Bill and I are used to journalists calling us data nerds. Sometimes it's meant as a compliment, sometimes it's not, but we always take it in a positive way. At Microsoft, we analyzed mountains of data to make the best possible business decisions. We have tried to bring the same culture to our foundation. However, we've had to come to terms with the fact that in certain areas of global health, the data just aren't very good.
My primary focus is women and children's health. I'm enthusiastic when I look at child health statistics because child mortality is declining steadily. When I look at maternal health statistics, though, it's more frustrating. For years, the number of maternal deaths worldwide remained relatively constant at just above 500,000 per year. In 2005, a big World Health Organization study put it at 536,000. It was agonizing watching the numbers hold steady. The Millennium Development Goals (MDGs) had set a very ambitious target of a 75 percent reduction in maternal deaths by 2015 (compared to the 1990 figure). The problem wasn't just that we were going to fall short of the target. It was that we weren't making any progress toward it whatsoever.
Then, in 2010, a new study in The Lancet put the number of maternal deaths at 342,000. The change reflected a new and better methodology for doing the estimates. According to more up-to-date statistical techniques, we'd been making gradual progress on maternal health for years; we just hadn't been able to measure it. Now, there is consensus in the field that maternal mortality is down by about a third in the past three decades -- well short of the MDG target, but much better than total stagnation.
Obviously, everyone is pleased with the newer estimates. Fewer mothers dying is the goal. But the data are still far from perfect, and our ongoing difficulty in accurately measuring maternal mortality also makes it harder for us to know how best to prevent it.
In his annual letter, which came out Wednesday, Bill explains "how important measurement is to improving the human condition." When we set a clear goal, intervene in the ways we think will best help us achieve the goal, and then measure the impact of the intervention as we go, Bill argues, we essentially have a report card. We can see which interventions work and which don't, and we can keep doing what works and fix what's not working. When measurement is public, as it is with the MDGs, countries have a strong incentive to focus on important global health goals. No country wants to be in last place on the list of maternal deaths.