IHME’s Global Health Insights

Dr. Emmanuella Amoako, a pediatric oncologist at Cape Coast Teaching Hospital in Ghana, is the winner of the 2026 Roux Prize. We talk with her about how she has used evidence to improve early diagnosis, expand access to treatment, and strengthen locally led cancer research, including a shared-care service that brings treatment closer to families and a program that trains parents to help detect childhood cancer early.Learn more about Dr. Amoako's work: https://www.healthdata.org/news-events/newsroom/videos/roux-prize-2026-recipient-dr-emmanuella-amoako
Nominations for the 2027 Roux Prize are open on November 1: https://www.healthdata.org/about/awards/roux-prize
__________________Transcript
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. I’m Rhonda Stewart.
 
In this episode, we’ll hear from Dr. Emmanuella Amoako, winner of the 2026 Roux Prize. Known affectionately to her patients as Dr. Ella, she’s a pediatric oncologist advancing childhood cancer care in Ghana.
 
The Roux Prize, supported by David and Barbara Roux and awarded by IHME, recognizes a person who has used health evidence in bold ways to make people healthier and includes a $100,000 award.
 
Childhood cancer survival exceeds 80% in many high-income countries, compared with less than 30% in many African settings. As lead pediatric oncologist at Cape Coast Teaching Hospital, Dr. Amoako established a shared care pediatric oncology service in 2019, bringing treatment closer to families who had traveled up to nine hours to reach specialist care. The service has since cared for more than 150 children.
 
Dr. Amoako also developed COMPASS, a community program that trains parents of childhood cancer survivors and primary care workers to recognize warning signs and guide families to specialized care. And through the African Cancer Atlas, she is helping build evidence that better represents African patients in cancer research.
 
Thank you so much for joining us. Dr. Amoako. What drew you to pediatric oncology? Was there a particular moment or a particular patient that made you decide this was your life’s work?
 
Dr. Emmanuela Amoako: Thank you very much for having me. Pediatric oncology, I always – whenever I’m asked this question, I always laugh because it was like the last thing on my list when I became a pediatrician. I always used to think I would do something related to maybe procedures or just genetics. I always wanted to do genetics.
 
And then I quite remember as a resident rotating through the pediatric oncology rotation, I sat once with a senior colleague of mine, Dr. Nihad Salifu, and she was asking me like what my future plans were. And then I looked at her and I’m like well, it’s not going to be oncology. I want to do something I want, like genetics. And then she looked at me like very seriously and said yeah, if you do genetics, just like clinical genetics here in Ghana, what are you going to use it for? I’m like, well, I’ll make the diagnosis – like then what?
 
Then what? And I’m like okay, I do not know. And she’s like, well, cancer genetics is emerging. If you really want to do something in genetics, you should consider it. Go read on it and then let me know what your thoughts are. I mean the next obvious thing I said was, yeah, you just want me to do it because it has oncology in it, and she said, no, no, really, just go think about it.
 
So that sat with me for a bit. And then when I completed my residency and went back to the station where I was to practice as a general pediatrician – so I started in September 2019 and then in November 2019, this child comes in to us at the Cape Coast Teaching Hospital. So a 14-year-old boy, he had lymphoma – he was very sick, and he had one of the side effects that comes with that particular cancer, which is the cells break down quite quickly, we call it tumor lysis syndrome. When the cells break down, there’s this overload on the kidneys, so he was in acute kidney failure. He was very ill.
 
Now at the time in Cape Coast, what we always did was we would see the child and when we suspected cancer we referred to Accra. So just for context, Accra to Cape Coast is about a four-hour drive. And so we had to put this child in an ambulance to move to Accra. But I picked up the phone, I called the person who trained me in Accra and I called her, Prof. Lorna Renner. And I’m like, Prof., I have this child who is very sick. I need to move them. Do you have a bed? Do you have space?
 
And she just is like, Ella, from what you’re describing, you know this child is not going to be able to travel, right? I’m like, yeah, Prof., but I cannot do anything here in Cape Coast. She’s like, well, I trained you, so you can try. I can guide you from here.
 
And I’m like, Prof., I don’t think I want to get my hands dirty. And she’s like, well, I believe you can do something. It’s two things: He’s not going to make the trip. He would probably die before getting to care, so you need to do something.
 
And so thankfully, Cape Coast is very close like the, what do you call them? The units are very closely knit. So I call the dialysis unit. The were willing to hemodialyze the child. I called – at that time the service that was provided there was for adult cancer, so I called the pharmacist. They were able to prepare some chemo. And so we would give chemo, would dialyze. We would give some chemo, would dialyze. And he lived. He actually lived. Yeah.
 
And I remember when we were out of the woods, I called Prof. Renner. I’m like, Prof., I’m going to send him now his stable. She’s like, you’ve done the hard part. You can do whatever is left. I’m not taking this patient. Okay?
 
So I’m like, wow. Okay. So she sent the protocols. And it was not just me – there was a team that was there that was willing, and we worked with him, and it was quite timely, I must say.
 
So subsequently, every child that came that was not even very ill, she’s like, well, you can do it. I’m not gonna take this patient.
 
It was quite timely because then 2020 COVID hits, and mind you, Cape Coast serves three different regions and one of the farthest regions would be like nine hours from Accra, the center. And most of the patients came from there.
 
So then it was like, well, we would have to start treating children in Cape Coast. And so that piqued my interest in pediatric oncology, and I had to go and get formal training. So 2019, 2020, I didn’t have formal training in pediatric oncology but I was treating the patients, and then 2021 I had to go get formal training.
 
Rhonda Stewart: That’s incredible. So it sounds like your mentor really changed your career by pushing you to think about then what. So you were going to do genetics, but then what? And just to keep going.
 
Dr. Emmanuela Amoako: Yeah.
 
Rhonda Stewart: Then to give you the confidence, to push you, to say that you could treat this child locally, which then made it possible for you to treat other children locally. That’s incredible.
 
Dr. Emmanuela Amoako: Yeah. And I must say that it’s been amazing being in this field.
 
Rhonda Stewart: Wow, that’s fantastic. Let’s talk a little bit about the survival gap. In many high-income countries, more than 80% of children with cancer survive, but in many African settings, unfortunately, fewer than 30% do. What drives that gap, and what part of that gap can be closed by having better evidence?
 
Dr. Emmanuela Amoako: Yeah, sad, these statistics. I mean, I think it’s always daunting when you hear it and to think, actually, it’s quite interesting because 80% survive in high-income countries, less than 30% in low- and middle-income countries.
 
However, the burden of disease, 80% of the cases are actually found in low- and middle-income countries. And only 20% of those cases are found in high-income countries. So it’s quite a very weird balance. But yeah, there’s a lot of data evidence to suggest that people present late to clinical settings, people abandon treatment, there’s a lot of toxic death. And for me, most important is the kind of protocols that we used are all adapted from clinical trials that were conducted in people that were not or are not of African descent.
 
Rhonda Stewart: Right.
 
Dr. Emmanuela Amoako: I mean, it is well known that clinical trials really across the world have only about 2% of people of African descent. Not to talk about clinical trials in Africa, and then in children in Africa, which barely exist.
 
So again, if these clinical trials are not happening in a certain population, but then the protocols are adapted to them, would it really work? So then I’ve always asked the question, is it that we have more aggressive disease, or the protocols are just not working?
 
Again, when it comes to genetics and genomics, it’s not been fully studied in people of African descent. Only about 2% to 3% of the global genome data bank consists of people of African descent. So we really do not understand the genetic basis of the cancers that we do see in our children.
 
Rhonda Stewart: You mentioned Cape Coast with the example of your 14-year-old patient. And with respect to shared care at Cape Coast, before 2019, as you mentioned, families sometimes had to travel up to nine hours to reach specialists. Tell us how you designed that shared care service and what’s changed for the children who’ve been treated – and it’s more than 150 children at this point.
 
Dr. Emmanuela Amoako: Yeah. So again, that initial conversation with Prof. Renner, like, you know what, I would guide and you can treat, I’ll send you the protocols, I’ll make sure I guide you, was what gave the whole idea of the shared care center.
 
And so what we started with was to treat critically ill patients who could not make the journey. We could also treat, for lack of a better term, easy cancer. So there are some cancers where the protocols are not too toxic. And so we could provide that kind of treatment for the children there.
 
We did build up a very good referral network. So it’s sort of a hub-and-spoke model where the hub was the Korle Bu Teaching Hospital, which is the biggest referral center in Ghana. And then the spoke was the Cape Coast Teaching Hospital, which is a smaller teaching hospital in Ghana.
 
Korle Bu Teaching Hospital, of course, had all the members of the multiple discipline team. They did have all the tech and all the protocols, like we had all the specialists there. And so we made that link with good referrals, discussing cases, having MDTs [multidisciplinary teams], making sure that we referred on time. And very interestingly, some of the cases that were being treated at Korle Bu that were stable requested to start receiving their chemotherapy closer to home, which was Cape Coast.
 
So yeah, for me, that whole system brought families closer to home and it has reduced abandonment, something that we are working on publishing hopefully soon. But that model does reduce abandonment because imagine that you have to take a nine-hour drive for treatment and then you manage to go home for a break one time during your treatment. When you go home, you’re like, okay, I don’t think I want to go back to the hospital.
 
Because usually they didn’t. Sometimes during the treatment, the children look way better – they are fine. So parents are like, okay, I do not need to go back. And so all of that sort of increased abandonment.
 
But having a shared care model and having a center closer to home also made it easy for parents to have their children receive treatments closer to home. The other thing was that they did not have to drive back and forth in and out of the main center. They could just come to this shared care center and receive their treatment.
 
And again, this is quite interesting, most of the things that have happened around people. So we did have a mom who unfortunately lost her child to cancer. She lived in Cape Coast, and during her time, she had to make the journey in and out from Accra to Cape Coast or Cape Coast to Accra. And on her way back, after the child had received chemo, sometimes the child would vomit in the car. And when she lost her child, she walked into the ward one day and was like, why can we not do this here?
 
And I’m like, well, we’ve already started. And she’s like, okay, I want to be part of this. I want to have a purpose for this loss. I do not want parents to make the journey. So she started like a support system for the parents, shared her story with them. And yeah, I mean, all of that has been very interesting. Jane Williams, who lost her child to Wilms tumor.
 
Rhonda Stewart: Oh, that’s incredible. Out of something so terrible with the loss of a child,
that mother was able to do something to help support other parents in that situation. That’s fantastic.
 
Dr. Emmanuela Amoako: Yeah.
 
Rhonda Stewart: And let’s also talk about parents as navigators a little bit. So the COMPASS program trains parents of childhood cancer survivors to help other families spot warning signs and get through referrals. What do they bring that health workers can’t?
 
Dr. Emmanuela Amoako: Oh, yeah. As I said, I’ll always tell you a story around almost every question you ask. So COMPASS is community parents navigating early warning signs of childhood cancers. And it was born out of an idea that sort of came on a Christmas morning, I would say.
 
During Christmas, we almost always have Christmas parties for the survivors. And during this Christmas party, one of the mothers had approached me. One of the mothers whose child was well had approached me, and she was like, oh, Dr. Ella, I saw a child in my community who has what I think my son had. Can I send them to you? And I’m like, yeah, why not?
 
And then subsequently, she sends, I think, four children, or six – I don’t remember the exact number. But then all of them were actually diagnosed with cancers because she had seen symptoms of what her own child had. And so I’m like, oh, okay, if a mom who had gone through this can advocate for other parents, this could be a model that we could adapt. Number one, they had their story. They had a lived experience.
 
As health care workers, we try to tell the patients’ stories, but I find it more powerful when the patients tell their own stories. What if, especially given how stigmatizing childhood cancer still is in many communities in Ghana, what if parents who have children who had survived use their children as a medal of honor and share their stories, and then through that, are able to convince other parents to bring in their children to hospital, advise them that childhood cancer is actually curable when detected early?
 
And so that idea was born. I discussed with my mentor, I discussed with my colleague, Dr. Gloria Tagoe, who is always buying into my crazy ideas. And reports down this together and started working on it.
 
But then one thing that we quickly realized was that it wasn’t only the parents of survivors who wanted to be part of it. We had parents that had lost their children, who wanted purpose, who wanted to do something out of that loss. So a few of them reached out, like, even though I’ve lost my child,
what can I do to help?
 
So then the question was, okay, how do we tell other people that you’ve lost your child, but you still have faith that treatment works? Right? And so, I mean, I feel like when it’s coming from the one who has the lived experience, it’s a more powerful story, whether the child is dead or alive. As a health care worker, I could tell you that, yeah, even though this person died, we can cure. I think people will look at me like, yeah, you’re a doctor. You just want to see the children. When it comes from a parent who has lived that experience, it is more powerful.
 
And so with that, we were able to put together a grant. We also wanted to make it technology-facing and also didn’t want people to refer children directly to the treatment centers if it wasn’t confirmed. So COMPASS is like three-layered.
 
The first layer is the parent who goes out to advocate and hopefully have people see children and have people come to them to seek help. The next phase is like a primary health care center. So we train parents to be able to advocate and to be able to pick up early warning signs. But we also train primary health care workers to be able to triage: Is this cancer? Is this not cancer? Now when they see all of that, they are able to refer to the treatment center. So it’s three-layered, and with all of this, we have technology in between.
 
So I have a very good friend of mine who just likes building apps, and he came up with this excellent app that we work with. So the parents put in details of who they’ve seen with a phone number. And because the parent is the COMPASS, one parent might have like six primary health care facilities matched to them. So when they put in the referral, it goes to the nearest health care facility.
 
Now they receive that notification and then if in 24 hours they have not received any patient, they start making calls like, how can we get you here? And once they make the confirmation, the same is for how to refer to the major treatment centers. But one major challenge that we faced is, and I think we didn’t think of it very early on, is transportation, like how do we move them? Because people do not come because they do not have the money to even pick transportation to get to the centers. And so it’s something that we are working on, maybe looking for another grant to sort of buffer the transportation part.
 
Rhonda Stewart: There are so many different components to consider. Transportation is one part of it, as you said. You talked earlier about the fact that people of African ancestry make up a very small fraction of global cancer genomic datasets. Tell me a little bit about the African Cancer Atlas. How might that change things, and what might that mean for African children with cancer?
 
Dr. Emmanuela Amoako: Right, so currently the African Cancer Atlas is an initiative by Yemaachi Biotech, which is an African research company startup, actually headquartered in Ghana, fully African owned and if I remember quite well, started operations in 2020.
 
And what Yemaachi brings to the table is that Yemaachi wants to diversify precision oncology. And I do sort of work part time there as the director of clinical affairs, working together to make sure that research projects go on smoothly.
 
Now the African Cancer Atlas is aimed at diversifying the pool that exists. And so currently we are working with various partner facilities in Ghana, Nigeria, Côte d’Ivoire, Seychelles, Kenya. And what we are doing is recruiting participants into studies. We are taking blood, which would look at germline, and then we are taking tumor samples, which would look at somatic mutations, and trying to build this whole bio-databank of different cancers that exist for people of African ancestry.
 
And the goal, the hope, is that we find mutations that are sort of specific to people of African descent, maybe a founding mutation. I know that it’s going to be difficult because people of African ancestry are actually very genetically diverse. And their goal, actually, is not to find the cure just for the Africans, because that genome is so diverse. Finding, like unlocking the code to the African genome would unlock it for everybody.
 
I’ll take you back: Evolution started in Africa right there – Namibia, Ethiopia. I mean, there’s evidence to all of this. And so everybody sort of came from the motherland, and that’s why it’s called the motherland, right? And so the hope is that unlocking this would lead to finding new targets that are druggable, new targets for cancers among everybody, not just people of African descent, and for children.
 
Currently, the African Cancer Atlas does not include children, but subsequently, the hope is that we’ll be able to fund it to include children. And I think that when we are able to do this – I mean, the cancers that we see in African children definitely behave very differently from the cancers that we see in other people of other ancestries. And I would say this because I’ve worked on both sides. I’ve worked in Ghana, worked in South Africa, and currently working in Canada. And I see the difference with the kind of cancers that we see in these children.
 
Rhonda Stewart: And so you’re now a cancer genetics fellow at SickKids in Toronto. What skills or approaches or experience are you most eager to bring back to Ghana in terms of bringing really precision oncology and making it realistic there?
 
Dr. Emmanuela Amoako: Right. I didn’t know this until a few weeks ago that I’m actually working with a world superstar when it comes to cancer genetics, Dr. David Hawkins. So he came up with the whole surveillance protocols that survey people who have cancer predisposition syndromes. And I had no idea up until recently. So it’s quite humbling working under him and picking up all the skills and learning from him.
 
I think one of the things that I hope to pick up is how to even incorporate surveillance into our setting. Because for most cancers over here, genetic studies have become very straightforward. Like, almost every child gets their blood sequenced or their tumor sequenced, right? And then whenever anything is found, of course, they do move on to the next stage. So the goal is to learn all of that. And just earlier this week, I did have a chat with him to sort of discuss projects that we could link SickKids to the facilities back in Ghana to see how easy it would be to sort of sequence almost every child who comes through, which is a project that we started in Ghana a while back but ran out of funding.
 
So we’re looking at ways to sort of bring that back and fully understand exactly what happens genetically to the children who have cancers in Ghana and then hopefully expand. Of course, the goal is to definitely expand beyond Ghana to across Africa, because, as I mentioned, we are very genetically diverse. And so just looking at one, like a small country in West Africa, would not do justice to the African genome.
 
Rhonda Stewart: You are, of course, the 2026 Roux Prize winner. What will the prize allow you to do that you weren’t able to do before? And then also I would ask, if governments and funders across Africa took one step on childhood cancer, what would it be? So let’s talk about how you plan to use the prize and how policymakers and other decision-makers might benefit from your work.
 
Dr. Emmanuela Amoako: Yeah, it’s still quite surreal being the Roux Prize winner. For me, it’s going to advance the work that I do, whether advocacy, whether policy, whether the research work. And I think really, it has sort of put me in the space where people are reaching out, looking out, and reaching out.
 
So it’s not just the prize money, but what comes with the prize, because now people are asking questions – oh, does something like this exist in Africa? Is someone doing this? And I’ve had, since the announcement in August, I’ve had a few people reaching out, willing to collaborate.
 
So for me, it’s really not just about the prize money. It’s about the network that this prize has brought for me. And I believe that would definitely advance the work that I do. It’s going to be definitely beyond the shores of Ghana, beyond Africa. I believe it’s going to open doors to even bigger things.
 
So, yeah, still, thank you very much, IHME, and thank you to the Roux family. I mean, to say that I’m grateful is an understatement, but I am truly grateful.
 
One thing I think governments should do is most governments should have a policy on childhood cancers. And because again, unfortunately, children are always an afterthought. Last month, September, was childhood cancer awareness month. I didn’t see a lot of likes – I’ve been fighting a lot with my friends because I see their status. Since yesterday, everybody’s putting up pink. I’m like, hm, last month you didn’t put up gold. I’m not happy with you.
 
Unfortunately, in many places, people still think childhood cancer is a death sentence, but it is not. People think that children might not survive, but they do. And they are quite resilient. And if we go back into history, in fact, the cure for cancers generally came from children with leukemia receiving chemotherapy. So childhood cancers have been the pointer for many, many cancers in the world.
 
Unfortunately, when it comes to advancements, our children still have to receive chemotherapies because of course, there are not so many studies that exist with immunotherapies and targeted therapies in children. So I generally think that governments should have a national childhood cancer plan. I think research institutions and grantors should also look into funding childhood cancers.
 
I always say that if you’re able to cure a child, you are looking at your future employment of the country. They are the ones that are going to hold the country. And people might think that children are a small population. Last week I was making the point somewhere that children are 30% of the population in the world right now, but they are definitely 100% the future, and we definitely cannot leave them behind.
 
So even though childhood cancer is supposed to be rare in certain settings, they are not as rare as they are thought to be. They are just under-reported. And so we should actually make efforts to make sure that we are diagnosing these children, treating them, and knowing that they would definitely contribute to the future work pool and the economy of the country.
 
Rhonda Stewart: Wonderful. Well, Dr. Amoako, thank you again. Congratulations, and continue to do your amazing work.
 
Dr. Emmanuela Amoako: Thank you. It was really nice meeting you.
 
Rhonda Stewart: Details about the Roux Prize, Dr. Amoako’s work, and past winners can be found at healthdata.org. Nominations for the 2027 Roux Prize open on November 1.
__________________
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.
Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube
Bluesky

Dr. Christopher Murray, Director of IHME and co-chair of the Lancet Commission on 21st Century Global Threats to Health, discusses the threats most likely to shape human health through 2100. We talk with him about why obesity and low educational attainment carry such large burdens, why sub-Saharan Africa bears a disproportionate share of risks created elsewhere, and what leaders outside the health sector can do now.
Learn more about the Commission
Read the Commission's report published in The Lancet
Watch the launch event at the World Health Summit
Contextualize the threats to health through the new data visualization tool
___________
Transcript
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. I’m Rhonda Stewart.
 
In this episode, we’ll hear from Dr. Chris Murray, Director of IHME and Co-Chair of the Lancet Commission on 21st Century Global Threats to Health. The Commission assessed threats to health over a 75-year horizon from 2025 to 2100 and identified 17 catastrophic threats, including two with extinction potential: malicious use of AI and nuclear conflict.
 
Rather than focusing on worst-case scenarios, the Commission measured each threat’s amenable burden, the difference in healthy years of life between a plausible best and plausible worst future. The analysis is not a policy ranking, but demonstrates the interconnected nature of these threats.
 
We cover why sub-Saharan Africa bears a disproportionate share of risks, what finance ministers, business leaders, and security officials should take from the report, and how a recurring monitor could keep these threats on the agenda between crises.
 
Chris, tell us why this Commission, and why now? Given things like Ebola outbreaks, major geopolitical conflict, cuts to development aid, and how powerful AI has grown, why create a 75-year view of threats to health?
 
Dr. Christopher Murray: When we started the Commission three-plus years ago, we all had in mind three big threats. One was very long-term climate change, where in the analyses around the effects of emissions, the largest impacts of emissions actually happen in the next century. So to deal with a threat like climate change, you really need a long-term perspective to fully capture its impact.
 
We had conflict in Ukraine, and we had just come out of a pandemic – COVID, of course – and COVID is another example, or pandemics are another example, where a long-term view is necessary because we can’t know when the next pandemic will be. But we have increasing confidence, when you take the long-term view, that there will be another pandemic, or several of them. And so the long-term view is critical for some of the threats that we need to manage. And if you just look in the short term, you’re going to miss some of the biggest impacts that’ll be out there.
 
And so that was part of our motivation, trying to get the right time frame for thinking to help governments, the global community, think about these threats. And so we ended up with the 75-year view.
 
Rhonda Stewart: And in addition to that long-term time horizon, one of the other points made very powerfully in the analysis is the need to address these catastrophic threats simultaneously, not to focus on one at a time. Tell us why that’s so important.
 
Dr. Christopher Murray: I think we’ve become very familiar with single-issue groups, whether scientific or advocacy focused, that bring to bear a lot of energy and focus on one issue, let’s say conflict or climate change.
 
But if we just go about looking at threats one at a time, we’re going to miss the fact that there are a lot of threats that we have to manage. It’s not just two or three, it’s many. And in our case, we argue for 17 and that there are common strategies that can be used to tackle multiple threats at the same time.
 
And so the one-by-one strategy really can give us almost a false sense of security. If we put all of our eggs in the basket of dealing with one issue, we’ll be okay. But we have to live with the reality that there are many challenges that the global community and national governments have to face.
 
Rhonda Stewart: Along with the interconnected nature of the threats, the analysis also measures threats in a different way, and the Commission explores the threats by amenable burden, the gap between a plausible best and a plausible worst future. Can you break that down for us and help people understand what that means?
Dr. Christopher Murray: Yeah, we spent a lot of time thinking about and debating the pitfalls of forecasting, because of the 75-year time horizon, which is necessary because of some of the threats that are changing slowly and have their big impacts in the future.
 
You know, think climate change. We depend very much on the forecasts or the scenarios being reasonable. But we know from the history of forecasting that when your forecast can alter policy priorities, then you are in the territory that’s sometimes called reflexivity or self-defeating or self-fulfilling forecasts. Lots of names in different fields, but a well understood problem. And our solution to this was not to say we have a crystal ball and can predict how governments will respond, and this is the pathway of the future for sure, but rather that we can do a better job if we bound the range of possible futures by using empirical approaches to say what’s the plausibly worst that can happen? And plausibly best.
 
And it’s that zone that we can end up influencing where we land. And the difference between plausible best and worst we call amenable, or amenable burden. And the plausible part is also really key in that thinking and goes into the notion about amenable burden because we can dream up all sorts of scenarios – terrible scenarios, utopian scenarios – but we want to ground our plausible best and worst in what we’ve observed across all countries in the past 35 years or so, where we have good data.
 
And so we can say look, let’s take the best and the worst we’ve observed across countries and say, what if the whole world moved to that best or worst that we’ve observed? And that gives us an empirically grounded view of plausible best and worst. And that’s been the key lens through which we’ve been looking at the threats into the future.
 
Rhonda Stewart: The report is very clear that this is not a policy ranking when we look at the different threats. Obesity has the largest amenable burden of the 17 catastrophic threats. And that might be surprising to people that such an everyday condition might appear so high.
 
Dr. Christopher Murray: I want to reiterate that the main message from the Commission is not necessarily which threat has the biggest amenable burden, but rather there is this multiplicity of really profoundly large catastrophic threats.
 
Nevertheless, obesity is very large. It is the largest in terms of the estimated amenable burden. And the reason that we do this exercise is the surprises like obesity coming through, which is, until you run the models and map out the trajectory of the possible for the future, we don’t really know whether something that affects many, many people, like obesity, that's getting worse very steadily, will turn out to be super amenable to policy intervention or it’s going to be much smaller.
 
And so, having done that analysis, what we observe is there are some countries that have held the increase in obesity over the last 35 years to a relatively small amount. Nobody’s brought it down, but some have sort of kept it from going up dramatically. And then there are other places in the world where obesity has really skyrocketed and is on a trajectory of going up and up. When you look at the gap between those and look at the many, many outcomes related to obesity – cancers, heart disease, diabetes – then you end up with a really large potential to improve human health by getting us on the plausible best trajectory for the world.
 
Rhonda Stewart: Let’s talk about another one of the threats, which is education, and specifically, education as a health lever. So low educational attainment accounts for 16.1 billion years of life lost. More than two-thirds of that falls on sub-Saharan Africa. How does education shape health and even the size of the world’s population?
 
Dr. Christopher Murray: Well, one of the more robust findings from public health research, both in low-resource settings and high-resource settings, is that educational attainment is a huge driver of child mortality – so that’s the mother’s education – as well as adult mortality. And many people have studied this, and there are many published reviews of the magnitude of this.
 
And so education, we know, is connected to health. It’s also really strongly related to women’s fertility choices. For every year of completed schooling, it turns out that women end up choosing to have fewer children. And so that is a big driver of fertility and ultimately of world population.
 
Now in the Commission’s work, the second piece was those plausible trajectories, which is, does education just march along in every country in the same way, or is there a range of countries where they’ve been able to increase educational attainment much faster and others where it’s been much slower? And the answer is yes, there’s a big range.
 
So if we can get on the pathway of more rapid educational expansion compared to the slower educational expansion, it makes a really big difference. And interestingly, the standout performers on raising particularly girls’ education have been in the Middle East, where they’ve made, essentially over a generation, incredible increases of educational attainment for women with all sorts of benefits that have followed from that.
 
And then there are places where it's been much slower – some countries in the Sahel where educational attainment has barely moved, particularly for women, over the last 30, 40 years.
 
So combining those two together, a big range of possible trajectories for education and big connections between education and health outcomes and fertility is why it turns out to be a really important threat. And if we can get the world on the high education attainment trajectory, it will make a really big impact in many domains.
 
Rhonda Stewart: And of course, we can’t talk about threats without talking about AI, specifically malicious use of AI or AI-enabled bioweapons. That is one of two threats with extinction potential. So explain to us how the Commission approached that risk when there’s so little historical data on this.
 
Dr. Christopher Murray: So, for two threats, malicious use of AI and nuclear conflict that’s large enough that it can lead to nuclear famine, there we can’t build statistical models. There have only been two nuclear bombs released, in World War II, and there’s not enough data to fit a model on that. Although we did do some interesting modeling using the near-miss literature and for malicious use of AI, saying of course we haven’t observed any major catastrophe yet from AI, so we’ve had to use qualitative approaches for these.
 
We’ve gone and looked at what experts, domain experts, general citizens, and a group called superforecasters – people with a proven track record of predicting things – and looked at the very wide range of probabilities. And when we started doing this work three years ago and we identified malicious use of AI, there was a group of people who were saying even back then, this is a real threat, particularly using AI to build bioweapons. And, you know, people just laughed at us, to be honest, when we talked to policymakers and other groups and had our various Commission meetings. This was sort of a fringe view three years ago. It is certainly not fringe today, given all the media and attention on AI.
 
But we’ve seen this as a threat from our reading of what’s out there already and the rapid gains in AI from the beginning of the work of the Commission. And of course, when we get to the end, it figures very prominently in what we’re saying. And I think now that we’re seeing other capabilities of AI so rapidly improve, it’s right to be there at the top of our list as being something with extinction risk potential.
 
Rhonda Stewart: We often talk in our work about disability-adjusted life years, DALYs, and the importance of health loss as a metric. By 2100, people are expected to spend about 13 years in poor health, which is up from eight years in 1990. So people are living longer lives but more years in poor health. What should health systems and governments be doing now to prepare?
 
Dr. Christopher Murray: Well, one of the threats is healthy aging for the very reason that there’s a lot of variation across countries. Even if you just take survival as given, there’s a lot of variation in how much time people spend in ill health at each age, particularly the older age groups.
 
Some of that has to do with some of the risk factor profiles – physical activity and diet. Some of that has to do with classic metabolic risks – high obesity or smoking. And some of it has to do with social policy. Is it easy to exercise? Is the government doing urban planning to make it easier for people to have a healthy diet, etc. So there’s an interface there between public policy as well as managing some of the key risks. And over time, we may well see therapies that can help as well maintain that sort of healthier trajectory.
 
But the data are very clear that we’re on the wrong track right now. We’re on the track where we are making more progress on reducing mortality and not reducing particularly the things that get worse with age – musculoskeletal disorders, vision, hearing, mobility, a number of other factors that generally get worse as you get older. And as we live into those age groups, we will end up with more people with needs that the health system will have to tackle unless we change the trajectory toward a healthier trajectory with age.
 
Rhonda Stewart: So many of these threats, from inequality to conflict to low education, start outside of health. What does the Commission want finance ministers, business leaders, security officials, and other decision-makers to take away from the report?
 
Dr. Christopher Murray: You know, we had on our Commission Mario Monti, former Prime Minister of Italy, who argued from our first meeting that we should be very worried, in terms of threats, about two views, and we need to counteract those views.
 
One was short-termism, not seeing the long run, not seeing these threats that can evolve like climate over many, many decades – and localism, just caring about your local community and not the rest of the country or the rest of the world.
 
And the antidote, in his mind and in the conclusions of the Commission, is to bring to the attention of ministers of finance as well as ministers of health and heads of state, this sort of regular assessment of what are the big threats, how are they evolving? Are there new threats that have emerged? And that there should be within each government a resourced group whose job it is to anticipate, prevent, and prepare for threats.
 
And then at the global level, we should continue tracking those threats. And thus the idea – one of our recommendations is a monitor, like the Commission has done, but as an ongoing mechanism to feed into various fora – G20UN, the Munich Security Conference – these empirical findings on threats because they cut across security, economic policy, social policy, health. And that’s the way it should be because it’s a diverse set of problems that impact health, and therefore we need a diverse set of actors to do something about those threats.
 
Rhonda Stewart: Great. Thanks very much, Chris. Details about the Lancet Commission on 21st Century Threats to Global Health, including the full report and underlying data, can be found at healthdata.org.
___________
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.
Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube
Bluesky

A new $540 million, 10-year investment from the Gates Foundation will support IHME’s global public goods: the Global Burden of Disease study (GBD), forecasting of future health scenarios, and tracking of financing for global health. We discuss the investment with IHME Director Dr. Christopher Murray, including how GBD will expand to nearly 5,000 locations and why timely, local health evidence matters as global health funding declines.________________________________
Transcript:
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. I'm Rhonda Stewart. In this episode we'll hear from IHME director Dr. Chris Murray about a $540 million, 10-year investment from the Gates Foundation and what it means for health evidence as a global public good. 
The investment will support IHME's three flagship research areas: the Global Burden of Disease Study, also known as GBD; IHME's future health scenarios forecasting platform; and its tracking of financing for global health. 
Knowledge about what harms health, and what works to improve it, benefits everyone. Over the next decade, GBD will expand from about 925 locations to nearly 5,000, with estimates at the state or provincial level in every country. This more detailed view can reveal health disparities that national averages hide. 
IHME's work is carried out with a network of more than 20,000 Collaborators in approximately 150 countries. IHME estimates have been cited in nearly 8,000 policy documents worldwide. 
As an organization, we were recently incredibly fortunate to receive from the Gates Foundation a very significant grant to help continue our work and wanted to talk a little bit about that grant and what it's going to allow us to do. So why don't we start there? 
Dr. Chris Murray: Yes, we're very excited that we received a $540 million investment, if you will, into the next 10 years of the Institute for Health Metrics and Evaluation. The purpose of that very large grant is to allow us to continue producing our three flagship what we call global public goods, and that's the global burden of disease, our future health scenarios forecasting scenario building platform, and our monitoring of resources for health, finance, and global health. 
So it's a great endorsement of what we've been doing over the last 20 years, and we're looking forward to the exciting directions that these new resources can allow us to go. 
 
Rhonda Stewart: When you say that health evidence is a global public good, what does that mean and why does that matter now more than ever since the GBD was first launched in the 1990s? 
 
Dr. Chris Murray: So public good is a term that actually comes out of economics. It's the idea, for example, that there are things where my enjoyment of something does not affect your enjoyment of it. So the classic one that, that students are taught in university or high school is a park. A park is a public good because you can enjoy the park, I can enjoy the park. It's not like eating food where the person who consumes the food means that somebody else doesn't consume the food. 
In a similar way, building up knowledge and evidence about what are health problems and what works to solve those health problems is also a public good. Because if we learn that information, then one community can use that, and another community can use it, and a third, and a fourth, and a fifth, and on and on because it's knowledge and my use of that knowledge does not decrease your ability to use that knowledge.  
So that's where this language around public good comes from. And you know, it's a useful idea because the other thing that economics tells us about is that for public goods, unless somebody comes along, a government or another organization, a philanthropy, and funds public goods, everybody will tend to say, well, I'm not going to pay for that because somebody else is also going to benefit. And so I'm going to wait for the other person to pay for that public good. It's called in economics the free rider problem. 
Fortunately for us, the Gates Foundation have the vision that even though so many people are going to benefit from what we do, they're willing to make this investment so that this is available for everybody and everybody can take action on the analyses that we do. 
 
Rhonda Stewart: This is a 10-year investment. What does that decade-long horizon allow us to do that a shorter term grant might not allow us to do? 
 
Dr. Chris Murray: This decade-long investment – and this is the third – because we've had two 10-year investments from the Gates Foundation. This is larger, but still it's been a sequence, and that's allowed us to build up this huge global movement collaboration for the global burden of disease because we can do things that will take many years to come to fruition. It allows us to recruit and retain top talent because people don't like to move around for short term projects, but they're willing to come for a longer term period. And it allows us to sort of say, hey, here are things that we can build, for example, the scenarios platform. 
What are the things that work best to change the burden of disease? We can take the time to build up a resource like that that wouldn't be achievable in a three-year grant. 
And so the long term horizon gives us that stability and the opportunity to innovate and build a better set of results for the world that we wouldn't otherwise be able to do 
 
Rhonda Stewart: With respect to the global burden of disease, this investment is going to allow us to go from roughly about 925 locations in the study to nearly 5,000. Walk us through what those kinds of changes mean for people who are looking to use the information. So, what will they be able to see in the data in 2030, for example, that they can't see today? 
 
Dr. Chris Murray: So what we've learned along the way in the now 35 years of the global burden of disease work is, initially it started out at a regional level when it was done for the World bank in 1991–93. Then it became country-specific when it was based at WHO.  
And then in the last 20 years, where it's been based at the Institute for Health Metrics and Evaluation, we have been able to, for where certain countries have asked for it, we've been able to do the burden of disease analysis at the subnational level. So, the first to ask for this was actually the United Kingdom. 
And so, then we did the burden of disease at local health authorities. Soon thereafter, Mexico, Brazil, India, China, and Nigeria were added, as well as Norway, New Zealand, and Brazil. So it's come to the point where we have about 22 countries at the subnational level currently. 
And what we have the vision and what we've learned from that is that as soon as you do subnational assessments, there is more local engagement. We get more Collaborators in those countries, more policy uptake, and all sorts of innovative ideas of how to use subnational burden. Use it for human resource planning, use it for resource allocation, using it for figuring out how to target different groups and needs. 
And so there has been a long-running list of countries that would like subnational burden. And we haven't been able to meet that demand. And now we've decided as part of this new installment of funding, we will just do subnational everywhere. And so every country will do at least to state or province. 
And then we will also make sure that there is no state or province, that if there's anywhere that's over a population of 10 million, we'll go to the next level. So, we're always looking at a reasonably granular view of health, which helps reveal the disparities and inequalities that exist. And that turns out to be very useful for governments. 
 
Rhonda Stewart: You said previously that national averages can obscure disparities. Can you think of a specific example where, because we were able to go deeper and to be more granular at the subnational level, there was something that was revealed that was especially useful to decision-makers and maybe even helped them to change or take a decision? 
 
Dr. Chris Murray: Well, you know, if we start in the United States, I think there's been a long tradition that even started as sort of a spin out of the original burden of disease work in the 90s of looking at county-level outcomes in the US, and then now more recently we have funding from the National Institutes of Health to do county intersected with race/ethnicity.  
So more than 3,000 counties in the US, five race/ethnicity groups or at least that's what you can get from the data – and there's more clearly – and that's about 15,000 units of analysis. So it's very detailed. And what it reveals is that within the US, even though we have some of the best outcomes in the world, in some counties, Asian Americans have life expectancies in the mid-90s, 95, 96. So some of the highest on record in the world, if not the highest. And at the other end we have Native Americans on the Pine Ridge Reservation in South Dakota with a life expectancy of 56. And so you have a 40-year range from the worst to the best. 
And even if you look more generally there is a sort of, there's a quite diffuse set of places and race/ethnicity groups with life expectancies in the US that are much more similar to a low-income country than to a high-income country. And that's really useful to figure out where to target interventions, what sort of public health and medical care interventions are needed.  
And this is why NIH is invested in trying to do this work because it helps on a very granular disease specific level. Say, hey, we really need to target blood pressure management over here, or we need to recognize the large disparities that exist and figure out intervention strategies appropriate to each community to make a difference 
 
Rhonda Stewart: With respect to policymakers and policymaking. IHME's estimates have been cited in almost 8,000 policy documents all over the world. And can you give us some examples of how the global burden of disease work has been used in evidence-informed decision-making? 
 
Dr. Chris Murray: You know, there's lots and lots of examples of it. Some, you know, and they've evolved over the course of the GBD. I think when we first showed that mental health disorders was really a big issue, not just in certain high-income countries, but everywhere in the world, that led a number of countries to create mental health strategies, to create national institutes of mental health to both research and develop strategies. So, we really played a pretty key role in the growth of interests in tackling mental health challenges. 
There are lots of examples of specific applications around the GBD. In Indonesia, Minister Budi has been using the GBD to help plan for the next generation of human resources for health. How many cardiologists do we need? Well, that's a function of how much cardiovascular disease burden you have today, but even more importantly you'll have in 20 years. 
And we're able to answer those types of questions usefully for him and for the country of Indonesia, places where the GBD is being used to, you know, develop taxes on alcohol because the burden of disease. For example, in Botswana, where the president used the GBD to make the case that alcohol was a big cause of burden, it needed to be taxed at a higher rate to reduce alcohol consumption. 
Some countries have even put the GBD into legislation. So, Colombia has a law that says you need to reach certain targets by province for burden reduction. And as measured by disability-adjusted life years are sort of apex measure in the GBD. 
 
Rhonda Stewart: Going back to the health financing work, part of what that work examines is how governments respond when outside funding declines. So, how can the expansion of our health financing work help decision-makers navigate some of these new and increasing funding constraints? 
 
Dr. Chris Murray: Yes, you know, it's a huge issue, particularly since the collapse of USAID in 2025 and the sort of abrupt nature of the withdrawal of funds for some for the USAID programs led to a recognition that many countries need to look seriously at what they can finance themselves and what are alternative ways to finance their health systems. 
And that's, you know, if you're a middle income country, it's sort of happening anyway because development assistance for health is a relatively small share of what you spend. But for low-income countries where development assistance for health is as much as 40, 50% of health spending in a country, an abrupt cut is a big issue. 
So there's a lot of policy, energy, there's the Ghana reset, for example, which was led by the president of Ghana about how to rethink financing. And so there's a real need for real-time information about what ministries of finance are able to afford given debt and other constraints and what other donors are doing. 
How much is the decline of the US, of France, of Germany, the UK continuing, or will we see a return to higher levels of finance? Probably not, given the other constraints in the world. But it's why the salience of what's happening to the funding has become so key.  
And it's surprisingly difficult to know what's happening because – take the US for example – it's not enough for Congress to appropriate the funds. It turns out that through the process of apportionment by OMB and on down the chain, there can be, as we're learning many delays in how the funds get dispersed. And so that requires a more timely and more detailed understanding of the financial flows than we've even had in the past. 
 
Rhonda Stewart: And the forecasting work is the other area that's going to be further supported by the latest investment that we've received. And the forecasts run all the way out to 2100. They point to a major shift in the world's population towards sub Saharan Africa, alongside rapid changes in diseases and risk profiles.  
Looking out very far into the future, what are decision-makers least prepared for? 
 
Dr. Chris Murray: Oh, many things, I think, you know, we've been able to use the forecasting platform to support the Lancet Commission on 21st Century Global Threats to Health.  
And in that work we've looked at 17 catastrophic threats and those are very diverse. They range from obesity, which is probably the largest. Include things like sustained income inequality and low educational attainment, and then things like war or nuclear war or antimicrobial resistance, scaled-up tobacco use in Africa, a long list. And then of course, pandemics, and climate change are on that list as well. 
So, I think what most decision-makers are not ready for is the complexity and diversity of threats that are coming. You know, we've gone through phases. During COVID, everything was pandemics, and then, you know, we've had the pandemic treaty. But then very quickly, as COVID faded away, interest in pandemics has gone down, which is part of the cycle that we see with threats. 
Likewise, you know, there was a period where a lot of the attention in the policy space was around climate and health, which is one of our 17 major threats. But there isn't just two. It's not just pandemics and climate or even pandemics, climate, and conflict. There's this longer list.  
And so governments need to be threat-ready, they need to take on board – which our forecasting can help elucidate – but they need to be ready for in their setting, for a quite complex set of challenges that are coming and require a coordinated, sustained response from government. 
 
Rhonda Stewart: The work that we've been discussing is carried out by the Collaborator Network, which is more than 20,000 people across 150 countries. And how do you imagine that the Collaborator Network, might continue to evolve? 
 
Dr. Chris Murray: Well, that's a really important question because the Collaborator Network has been absolutely essential for the progress to-date in the burden of disease and now the forecasting work and the tracking, and financing work. It's one of the core strengths that we have in tackling these global public goods is this enormous network of Collaborators in almost every country of the world. 
And I think we see, as we try to make, for example, the forecasting work answer the question, for each country, what are the 20 (or whatever number) most effective ways to reduce the burden of disease in your country or location? 
I imagine that a Collaborator Network can be a very effective mechanism to figure out what types of policy scenarios we should be modeling and then how to convey the results to the right groups and stakeholders in different countries. 
So even above and beyond what we've been doing so far, just building the GBD and tracking what might happen in the future, I think that connection to sort of policy debate and choice, where these evidence never substitutes for decisions, it can help inform them. 
So we're hoping that the Collaborators can be a vehicle for more evidence, informed decision-making around ways to reduce the burden of disease. 
 
Rhonda Stewart: And finally, the investment from the Gates Foundation comes at a time when financing for global health has declined and there have been shrinking budgets for aid. And what does an investment of that size signal at this particular moment? 
 
Dr. Chris Murray: I mean, we feel very fortunate that we are receiving this sustained investment. And in any environment, it would be a tremendous thing because it allows us to produce the global public goods we've been talking about. 
But in a time when many organizations are having to retreat from some of the tasks that they were doing, the fact that we can expand what we're doing, provide more, we hope, useful, more local, more timely, and more relevant information, is just a tremendous opportunity. 
And you know, in the sort of public reaction and people outreach I've been receiving since the grant was awarded, I mean, that's just been the theme of it, that this is a unique opportunity for us to fill some of the gaps that are emerging on the evidence front.  
So we hope very much we'll be able to live up to that expectation. 
 
Rhonda Stewart: Great. Thanks very much, Chris. 
 
Dr. Chris Murray: Thank you, Rhonda. 
 
Rhonda Stewart: Details about the Global Burden of Disease Study, IHME's forecasting, and health financing work, and a wide range of related resources can be found at healthdata.org. ________________________________
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.
Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube
Bluesky

The NUS-IHME Global Burden of Disease Research Centre is a new regional hub to serve as a key analytical engine for Southeast Asia and the surrounding region by delivering scientific evidence that its leaders can translate into policy. We discuss the Centre with IHME Director Dr. Christopher Murray and Professor Chong Yap Seng, Dean of NUS Medicine, the Yong Loo Lin School of Medicine at the National University of Singapore.
__________________________________
Transcript:
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. I’m Rhonda Stewart.
 
In this episode, we’ll hear from IHME Director Dr. Christopher Murray and Professor Chong Yap Seng, Dean of NUS Medicine, the Yong Loo Lin School of Medicine at the National University of Singapore. They discuss an exciting new collaboration, the NUS–IHME Global Burden of Disease Research Centre.
 
This is a new regional hub to serve as a key analytical engine for Southeast Asia and the surrounding region by delivering scientific evidence that its leaders can translate into policy. Southeast Asian countries are home to nearly 1 in 10 people worldwide and face a variety of health challenges driven by a rapidly aging population, changing disease patterns, and the growing health impacts of climate change. Yet within the region, many lack critical data and insight that would help local leaders allocate resources more efficiently, target inequities, and operate proactively rather than reactively, particularly during an outbreak or a pandemic. The Centre will study a range of issues, including antimicrobial resistance or AMR, metabolic risks, women’s health, and dietary and lifestyle factors.
 
Professor Chong and Dr. Murray, thank you so much for being with us on the podcast. Let’s talk first about how the new NUS–IHME Global Burden of Disease Research Centre came about. What was the impetus for launching the Centre? And Professor Chong, let’s start with you.
 
Professor Chong Yap Seng: Thanks, Rhonda. I think it’s a matter of admiration, friendship, and persistence that got this Centre started. I’ve been a great fan of the Global Burden of Disease study for a long time, and the work of IHME. One of their former faculty, Associate Professor Marie Ng, joined NUS Medicine a few years ago, and in 2023 or 24, she introduced me to Stephen Lim from IHME. We got along very well, and there was great interest for us to work together because I’ve been a great fan of the Global Burden of Disease study.
 
And then we persisted to discuss more and more details, and in November 2024, we signed a memorandum of understanding between NUS Medicine and IHME to work on creating a joint center. And then from there it grew and gained momentum. And in February this year, we actually launched the Centre.
 
So as I said, because we respected the work of IHME so much, we had great friends – Marie Ng with IHME, and then meeting Stephen, and then Emmanuela [Gakidou], and then finally Chris [Murray]. And we persisted and overcame all the hurdles that came in the way, and that’s how the Centre got started.
 
Rhonda Stewart: Wonderful. And Dr. Murray, what would you like to add about partnering with NUS?
 
Dr. Christopher Murray: Well, I think this was a very exciting opportunity for us. NUS is one of the leading universities in the world. And so given Marie’s history with us and her energy and Yap Seng, the willingness to foster and catalyze this sort of collaboration, this is just great. I mean, we want to be working with the best institutions in the world. And here’s this fantastic opportunity for us to be able to work with NUS and particularly the School of Medicine. So this was really simple from our point of view.
 
Rhonda Stewart: And the Centre will focus on Southeast Asian countries. Let me ask you both, why is this region particularly important to study?
 
Professor Chong Yap Seng: Okay. From my point of view, I would say that Southeast Asia is not an area that has been well studied by many people, including the region’s own investigators. And it’s an important region that’s almost 700 million people and growing quite rapidly – so I think increasingly important in terms of population and economic activity, and also an area that’s subject to a different set of diseases than you might see in other parts of the world. So a different kind of emerging infectious diseases, issues brought on by climate change, which particularly hits this area hard. So we have quite a lot of natural disasters, and of course, more than half of the population here stay in urban centers. So we are facing all these urban issues that are happening at an incredible pace. One of the big issues affecting this part of the region is our declining fertility, declining total fertility rate. So Hong Kong, Taiwan, South Korea, Singapore are probably some of the countries with the lowest total fertility rates. And this brings up a lot of questions, especially regarding women’s health as well. So I think it’s important to focus on this region to start to understand what the problems are so that we can deal with them with a strong base of data.
 
Rhonda Stewart: Dr. Murray, obviously, in the Global Burden of Disease study, that work covers regions all over the world. And so you have a perspective on the unique challenges in each region. What would you say is particularly important to study in Southeast Asia as a region?
 
Dr. Christopher Murray: You know, as Yap Seng said, this is a region that has had – I mean, there’s a lot of diversity within the region – but on average, incredible economic growth. It has been undergoing this very rapid epidemiological transition. It still has a number of diseases like dengue, let’s say, that we don’t have much in other regions, or much less.
 
But the shift from the pattern dominated by communicable, maternal, and neonatal causes toward the non-communicable diseases is very rapid. I think that puts a lot of stress on health systems in the region, and it means that these sorts of analyses that can be done through the Centre can be really helpful in both identifying the sort of unique diseases in certain countries, but just how do you manage this change?
 
You have countries with really high smoking rates in the region as well as places that are much less. The obesity epidemic is unfolding pretty quickly in some parts of it. So it’s sort of an advanced version that other regions will probably end up looking like as we go ahead a few decades, just because of the economic trajectory that’s been underway.
 
Rhonda Stewart: You both mentioned some of the different health issues and trends in the region – fertility, women’s health, NCDs. When you think about the pace of change – what are some of the most urgent or pressing issues to examine first?
 
Professor Chong Yap Seng: Well, I think as Chris mentioned, this region is unique in the sense that it’s undergone such quick socioeconomic transition. So just take Singapore, for example. We are only going to be 61 years old this year as a nation, and we’ve gone really in that time from 1965 and now from third-world to first-world very, very quickly.
 
So I think former agricultural-based economies in this region have now mostly gone into more industry and then technology-led sort of economies. And that’s going to put a huge strain on issues like obesity, diabetes, hypertension – all those things are rising very fast. And because this region hasn’t had that long history of health surveillance or public health agencies that have been very careful in monitoring the situation, we have fallen far behind in that respect. And so bringing in the methodology and precision of the Global Burden of Disease study work to this region is something that’s really important for governments to make rational decisions about where to invest in the public health structures.
 
So I think this is something that is very timely for the region. And with modern technology, AI, and digital data sources becoming increasingly available, this is really the best time to start to leverage this capability that IHME has.
 
Rhonda Stewart: How do you balance the challenge of assessing health trends at the broader regional level while taking into account issues that are specific to each country in the region? So obviously, in a region of this size, not all countries are the same. They don’t all experience health issues and trends in the same way. So how do you strike that balance of regional and country-specific analysis?
 
Professor Chong Yap Seng: Well, okay, I’ll start off first. So I would say that for example, Singapore – the Ministry of Health has worked with IHME for some time and have used the data specifically for Singapore to understand just what’s happening in Singapore. But this is something that not many of the other countries in this region have done.
 
So I think it’s timely that this Centre is set up so that we can start to help train the people in the region and expose them to the methodologies that have been developed by IHME so that other countries can start to use the kind of work IHME does to get better data about themselves. So I think it’s important both to study the region as a whole because of course the fact that it’s big and growing both in population and economic activity, and also to help countries to deal with the problems that they have within their own borders.
 
Rhonda Stewart: And Dr. Murray, how do you see that?
 
Dr. Christopher Murray: Yeah, I would just add to that that I think the value of both the country-specific work, which you obviously have to do if you’re going to inform local decision-making, local priorities. But having the ability to benchmark across countries in the region using very standardized methods is really helpful because I think it’s much easier to make a compelling case for change in a country looking to somebody in the region – looking to your neighbors essentially to say, yeah, it’s possible, look what’s being done in Singapore or look what’s being done in Vietnam, wherever you’re looking – that’s a more convincing story to say, let’s learn lessons across nations in the region. So I think that regional and of course country-specific efforts really reinforce each other to a very large extent. And I think that’s a great model for the future.
 
Rhonda Stewart: Obviously we live in a time of resource constraints with vast changes to development assistance for health. And so why is this type of collaboration across institutions so important? It would be very easy for IHME to operate on its own or NUS to operate on its own. But in terms of the collaborative model, why is that so important at this particular time?
 
Professor Chong Yap Seng: Well, for Singapore and NUS, I think it’s important because from the point of knowledge transfer, instead of trying to develop all these methodologies ourselves, we can learn from the best.
 
Dr. Christopher Murray: Right.
 
Professor Chong Yap Seng: So I think UW and IHME are the leading people in this field, and so working with them collaboratively and collegially is probably the most efficient way of bringing the methodology to this region.
 
And as you mentioned earlier, I think the region, they’re not equal in terms of resources. So having Singapore as a base to start to have this methodology is a good way to bring it to this part of the world. And one of the missions of this Centre is to train people in the region so that instead of having to go all the way to America, they can just come to Singapore, or we can go to the surrounding regions to spread the knowhow. And I think that’s something that will benefit both the region, Singapore, as well as IHME eventually.
 
Dr. Christopher Murray: You know, for quite some time now on the Global Burden of Disease front, we have been building up a network of individual researchers. We have 19,000 in the GBD network. And I think what’s really important for us now with this collaboration with the School of Medicine at NUS is adding to this large pool of individuals, this institutional relationship where we can hopefully take advantage of the incredible depth of talent and skill at NUS and bring that to bear on the countries in the region – training, research, policy uptake – in a way that will be a real addition to the collection of the many individuals that have been working with us. And the other thing for me is that I’m a huge believer that we all improve if we challenge each other. And if we can get people scrutinizing what’s done, we’re going to end up doing a better job at IHME as well. It’s really a two-way street in my mind. So all those reasons are part of why I think this will be a real success.
 
Rhonda Stewart: Dr. Murray, you mentioned policy uptake. So how do both of you hope that policymakers and other decision-makers might use the Centre’s work?
 
Dr. Christopher Murray: Well, I can start and then Yap Seng can close. I’m really keen to see, in addition to the description of the state of health in a country of the region and what are the risk factors and what are the diseases and injuries getting worse or better – I’m very keen to see more use of forecasting, bringing out what might the future look like if you pursue different policy strategies? Because I think that can be a very powerful tool, whether you’re a rich country like Singapore or a less rich country like Laos.
 
I think the scenario building task can be really useful as a vehicle for bringing the evidence and science to the decision-maker. And I think this is a region where there’s enough sophistication in government that there’ll be an audience for that type of work.
 
Professor Chong Yap Seng: Yes. And to add on to that I would say Singapore’s policymakers are very much data-driven and very long-sighted in terms of their planning. So having good data of the kind that IHME provides, I think it’s critical for us to make the right decisions.
 
So as I said, Singapore Ministry of Health has worked with IHME for some time, and I think having that Centre in Singapore will now lend them increased acuity in terms of looking at all the various problems that are present in Singapore.
 
And of course, we learned from COVID-19 that no one country can be sufficient on its own. You have to work with your neighbors to ensure health security for all. And I think that’s one of the reasons why we do want to spread the knowhow in the region to make sure that everybody has good access to data. And I think the policymakers in this part of the world will definitely value this data and act on it.
 
So I think from a policy point of view, for me that is one of the main deliverables. We are not looking for more publications and things like that. I think what we really want is to see how the data can guide policymakers to create impact in the region. And I think some of the new ideas that Chris has just brought up about forecasting are incredibly exciting to me, because I think the world is changing so fast, the governments have to really plan.
 
Rhonda Stewart: Wonderful. And before we wrap up, is there anything else that either of you would like to share about the new Centre?
 
Dr. Christopher Murray: I mean, from my point of view, we’re really appreciative of the support from NUS and to see this Centre get over the finish line and looking forward to many years of working closely together.
 
Rhonda Stewart: Great. Well, thanks so much to you both. Details about the new NUS–IHME Global Burden of Disease Research Centre can be found at healthdata.org.
__________________________________
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.
Where to follow us:
LinkedInFacebookX (Twitter)YouTube

IHME Director Dr. Christopher Murray and UCLA Chancellor Dr. Julio Frenk discuss The Lancet Commission on Health Systems Performance Assessment and how the information will allow policymakers and other decision-makers to use resources strategically and improve health outcomes.
___________
Transcript
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. I’m Rhonda Stewart.
 
In this episode, we’ll hear from IHME Director Dr. Christopher Murray and UCLA Chancellor Dr. Julio Frenk as they talk about the Lancet Commission on Health Systems Performance Assessment. The Commission’s work builds on a report by the World Health Organization in 2000 that analyzed and ranked the performance of health systems in WHO member states.
 
In the quarter century since the WHO report, the need to understand health systems performance has become more complex and more urgent. Disease burden has evolved along with health expenditure. Globally, low-, middle-, and high-income countries face unique challenges as well as challenges that cut across all countries.
 
The Commission is made up of experts from around the world. It will estimate the performance of countries’ health systems using the best available evidence and propose enhanced measurements of health system functions and goals. The information will allow policymakers and other decision-makers to use resources strategically and improve health outcomes.
 
Dr. Frenk and Dr. Murray, people are familiar with the components of a health care system, but what makes a health system broader, and what are those specific components?
 
Dr. Julio Frenk: Well, the health care system is a subsystem of the larger concept of the health system. Specifically, what most people come in contact with on a daily basis and as part of their personal experience is the health care system. Most people in the world today are born in contact with the health care system, will die in contact with the health care system, and will spend significant parts of their lives in the health care system.
 
What that refers to is the set of institutions that are mostly charged with providing what is conventionally defined as health services or personal health services or clinical services. The health system encompasses a broader set of institutions and actors and actions which we basically define as all those actors and institutions in a society whose primary intent is to improve health. And that includes most of the entities we call the health care system, hospitals, clinics, labs, the pharmaceutical industry, et cetera, et cetera. But it includes a broader set of institutions that are concerned with conserving, promoting, or improving health in a society.
 
Rhonda Stewart: Dr. Murray, anything to add on the components of a health system?
 
Dr. Christopher Murray: Well, there’s always a contingent of people who rightly point out that there are drivers of health like educational attainment, whose primary intent is not to improve health, but happen to be super important drivers. So the notion of the health system defined by primary intent does not deny the idea that there are broader social determinants of health. It just says there are these institutions in society who we have funded and created whose primary purpose is to improve health. And it is useful for us to look at that cluster of institutions and figure out who does well and what lessons we can learn about those primary institutions that are focused on improving health.
 
Rhonda Stewart: And in addition to educational attainment, are there other factors that are not technically part of a health system but influence health systems?
 
Dr. Julio Frenk: Yeah, there’s all kinds of what are called social determinants of health, which are other institutions. I mean, the economy, the economic forces, employment is a determinant of health, and housing is a determinant of health. But the purpose of housing is not directly to improve health, it is a determinant. When we talk of the health system as larger than the health care system, we’re talking mostly about other services that are not conventionally part of or even administratively part of the health care system. For example, a lot of what we do in public health, like the provision of clean water and sanitation, or some actions to improve the environment – because the primary intent of those actions is to improve health, they are part of the health system. There are also determinants of individual health status for the individuals that form that population.
But that’s distinct and different than the education or employment or housing that are outside of the health system, although they exert a determination on the health of a community and of the individuals that comprise that community.
 
Rhonda Stewart: And tell us, both of you, what prompted the creation of the Lancet Commission on Health Systems Performance Assessment?
 
Dr. Julio Frenk: Well, let me say it was 25 years ago, a quarter of a century since the World Health Report 2000 was published. And a lot has happened in these 25 years.
 
Now that World Health Report 2000 did two things. It developed a very, I think, well thought through conceptual framework to understand what is a health system, what are the goals of health systems, what are health systems for, what are the functions that a health system has to perform to achieve its goals, and how do you define and measure performance? It was a very clearly articulated conceptual framework that’s been quite influential. Associated with the framework, the framework was translated into a measurement exercise that was carried at WHO by a new area that was created since Dr. Gro Brundtland became the Director-General in 1998 called Evidence and Information Policy that I was leading. And then within that, we have the Global Program on Evidence that Chris Murray was leading.
 
And Chris’s team orchestrated or developed a set of measurements and implemented those. And for the first time, the health system performance of all 192, I believe, was the number of member states of WHO back then – all of those were assessed and compared to produce some rankings that were highly debated, very controversial in many parts of the world, but it was the first rigorous attempt to measure and compare the performance of health systems.
 
Nothing of that scope has been carried out in this quarter-century, and yet the reality of health systems around the world has been transformed profoundly. So it’s, I think, an exercise that’s overdue to now rethink the conceptual framework, see if there are adjustments that are needed with everything that’s happened, including for example, the appearance of artificial intelligence as a major technological development and societal development, and also to try to again attempt a measurement. In the intervening 25 years, both the datasets and the analytical tools to apply to those datasets have improved enormously.
 
So we thought this is a great time to carry out again a comprehensive assessment of the performance of health systems that encompasses the entire world. There have been other assessments, but they are focused on subsets of countries. And this would be the second time that such an exercise for all countries of the world would be carried out.
 
Dr. Christopher Murray: Yeah, I think there’s, as Julio said, much better data, much better methods. But it’s also pretty timely to look at health system performance because we’ve gone through this big shock in 2025 in global health where funding was abruptly cut for a number of low-income countries due to the reductions of USAID and a number of European donors. And that’s reignited the interest globally, and in in fora with ministers of health, are there lessons you can learn about how to better organize health systems to get more health for the money, as Julio has often described in the past? So I think both the possibility of doing a much better empirical assessment and the interest – there’s a willing audience out there for whatever insights are possible in how to deliver both public health and health care more effectively, more efficiently.
 
Rhonda Stewart: Let’s talk about some of the specific challenges that face different types of countries. And let’s talk first about health systems challenges in high-income and middle-income countries. What are some of those challenges?
 
Dr. Julio Frenk: Well, there’s a huge number of challenges on the evolution of the health conditions of populations. First of all, the aging of populations has been for about a century changing the epidemiologic profile. And now we really have a very mixed bag of health challenges, both in terms of communicable diseases – some people had predicted that with the rise of non-communicable diseases, we would see communicable or infectious diseases become irrelevant. Clearly, if we needed any reminder, the COVID-19 pandemic just reminded us that infectious diseases are not going anywhere. They’re there. They continue to be a threat not just as outbreaks or pandemics, but as comorbidities of chronic illnesses and as problems in and of themselves aggravated by phenomena such as antimicrobial resistance.
 
So the nature and the complexity of health conditions in populations have continued to evolve and are extremely complex because they demand interventions that are in general much more costly, and that adds pressure. And the demand side for services is just increasing throughout all countries in the world, but particularly in high- and middle-income countries. High-income countries in particular also face, and middle-income countries as well, fiscal crises of different magnitudes and natures. We’re still feeling the after-effects of the pandemic in terms of inflation and budget constraints from all the stimulus that was mobilized to deal with the economic consequences of the pandemic. And then there are longer-term structural forces in the economy.
 
And then we’re living in times of huge polarization. So measures like public health are being undermined, like public health measures. We are seeing growing vaccine skepticism. We’ve seen basic public health measures like wearing protective face covers during an epidemic become the subject of political debate. We didn’t have that, at least not to this extreme, before the pandemic. I think the pandemic really triggered a number of challenges. They affect all countries in the world, but high-income countries and middle-income countries are certainly not exempt from those. And there are others that I’m sure Chris can add.
 
Dr. Christopher Murray: Yeah, I would add to Julio’s list there two long-term, broad drivers of health challenge that many systems need to take on.
 
The first is quite universal, and that’s the rise of obesity, where we see in any of the forecasts that we tend to make that becoming an enormous determinant of ill health in the future. It’s rising everywhere. And so nobody’s really figured out a formula to put the brakes on increases in obesity.
 
And then the second one, which is much more specific to certain localities, unfortunately very often the lowest-income localities, is rising temperature, where we know that there’s an intersection between temperature and a number of chronic conditions – heart disease, diabetes, kidney disease. And that interacts with obesity, so that we expect to see really big increases in quite expensive disorders like chronic kidney disease and diabetes in many parts of the world that will tax the available resources to deliver meaningful care.
 
So again, back to that theme, that there is this rising recognition that demand for care is going to outstrip the ability of governments, in particular, to deliver services that the public expects. And I think that creates lots of social and political pressure on health systems to perform better.
 
Rhonda Stewart: And Dr. Murray, you just referred to low-income countries, and those countries do face some specific challenges, some challenges that are slightly different or very different in some cases than the challenges faced by high-income or middle-income countries. So what are some of those specific challenges for health systems in low-income countries?
 
Dr. Christopher Murray: Well, I’ll jump in first and let Julio respond. Remember, in the lowest-income countries, we still have really quite rapid population growth. So governments with very modest resources, less than they had before because of the reductions in development assistance for health, have to provide or attempt to provide services for a rapidly growing population. The most extreme case is the Sahel, where over the next one or two generations we will see multiples of the population increase in places that are already poor and have sort of marginal prospects for growth in income per capita. And what that means is that they will face the sort of ongoing challenges of the infectious diseases characteristic of the poorest places – malaria, pneumonia, diarrhea, others, TB, depending on where, HIV.
 
There’s been a lot of progress on those diseases due to development assistance for health. Now that those monies are reduced, there’s very little fiscal space in low-income countries to replace that money with their own resources. So we’ll be back to this theme – why do some countries in the low-income world, are they able to deliver the same service at a fraction of the cost of a neighboring country? And if can we learn from that and share those results so that you can see more service delivery achieved with the limited resources that are available?
 
Dr. Julio Frenk: And I would just add that we’re actually seeing major reversals of challenges that we were on the path of overcoming. And this is across the board – they’re more acute in low-income countries, but you see them in middle- and even in high-income countries. To give just one concrete example, my own country of Mexico is experiencing an epidemic of an outbreak of measles that has already led to children dying from measles. So before 2025, the last death from measles in Mexico occurred in 1995. There had been no deaths in 30 years. So after 30 years of sustained progress, thanks to massive vaccination campaigns, we now see the reappearance.
 
There are concerns in the United States of a reappearance of polio cases because there’s still polio around the world and with reduced vaccination. So you’re seeing not just challenges that arise from progress – you know, the fact that countries become wealthier and reduce their fertility and that leads to aging of the population. That’s actually a movement that has consequences for health systems, but it’s positive.
 
They’re also side by side with situations where we could say that we are victims of our own success. We are now seeing the backward movements in those successes and the re-emergence of problems that we thought had been controlled or we were very near to controlling, like the example of vaccine-preventable diseases. And that really poses a set of challenges. We were almost now unaccustomed to those issues. They were no longer part of our dashboard of concerns. And now all those red lights are turning on again after decades when they were pretty much subdued.
 
And I believe overall, I would reiterate that the polarization, the rise of populist governments who doubt science, that is probably the biggest challenge. And health systems, one of their most important impacts on societies is to produce evidence to guide people making decisions. And that includes decisions at the household level, like whether to vaccinate or not. And that is a challenge for health systems to actually elevate the health literacy of the population and avoid the sort of nefarious forces of voices that sometimes from the highest position of government are doubting the benefits of scientific research and lifesaving measures like vaccines.
 
Rhonda Stewart: Those are some very sobering developments that you mentioned, Dr. Frenk. Going back to the Lancet Commission, can you both give us an idea of the subject area expertise on the Commission and the geographic representation on the Commission?
 
Dr. Julio Frenk: Go ahead, Chris.
 
Dr. Christopher Murray: Yeah, we fortunately have a Commission of experts from every region of the world, a number of people who’ve published extensively on health system performance or health systems more generally, a number of current and past health system leaders, ministers of health, secretaries of health in the mix, and I think some people that have dug deeply into certain functions, as Julio mentioned, of health systems, like human resources, or on primary care and its role in making a well-functioning health system.
 
We have people from the major agencies, WHO, the World Bank, that have been very engaged over time in trying to foster improvements in health systems or investments in health systems. It’s a mixture of expertise from around the world that hopefully will trigger lots of vigorous debate, because I’m sure we don’t all agree on what are the biggest weaknesses in health systems and how we can address them.
 
But it’ll be a group, I hope, that shares the idea that we should foster the evidence building and share that evidence – like 25 years ago, but done much, much better, to be a stimulus to looking at health systems. We’ve gone through successful decades that have been very disease- or intervention-focused in the global health arena. And I think because of the budget cuts around the world or the perception of demand outstripping the available resources, we’re in a window where there’s a lot more interest in the system part in addition to the disease-, risk-, or intervention-specific issues that global health has largely focused on since the MDG [Millennium Development Goal] era started.
 
Rhonda Stewart: What will be the duration of the Commission’s work, and what will the Commission produce?
 
Dr. Christopher Murray: Well, like every Lancet Commission out there, the duration is a little bit a function of how much we both forge consensus across the group and stimulate a parallel set of research that will feed into the report.
 
And let me pass it over to Julio. I expect that in addition to the main report, which would be in two to three years, there’ll be a number of spinoff types of research articles and other types of communications targeting health system leaders that would follow from forging a new consensus around health system performance and what lessons can be learned to share more broadly. But I hope, Julio, that sounds about right to you.
 
Dr. Julio Frenk: Absolutely. You know, I think it’s important just to place this particular Commission in the context of what’s really been one of the most innovative aspects of an incredibly innovative leadership of The Lancet under Richard Horton, which have been this figure of Lancet Commissions. I participated in, I think, the second or third Lancet Commission, and that was around the year 2010. So we’ve seen now for a little bit more than 15 years, just the figure of Lancet Commissions flourishing and producing reports that have really been hugely influential.
 
So contrary to the last time, where the first assessment was done within the confines of a multilateral agency, the World Health Organization – the premier health agency in the world, nonetheless subject to a lot of political constraints and dynamics – this time we have much less restrictions on the possibility of pursuing even highly controversial ideas and making an impact.
 
Now, what we need to guarantee as a Lancet Commission is the effective translation of the results into actual impact on policies and practices around the world. And so even though the Commission itself will culminate for sure with what I hope would be a very impactful report like the one in the year 2000 was, this time, just like being in WHO had a constraint for the political dynamics, but it had the advantages that you were closer to the space of translation into policymaking. And we did see countries where actually the framework and the findings of the Commission prompted major health reforms.
 
And of course, I’m not just talking about my own case, since I became the Minister of Health of Mexico shortly after that. And of course, I took everything that we had done with the World Health Report 2000 to a very comprehensive, ambitious health reform. But I’m talking of countries like China who saw the assessment as evidence of the urgent need to reform their health systems. And we saw countries like the United States shocked by the relatively low ranking that went counter to what people were assuming. And again, it didn’t launch the kind of comprehensive reform, but it did lead to some important reforms like the Affordable Care Act. So we need to be planning from the beginning for the afterlife of the Commission. The product of a report is not the end – it’s meant to trigger action and reforms in countries around the world.
 
Rhonda Stewart: And so before we wrap up, let’s talk a little bit more about the actions and reforms that could result from this report. As you both mentioned, we are living in a time of greater political polarization and resource constraints. So how do you hope that this work might have influence and impact on policymakers and other decision-makers?
 
Dr. Julio Frenk: Did you want to start?
 
Dr. Christopher Murray: You know, I hope that the message of getting more health for the available resources is – and presuming that we learn some insights into how to do that – that is one that will transcend the political polarization in some, maybe not all, countries, because it’s hard to champion inefficiency or less health for the money. And if you can learn some of those lessons: Are there architectures for health systems that seem to do better? Are there ways of structuring human resource development and on and on across the different functions of health systems?
 
I think there will be a pretty ready audience in many places for that sort of message. And so, I think this will be a case where the audience is much more in the policy realm probably than strictly in the academic realm, because it is such a salient, urgent topic right now. And I think whether you’re a high-income, middle-income, low-income country health system leader, there’s real interest in how do you, essentially, balance the books, with increasing demand, no expectation of huge increase in resources in many settings.
 
Dr. Julio Frenk: And for me, my hope is that the Commission, first of all, will remind people of the growing importance of health systems. Health systems in the intervening years between the WHO report and today have only increased their share of the global economic product. It is definitely now the health system that is the largest sector of the largest economy in the world, the US economy. But globally, now it represents about 10% of the global economic product, and in every country in the world – just because of the demographic dynamic and the epidemiologic transition – it’s just consuming more and more resources.
 
And the big thing is, to use that famous phrase from Professor Ramalingaswami of India, it’s not just a matter of more money for health, it’s more health for the money. And at a time when we are facing new restrictions that may slow down that growth or even lead to reversals, I think the need to think of what is the value that all of those investments produce and to maximize that value with available resources has just become much more prominent than before. I also hope that the Commission will bring back, front and center, the idea that policy, public policy, while obviously occurring in a political matrix, needs to, in the end, base its fundamental decisions on the best available evidence. That’s an ethos that’s been eroding over the last few years with the erosion of trust in science and in institutions. And I hope we can make a compelling case.
 
Finally, I hope the Commission will also allow policymakers to anticipate some technological developments that offer huge promise. Artificial intelligence is of course the most salient of those, but it also offers huge challenges. There’s no question that well-applied artificial intelligence finds in health, and health care specifically, one of its most promising and beneficial applications. But it’s really going to depend on how we deploy those technologies. It’s happened with every technology. But I think in the case of artificial intelligence, it’s even more important that we actually are able to provide some glimpses into what that technology is.
 
And lastly, alongside that, I hope it will also place front and center the urgent need to close the equity gaps, the disparities that happen within and between countries. Because we have seen in many quarters a loss of focus on closing those gaps. And technologies themselves can widen the gaps, or they can help shorten them. Some technologies, like vaccines, have been the great equalizers when deployed globally. But when vaccines are not deployed in the right way, like during the COVID pandemic, they can deepen inequalities.
 
So technologies need to be placed in that framework of accelerating the realization of the ideal that access to high-quality health services for everyone and with protection against the financial consequences of disease – that access is a fundamental human right. And I hope this work will also help to elevate again the notion of the reason why universal health coverage is a core part of the human rights agenda at a time where all of those fronts – evidence-based decision-making, a commitment to science, and a commitment to closing disparities – when all of those are under attack from different quarters. I think we hope the Commission will make an enlightened contribution to put us back on a path of progress in health which was launched during the 20th century and needs to continue going forward.
 
Rhonda Stewart: Dr. Frenk and Dr. Murray, thank you so much.
 
Dr. Julio Frenk: Well, thank you.
 
Dr. Christopher Murray: Thank you.
 
Rhonda Stewart: Details about the Lancet Commission on Health Systems Performance Assessment can be found at healthdata.org.
___________
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.
Where to follow us:
LinkedInFacebookX (Twitter)YouTube

The Global Burden of Disease Study (GBD) is the most comprehensive assessment of health trends and conditions across countries. GBD provides detailed analysis of disease burden related to life expectancy, non-communicable diseases, mental health, and many other health topics. We discuss the latest GBD with IHME Director Dr. Christopher Murray.Read the GBD 2023 capstones, published in The Lancet:• Global demographic analysis: http://ms.spr.ly/6047s2bOv• Global causes of death: http://ms.spr.ly/6040s2bOI• Global burden of diseases, injuries, and risk factors: http://ms.spr.ly/6041s2bOLAccess and share all things related to GBD 2023: updated data visualization tools, comprehensive infographics, informative videos, workshops, webinars, and more: https://www.healthdata.org/announcing-launch-gbd-2023-study-results.________________________Transcript
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. I’m Rhonda Stewart. 
 
In this episode, we’ll hear from IHME Director Dr. Christopher Murray as he talks about the latest Global Burden of Disease study, also known as GBD.  
 
GBD 2023 is a series of three papers published in The Lancet and presented at the World Health Summit in Berlin. The papers focus on demographic analysis, causes of death, and diseases, injuries, and risk factors. GBD is the largest and most detailed scientific effort undertaken to quantify health trends. GBD provides a unique platform to compare the magnitude of diseases, injuries and risk factors across age groups, sexes, countries, regions, and time. 
 
For decision-makers, the GBD approach provides a unique way to compare countries’ health progress and to understand factors that impact health such as high blood pressure, cancer, and heart disease. 
 
Led by IHME at the University of Washington, GBD is a truly global effort, with more than 16,000 researchers from over 160 countries and territories participating in the most recent update. The latest GBD includes data on topics ranging from life expectancy to mental health to non-communicable diseases. 
 
Chris, the 2023 Global Burden of Disease study covers three capstones published in The Lancet and presented at the World Health Summit in Berlin. The papers cover demographic analysis, causes of death, and diseases, injuries, and risk factors. 
 
Let’s start by talking about the demographic analysis paper. The global age-standardized mortality rate declined significantly since 1950, but that’s only part of the story. What are some of the other key findings from that paper? 
 
Christopher Murray: Well, in the demographic analysis, there’s both the long-term view of progress in expanding life expectancy that has been quite steady, except for the big interruptions due to the HIV epidemic in sub-Saharan Africa as well as the sort of mortality crises in Eastern Europe and Central Asia that occurred in the late 80s and 90s. 
 
But other than those, up to 2019, we had this sort of pattern of progress that we got used to. Then the COVID epidemic came along: 18 million deaths related to COVID and a big drop in life expectancy, and then it really was even worse in 2021 in many countries. And then it bounced back. And so by 2023, we’ve gone in most places back to 2019 levels, but not back yet to the levels we would have expected if the pandemic hadn’t occurred. So that’s one big part of the story. 
 
Another part is the fact that we’ve seen increases in child and adolescent mortality in some parts of the world, particularly some of the high-income countries – the US and Canada stand out. And then we've seen increases in mortality related to drug use disorders, suicides to some extent, in adults that are more in the 25- to 39-year range. 
 
And then there are some changes in methods and data that we now think that younger adult mortality in Africa is higher than we previously thought and older adult mortality is little bit lower than we previously thought. 
 
Rhonda Stewart: And with the causes of death paper, non-communicable diseases (NCDs) account for two-thirds of the world’s mortality and morbidity. What are some of the NCDs that are among the top causes and what accounts for this shift from infectious to noncommunicable diseases? 
 
Christopher Murray: Well, the shift, which is really profound, toward noncommunicable disease causes of healthy life lost, which in the GBD we tend to quantify using a measure called disability-adjusted life years, which reflects premature mortality as well as functional health loss, so this sort of notion of loss of healthy life. And those shifts are very noticeable in lower-middle-income countries and upper-middle-income countries. They’re still occurring in low-income as well, but it’s really profound in the middle-income slice of the world. 
 
So that by 2023, at the top of the list of NCDs and causes of burden is ischemic heart disease. And then the next among the NCDs is stroke, and then diabetes and chronic obstructive pulmonary disease. 
 
And then we get into things that cause functional health loss like low back pain, depression, anxiety, 
as other big NCD causes that are going up very substantially. And as we go farther down the list, there are things like lung cancer and chronic kidney disease, Alzheimer’s – these are things that are also going up. 
 
The transition toward NCDs is driven mostly by aging, that the average age of the population gets older in places, mostly because of the declines in fertility. Also, the rates of disease by age have been mostly declining, but declining at a slower rate in the older age groups than population growth. And so you get this more marked shift to NCDs because the rates of progress for the infectious diseases, communicable diseases, as well as maternal and neonatal causes tend to be faster. And so that’s also a contributor to this big transition we’re observing. 
 
Rhonda Stewart: Let’s go back for a second and talk about health loss. So you mentioned health loss and aging. Why is it so important to measure health loss, which is something that other studies really don’t do in the way that GBD does? As people live longer, you’re not necessarily living those years in good health. Why is it important to quantify that? 
 
Christopher Murray: Well, the reason in the 34-year history of the Global Burden of Disease that we’ve always focused on, in addition to reporting standard metrics like death and death rates and causes of death and disease incidence and prevalence, is we roll these up into measures of health loss so that we capture these conditions like mental health disorders, like musculoskeletal disorders, 
like drug use, where most of the effect is reducing people’s functional health and not necessarily increasing death rates. 
 
So if you only focus on death, you’re not going to pay attention to things like anxiety and depression and schizophrenia, or back pain, neck pain, that are quite widely experienced and really have a major effect on people’s life. So that’s why we like to look at health loss. When we do look at health loss, there’s a second component to it, which is we’re saying that if you die at a young age, let’s say from an injury at 25, a road traffic injury, that’s a greater loss of health than if you die at 95 from, let’s say, lung cancer. 
 
So we want to capture both the amount of life that somebody’s lost due to premature death, as well as this dimension of things that cause disability or impairment that don’t necessarily kill you. When you do that, you end up with this more complicated, mixed view of what are the leading causes. They include things like back pain or depression. And they also suggest that as lifespan has increased, 
We’re not making a lot of progress on reducing the number of years that people live with substantial loss of health function. 
 
Rhonda Stewart: Interesting. And let’s talk about risk factors. So the analysis notes that half of the world’s disease burden is not only preventable, but there are almost 100 modifiable risk factors. What are some of those and how do they contribute to disease burden? 
 
Christopher Murray: Well, the biggest sources of burden, of risk factor–attributable burden, 
are a mixture of things that are both behavioral, metabolic, and environmental. At the top is high blood pressure. It’s the number one risk factor around the world. And then that accounts for, as a percent of health loss, more than 8% of all burden is related to high blood pressure. 
 
And then we have, as number two, we have particulate air pollution, both indoor and outdoor, and that’s also slightly over 8% of all burden. And then we fall into a behavioral risk, which is smoking, as number three, and then high blood sugar is number four. Then low birth weight and short gestation, a 
critical risk for neonatal death, comes in at number five. 
Obesity and overweight is number six. And then we get into kidney dysfunction, high cholesterol, 
child growth failure. And interestingly now, which is sort of new for GBD 2023 in the top 10 is lead. 
And that’s a change from previous assessments, that lead is now so prominent. 
 
Rhonda Stewart: Okay, let’s go back for a second to some of the things you mentioned about anxiety and depression. The latest GBD provides really important information on mental health. Tell us about some of those findings. 
 
Christopher Murray: Well, mental health as a share of health loss is going up quite steadily around the world. And there’s a sort of steady rise that started in some countries. We can see that rise starting around 2010. 
 
But there was a big jump in anxiety and depression during COVID And although it’s come down somewhat after COVID, it has not come down to the sort of pre-COVID levels. And so there is this rise in the burden of mental health disorders. 
 
A lot of controversy as to what’s driving that, with theories ranging from device use, cell phone use, social media use, and then exacerbated by COVID lockdowns for children particularly. But it’s very hard to get a definitive answer. What we see in the data is that things are getting worse, and that trend started before COVID and is certainly made worse by COVID. 
 
Rhonda Stewart: It’s important to note that although IHME coordinates the GBD, the work is carried out by a global network of almost 16,000 researchers. What does their participation add to the study? 
 
Christopher Murray: Well, we take a very collaborative approach to the burden of disease and have done now for at least the last 16, 17 years of the study. And the reason that the network of collaborators matter so much is in multiple dimensions. So first, they find and contribute data that we might not know about, whether that’s a local study on the prevalence of depression or something on tobacco use. You know, there’s a broad array of studies that are often not part of one of the well-known global datasets like the Demographic and Health Surveys. So they identify and contribute important datasets. 
 
The collaborators help interpret data, giving that local knowledge that’s so critical. Like if there was a certain survey, they didn’t go to two provinces in a country because they were war-torn or because the rainy season was particularly challenging, or other biases that might exist in data sources for a particular country. And so that local insight, local knowledge is really essential. 
 
Then they help interpret the modeling process where we take all the raw data that’s out there on every health condition and over time and then use models to iron out fluctuations in the data or inconsistency across studies or make estimates where in years where we don’t have studies or data, and the Collaborators help in making sure those models pass the sort of face validity test – do they match local insight and understanding. 
 
And then lastly, they play a key role in writing papers, interpreting the results, thinking about local policy implications. And that’s why in addition to the capstones that we’re publishing now, we will follow suit with hundreds, or now with each cycle of GBD, thousands of reports and papers written by the Collaborators covering local regional disease-specific, risk-specific patterns that emerged from the study. 
 
Rhonda Stewart: And new data sources and new modeling methods have helped to expand the depth and the breadth of the latest GBD, contributing to the results that you’ve been talking about. Tell us about that. 
 
Christopher Murray: Well, you know, one of the important aspects of the Global Burden of Disease study is we are collectively across the collaboration always looking for ways to enhance the quality of the analysis. And so that’s, as we discussed, new datasets, but it’s also capturing methods innovation. 
So for this cycle, some of the main innovations have included a new approach to measuring or estimating all-cause mortality by age and sex that is much more driven by the data and does not use anymore what has always been a feature of demographic analysis, a thing called model life tables –that the original ones date back to the 1960s and they’ve been periodically revised and have a heavy influence on, for example, what we did in the past or what the UN Population Division or WHO does for life expectancy and age-specific mortality. 
 
And now we have very much a statistically driven empirical approach that doesn’t depend as much or at all on these model life tables. And that’s, for example, contributed to our understanding that mortality in some parts of sub-Saharan Africa is higher at younger adult ages and lower at older adult ages as an example. 
 
Other innovations, we’ve added as we do each round, some new causes. So we’ve added some of the thyroid diseases, we’ve added electrocution as a cause of injury, and a number of other causes have been broken into more detailed categories. We’ve very substantially revised the outcomes related to some key risks, particularly sexual violence against children, where the data is now there for many more risks, outcomes, diseases than we had previously appreciated. and as I mentioned earlier, a pretty big change in our understanding of lead, driven in that case by new data. 
 
But it does reflect our commitment to use the Burden of Proof methods to always be looking at what is the evidence base on the relationship between the risk exposure and particular disease outcomes. 
 
Rhonda Stewart: There are numerous examples of how GBD has been used by policymakers and others. You mentioned that one of the things that’s so useful about the Collaborator Network is their ability to gather information that might be policy-relevant at a local level. So what value does the GBD have for evidence-based decision-making by policymakers and other decision-makers? 
 
Christopher Murray: You know, primarily what the GBD provides is the broad comparative view for a country or a region or a province where it’s done subnationally of what are the biggest diseases and injuries, and are they getting worse, are they getting better, what are the biggest risk factors – that can become the targets for public health action. 
 
We’ve looked at how people are using in government, particularly the GBD. And so we’ve been trying to examine, how the user base out there is making use of the GBD. And it’s very interesting because what you find is thousands, actually, of examples of governments in reports, in policy analyses, using the GBD for a range of activities, priority setting, formulating strategic plans, using the current and future burden that comes from forecasting to plan human resource development – you know, what specialties, for example, to train – using the GBD for agenda setting to identify problems that maybe government hasn’t really tackled or had a plan for, but look to be large problems and therefore warrant policy review and formulation. And then some explicit examples where the results are used to push through policy change or legislation. 
 
Examples are tobacco and alcohol, but others as well where governments have used the results to argue in parliaments and legislatures for legislation to tackle a risk or a disease. 
 
So a pretty innovative, diverse set of uses. And we keep learning about more and more ways that the GBD is used to enhance resource allocation or prioritization. 
 
Rhonda Stewart: Great. Well, thanks so much, Chris. 
 
Christopher Murray: Okay, thank you. 
 
Rhonda Stewart: Details about the Global Burden of Disease study and a wide range of GBD-related resources can be found at healthdata.org. ________________________An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube

In Nigeria, less than 20% of the population has access to oral health care. This reflects a stark reality in many parts of the world--dental health remains one of the most neglected areas of public health.Dr. Adekemi Adeniyan, Executive Director of the Dentalcare Foundation, rural dentist, and advocate for oral health advancement in Nigeria, has been named IHME's 2025 Roux Prize winner. The Roux Prize recognizes individuals all over the globe who have used evidence-based health data to improve population health. The prize is sponsored by IHME’s founding board member David Roux and his wife, Barbara.• Learn more about Dr. Adeniyan's work and impact in her community: https://www.healthdata.org/research-analysis/library/2025-roux-prize-recipient-dr-adekemi-adeniyan• Read the press release announcement about Dr. Adeniyan for this year's Roux Prize: https://www.healthdata.org/news-events/newsroom/news-releases/ihmes-2025-roux-prize-awarded-rural-health-equity-advocate_______________________________Transcript
Rhonda Stewart: Welcome to Global Health Insights, a podcast from IHME, the Institute for Health Metrics and Evaluation. Hi, I’m Rhonda Stewart.  
 
In Nigeria, less than 20% of the population has access to oral health care. This reflects a stark reality: in many parts of the world, dental health remains one of the most neglected areas of public health. The Dentalcare Foundation has deployed mobile dental clinics and Nigeria’s first solar-powered tele-dental kiosks, delivering care to over 100,000 people in rural communities. 
 
Dr. Adekemi Adeniyan is the Executive Director of the Dentalcare Foundation. She is a rural dentist, advocate for oral health advancement, and winner of the 2025 Roux Prize. Now in its 12th year, the Roux Prize recognizes individuals all over the globe who have used evidence-based health data to improve population health. 
 
The prize is sponsored by IHME’s founding board member David Roux and his wife, Barbara. 
 
Dr. Adeniyan is passionate about collaboration. The Dentalcare Foundation has trained over 2,500 teachers and community health workers to promote oral health in their localities, helping to create a network of advocates that multiplies her impact across borders. 
 
Dr. Adeniyan joined the conversation from Nigeria. 
 
Dr. Adeniyan, congratulations on being named the 2025 Roux Prize winner on behalf of the Dentalcare Foundation. Before we dive into your work, tell us about why the foundation was established – what are the problems that it was created to solve? 
 
Dr. Adekemi Adeniyan: Thank you so much. It’s such an honor to be here and such an honor to be the 2025 Roux Prize winner. 
 
You know, I grew up in Agege, Lagos, Nigeria. It’s kind of a slum and a crowded community. And in that community, access to health care, especially dental care, is almost nonexistent. And for me, I saw many of our neighbors living with toothache for years. They couldn’t afford treatment. And I myself, at the age of 7, I had toothache and I couldn’t even afford to tell my parents about it because one, there was no access to a dental care facility. And at that time my parents couldn’t even afford it. 
 
So communities like this experience children’s laughter being silenced with pain. And this is something that can easily be prevented. So years later, as a dentist, I got to serve in a rural community in Nigeria. That was when I realized that little had changed. Nothing had changed. In fact, patients would travel hours to come into my dental clinic just to have one tooth removed. They wouldn't be able to pay for it. 
 
I would see many children come in, some who had never owned a toothbrush or seen a dentist in their life. And this broke my heart. Day to day, day to day. 
 
So that was why I decided to start Dentalcare Foundation – to make sure that every child has access to dental health care no matter where they are born, no matter where they find themselves. 
 
And the mission of the organization is simple. We just bring oral health care and education to communities that have been long forgotten. And our biggest problem, should I say the problem that we’ve been created to solve, is inequity – oral health inequity. 
 
For instance, in Nigeria, less than 20% have ever visited a dentist. And many in the rural communities where I work, they don’t even have access to a dentist. There’s only one dentist to every 100,000 people. And that in itself is a gap. 
 
If you want to compare it to the World Health Organization’s recommendation, which is like one dentist to 7,500 people, that’s a really staggering gap. And so that’s why my organization goes to ensure that there’s proper education. Because tooth decay and gum diseases are more common in this area of the world, yet their education is lacking. 
 
Rhonda Stewart: That’s incredibly powerful. So for you, it was a mix of personal experience and then things that you’ve seen as a physician and as a dentist. 
 
Dr. Adekemi Adeniyan: I feel like the organization was born out of pain and purpose. 
 
Rhonda Stewart: Yes, born out of pain and purpose. You spoke about the situation in Nigeria. What do you think accounts for the small number of dentists in the country? 
 
Dr. Adekemi Adeniyan: Well, first of all, we are a country of over 200 million people, and the country has fewer than 5,000 dentists. So you can imagine 5,000 dentists serving over 200 million people. And most of these dentists are concentrated in the major cities like Lagos and Abuja. So a child in a rural village could grow up and never, ever see a dentist. 
 
Now, number two is that most of the public dental clinics are very, very underfunded. Preventive care is not prioritized, and oral health care is generally not seen as overall well-being. And most of the national health campaigns that is in Nigeria, they are tailored toward malaria, maternal health, HIV, and it’s understandable. But rarely do you find things that are tailored toward oral health. And because of the lack of dentists and the lack of information, this gap is always existing. So even though poor oral health is linked to heart diseases, diabetes, pregnancy complications and all, it’s still being silent because nobody hears about it. 
 
And that’s why my advocacy really focuses on helping people and policymakers understand why the mouth is not separate from the body and why we need to change the narrative. 
 
Rhonda Stewart: And you just alluded to this in a very powerful way. Why is it that you think that dental care is such an overlooked component of public health? 
 
Dr. Adekemi Adeniyan: Well, that’s so interesting because I feel like this is a question I always ask myself all the time. But I think it’s because dental care doesn’t really scream for attention like every other health issue that we have, until it’s too late. 
 
A toothache doesn’t come like an emergency until someone can’t eat, someone can’t sleep, or someone can’t go to school because of pain. And the truth is, globally, 3.5 billion people around the world have been affected by oral health, yet it’s still being silent. That is because most people think is not a priority. 
 
Most countries spend less than 1% of their health budget on dental care – for Nigeria especially. And this is just negligible. And I would say part of it is perception. Perception, perception, perception. People think oral health is cosmetic. People think oral health is just one of those things that can be sidelined. 
 
But the truth is oral health is about your dignity. It’s about your confidence, about an opportunity. A child who hides their smile may struggle in school or in social life. It can even affect your relationship, or getting a job. So when we talk about oral health, we are really talking about the potential of people, but it’s seen in the wrong perspective. That’s why I think the perception around oral health needs to change. 
 
Rhonda Stewart: Absolutely. In addition to your work with the Dentalcare Foundation, you are also the founder of a health edtech company called Smile Superheroes. Tell us about that work. 
 
Dr. Adekemi Adeniyan: Yeah, Smile Superheroes is a health edtech company. And the main aim of the company is to simplify health information for children. 
 
So what we do is that we use storybooks, animation, and virtual reality to make learning about health fun, inclusive, and most unforgettable for them. I often describe this as the Disney of health care, because we believe that children everywhere deserve to see themselves as the heroes of their own health story. 
 
And that is why we create the stories and animations to allow children to think about health in a different way – allowing children to literally step inside a storybook or an animation and learn how to play but also learn about their health. 
 
Rhonda Stewart: That’s fantastic. And let’s talk a little bit about the impact of your work. We would love to hear about the impact of your Smile Superheroes work, as well as the impact of your Dentalcare Foundation work. 
 
Dr. Adekemi Adeniyan: Yeah, it’s a great thing because what started as a one-man organization, Dentalcare Foundation today has become a movement. And that’s the way I see it because we’ve provided free oral health care and education to over 120,000 children, not just in Nigeria, but across Philippines, South Africa, Ghana, just across the world. We’ve trained community health workers and teachers to promote daily brushing and oral hygiene in schools because we believe that they have first contact with children. 
 
And our Healthy Mouth campaign has distributed over 30,000 toothbrushes and hygiene kits in many rural communities. In Nigeria, we’ve partnered with Ministry of Health Education. We created the first dental kiosk in Nigeria that is reaching over 45,000 people in the rural community. And that itself, it’s great work. And coupled with what we are doing with Smile Superheroes, I was able to write the first oral health storybook in Nigeria called The Girl Who Found Her Smile. 
 
And that storybook has also become a movement, becoming the first virtual reality story or health storybook in Africa, not just in Nigeria, where children can immerse themselves in virtual reality and learn about their health and learn about their mouth. 
 
Rhonda Stewart: That’s fantastic. You mentioned the wonderful collaborative efforts, the ways that you’ve trained professionals in other countries. Tell us what’s next for you and the Dentalcare Foundation. 
 
Dr. Adekemi Adeniyan: I believe that what’s next is always about innovation, and I would say basically innovation for equity. Innovation, innovation, innovation. 
 
Part of our next movement is just expanding into other countries. Last year, we’ve been able to expand into Philippines to establish the work. But we don’t just want to stop there, we want to move into Southeast Asia. Other countries are experiencing the same thing that we do in Nigeria. We’re working on setting up toothbrushing hubs, vibrant community spaces for children where they can learn how to brush, have access to clean water, and also kind of create a safe environment to talk about their mouth. 
 
We are thinking of launching new creative projects that are merging arts, technology, and public health using virtual reality, games, music to teach oral health in schools and marketplaces. And we want to do it in the languages that these children understand. 
 
We want to take this to them and make them feel like they own the narrative. So one of the things that we’re also going to be doing is expanding our mobile dental units and tele-dental care through thinking about expanding it into different countries and different regions where they do not have access to a dental clinic. 
 
So basically, I would say that our vision is really, really bold, and we intend to pursue it because the main aim is to ensure that no child anywhere will suffer from a toothache, And that’s where we are going. 
 
Rhonda Stewart: Wonderful. Well, Dr. Adeniyan, thank you so much. The work that you do is so powerful, and it really does touch an area of health that is very much underrepresented. So thank you, and congratulations again for your win with the Roux Prize. 
 
Dr. Adekemi Adeniyan: Oh, thank you so much. You know, winning the Roux Prize has given me a global platform, and the truth is we’re going to use it to prove that oral health innovation can start from everywhere, can start from Nigeria and inspire the whole world. And that’s the aim. 
 
Rhonda Stewart: Fantastic. Thank you again. 
 
Dr. Adekemi Adeniyan: Thank you. 
 
Rhonda Stewart: Details about the Dentalcare Foundation can be found at dcarefoundation.org. 
__________________________
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube

Development assistance for health (DAH) is at its lowest level in 15 years. This funding backs health programs around the world and addresses diseases and conditions including HIV/AIDS, malaria, tuberculosis, and maternal and child health.
In 2025, many donors (including the United States) cut back sharply on their contributions. There are concerns that cuts to development assistance for health could reverse decades of progress made.
Lead author Dr. Angela Apeagyei (Assistant Professor at IHME) and senior author Dr. Joe Dieleman (Professor at IHME) outline changes to DAH and share highlights from the report, Financing Global Health in this episode. 
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube

“We chose these four topics to highlight some of the ongoing and emerging population health challenges faced by the region in recent years,” said Dr. Marie Ng, lead author and Affiliate Associate Professor at IHME and Associate Professor at National University of Singapore’s Yong Loo Lin School of Medicine. She discussed this four-paper series that studied the burden of mental disorders, cardiovascular diseases, smoking, and injuries in the Association of Southeast Asian Nations (ASEAN) region.Read the podcast transcriptRead the press release for the ASEAN series
Access each paper in the ASEAN series:
Burden of mental health disorders
Burden of cardiovascular disease
Burden of smoking
Burden of injuries
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health. Learn more about IHME.Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube

Health care spending in the US is expected to reach more than $7 trillion by 2031. New research by IHME examines US health care spending by county and health condition and finds significant variation. Where you live, the type of care you receive, and how it’s paid for makes a difference. Understanding these trends is critical to identifying ways to reduce costs and increase access to care. We discuss the data with study author IHME Associate Professor Dr. Joe Dieleman.
Transcript
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health.
Learn more about IHME: https://www.healthdata.org/ 
Where to follow us:
LinkedIn
Facebook
X (Twitter)
YouTube