exten d
the vision of the continuous ly updated resource into where money goes because
if we can both understand what people’s health problems are and where

resources are going , we think that w ill be further fuel for a more insightful
conversation about health priorities.

Mark Masselli: You have pioneered methods in identifying causes of death in
low resource settings and you have also increased the level of accountability in
financial reporti ng. Tell us how these features of the Global Burden of Disease
model are continuing to impact policy approaches for eradication of diseases and
can you give us some examples ?

Dr. Christopher Murray: I do think that you can see how the process of changin g
policy has to start w ith recognizing a problem. And so in some of the earlier
results in Burden of Disease where we found a surprising burden in many
countries of mental disorders , we have seen an array of policy responses in
countries to at least try t o understand their own mental health problems and
substance abuse . Even though we just release d the results of the Global Burden
of Disease 2010 in December , we are already seeing a pretty serious
engagement in some countries in trying to use the results to chart the next
direction for their health system s, rich and poor. So , in the United Kingdom ,
interestingly , they have taken the results and we have had a collaborative project
with the new leadership of Public Health England to say how i s the UK doing
compare d to the rest of Europe . And it’s doing much worse than they expected
and that’s leading them to want to focus on some of the diseases and risk s
where they (17:59 inaudible) table of their comparator countries. Similar process
underway in China. So I see th eir information as fuel for a more informed
national discourse about health priorities.

Margaret Flinter: Dr. Murray, you are one of the keynote speakers at this year’s
TEDMED gathering in April, always an exciting gathering and presentation. But
this year, the theme is the Coming Tsunami of Alzheimer’s Disease. This is
particularly interesting one I would think for the work that you are doing as
countries and nations try and prepare for an incredible challenge for which we
have no treatment, at least at present. How do you envision your work aiding
epidemiologists and governments and health workers to prepare for a challenge
like the coming Tsunami of Alzheimer’s?

Dr. Christopher Murray: Well I think in the visual pools, you see things ver y
quickly and incredibly simply about the enormous rise in Alzheimer’s in a country
like the US, where it’s now the number four cause of death, coming up from well
much, much lower rank back in 1990. And that just takes about 5 seconds of
looking at one o f the visuals to see that. So it aides I think in the recognition of
many problems that are on the rise like that, not just Alzheimer’s . I think another
example in the US is drug use disorders, where there is a huge increase. I also
think that as these measurements become annual, more the bread and butter of
what we are all looking at, we will have a very powerful tool to start to ask the
question about are we making progress on these rising problems. So I am
hopeful that not only does it help us identi fy problems as they are rising but also

help us to be more objective about where we are making progress on tackling
some of these new problems.

Mark Masselli: We have been speaking today with Dr. Christopher Murray,
Director of the Institute for Health M etrics and Evaluation at the University of
Washington , and creator of the Global Burden of Disease model. You can learn
more about his work by going to www.ihmeuw.org . Dr. Murray, thank you so
much for joining on Co nversations on Health Care.
Dr. Christopher Murray: Well thank you very much.

(Music)

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Ro bertson is an award - winning journalist and Managing Editor of
FactCheck.org , a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson: Well, Mark and Margaret, New York Mayor Michael Bloomberg
has said that more people will die from over - eating than under - eating this year for
the first time in the history of the world. He told David Letterman this in March
and added, it’s all happened in the l ast 20 years. So will more people die this
year from obesity than from being underweight for the first time ever? No. This
has been the case worldwide since at least 2005, according to the Institute for
Health Metrics and Evaluation at the University of Washington. But there has
been a shift in these risk factors for death sometime in the last 20 or so years.
Bloomberg has repeated this talking point many times, and when he says it’s the
first time in the history of the world, it’s a bit confusing. Th is year isn’t the first
time this will happen, and in fact, public health experts have been predicting this
for a long time.

It’s children, the vulnerable population, that die from being underweight. While obesity has become more of a health issue, the c hange in risk factors also shows
that there has been success in fighting infectious diseases tha t affect underweight children. Efforts to immunize and nourish kids worldwide has helped greatly in this regard. Between 1990 and 2010, child deaths due to be ing
underweight decreased by 63% while deaths due to being overweight or obese

went up by 70%. And that’s my fact check for this week. I am Lori Robertson,
Managing Editor of FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factual accura cy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like

checked, email us at www.chcradio.com . We will have FactCheck.org ’s Lori
Robertson check it out for you here on Conversations on Health Care.

(Music)

Mark Masselli: Each week, Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. A sthma is one of
the leading causes of trips to the emergency room for children . And there is
often a correlation between high density, low income neighborhoods and more
trips to the hospital for treatment and intervention. When officials at Boston
Childr en’s Hospital noticed a spike in asthma outbreaks in certain neighborhood
clusters, they decided to do something about it. They launched the Community
Asthma Initiative. They realized that if you could treat the environments in the
patients’ home that mi ght reduce the need to treat the patient in the emergency
room.

Dr. Elizabeth Woods: The home - visiting efforts work with children and families
that have been identified through their hospitalizations and emergency room
visits as an identification of havi ng poorly controlled asthma and also it’s a
teachable moment.

Mark Masselli: Dr. Elizabeth Woods heads the program and says the first step is
to identify the frequent flyers , those kids who make repeated trips to the
emergency room. Then they match with the community health worker who visit
their home several times and assesses the home for asthma triggers.

Dr. Elizabeth Woods: And they work on three areas: understanding asthma
itself, understanding the medications and the need for control medications, and
then working on the environmental issues.

Mark Masselli: Families are given everything from HEPA filter vacuum cleaners
to air purifiers. They are told not to clean with certain toxic products, and the
homes are monitored for the presence of pest o r rodents. The result, says Dr.
Woods, has been pretty dramatic.

Dr. Elizabeth Woods: What’s remarkable is that there was a 56% reduction in
patients with any emergency department visits and 80% reduction in patients
with any hospitalization.

Mark Mass elli: And while this program is expensive, there is a return on
investment in reduced hospital cost and healthier children. The program has
been so successful, it’s being deployed in other hospital communities around the
country. The Community Asthma In itiative, a simple reshifting of resources,
aimed at removing the cause of disease outbreaks in the community, leading to
healthier patient populations, now that’s a bright idea.

(Music)
Margaret Flinter: This is Conversations on Health Care. I am Mar garet Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org , and brought to you b y
the Community Health Center.