Count, analyse and interpret: Data for health

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Latin word datum means ‘to give’. In english this word means a ‘single piece of information‘. As information grows from singular to pleural, it becomes ‘data’. We subconsciously collect and process data all the time. For instance, a mere look at the watch tells us minutes, which our brain processes as remaining time for our leftover tasks. On the other hand another related term ‘statistics’ has quite a different origin. It comes from German Statistik, which means description of a political state or a country. A German scholar Gottfried Achenwall, who proposed Staatswissenschaft (politics), as a term to denote knowledge ‘necessary for statecraft’. Indeed analysis of information (or data) is necessary for the state (original usage of term statistics). By 19th century, we started using the word ‘statistics’ for either a method for, or an output from analysis of data.

Lets count us in

Leaders are always interested in numbers. They often have two basic numeric questions ‘How many ?’ and ‘How much ?’. Throughout history advisors to any leader were called upon for answers. While most answers are a broad estimate, a more accurate response needs a strong basis. In ancient times, some monarchs started to keep a count of their subjects. We know this count of all living within an administrative boundary as “Census” (derived from Latin censure for estimate). In ancient times it was a sporadic exercise. Such counts informed the monarch about how much tax could be collected or how many men could form its armies. Need for such demographic information changed when countries embraced democracy as a mode of governance.

While there is no start date to this system of counting, early efforts at census were limited in scope. First truly nationwide count was in US in 1790. Its purpose was to decide, which state will send how many representatives to the congress. US also started a tradition of a nationwide count every 10 years. US census has a greater focus on economy. On the other hand, England had its first census in the year 1800. Its initial purpose was to inform how much bread country really needs. Census in England and other countries in Europe also enquired into health. Number of deaths, disabled, diseases became part of this exercise.

Counting moves out of Europe

In 1850s, Spain and Portugal started counting men, women and children in their South American colonies.

India and Canada had their first nationwide census in 1871-73. In 1971, India observed its Census Centenary, and has issued postage stamps for 2001 and 2011 census. Due to Covid, 2021 census was delayed. This delay has happened for the first time in history of census in India.

Egypt followed in 1897. But it was only after the second world war, that most countries in Africa and Asia had their first count. Regular census is now a feature in most countries, and some have issued census postage stamps as a matter of pride. United Nations has a statistical division, which provides guidance to countries on how best to perform census. Some smaller countries complete the exercise in days, but for others it takes months.

Census numbers and health

Way back in 1660, John Graunt, an English trader developed an interest in counting deaths. His book “Bills of mortality” earned him a membership to the Royal Society. He was probably the first epidemiologist – a branch of medicine, that looks at numbers to describe state of health and disease.

Numbers are important for health. Census numbers define our denominator – a reference point for common and rare. In the current era of equitable distribution of health resources, census numbers help plan allocation of facilities, human and material resources. Countries frequently map these numbers or make interesting visuals to make a statement.

Population surveys for health

In later half of 20th century, public health expanded as never before. Coming out of ashes of two world wars, world had a renewed focus on doing good. Like a nationwide census, these health surveys were to look at trends in health, from a large sample of population. First nationwide health survey started in US in 1956. This was to be an continuing feature, and was more than just a count. It included an health examination, X-rays and blood tests. These surveys give more health information, beyond vital statistics (births and deaths) we obtain from census. Europe followed suit in 1960s, followed by many other countries. India had its first economic survey (National Sample Survey) in 1950-51. Started by Indian Statistical Institute, Government took it over in 1972. However, Indian National Family Health Survey (NFHS) started only in 1992. We have had five rounds of this health survey so far.

Today, census as well as nationwide health surveys are integral part of health planning. Census provides us with proportion of births, deaths, and growth in different population groups. We can also see trends in distribution of genders, vulnerable groups, housing standards, education levels and asset ownership. Health surveys, that look at a sub-set have a greater focus on health and disease.

Interpretation of demography for an equitable distribution of health resources

In 1974, we observed “World Population Year“. We were a little below 4 billion then. It took us 13 years to add another billion. Thereafter we have added a billion every 11-12 years, and stand more than 8 billion in 2023. As we focus health outcomes for entire population, we are passing through a data-analysis and interpretation explosion. We have moved from humble paper-pen surveys, to large digital data-bases. We continue to count, analyse and interpret with each passing day.