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Epic Measures: One Doctor. Seven Billion Patients.

Follows physician Christopher Murray as he exposes how unreliable numbers misdirected global health spending, then builds one measure of healthy years lost that shows where illness really strikes and where money does the most good.

Table of Content

Anyone who decides where money or effort should go depends on numbers, and Christopher Murray discovered that the numbers steering global health were often wrong. In the 1980s, the United Nations’ own methods for estimating life expectancy could disagree by as much as 15 years. In Epic Measures, journalist Jeremy N. Smith tells how Murray, a doctor, Rhodes Scholar and PhD, replaced that guesswork with one measure that counts both early deaths and the years people spend ill.

The argument running through the story is simple: what gets counted badly gets funded badly, and honest counting moves money toward suffering that was being missed. It runs from a desert hospital in Niger to the World Health Organization, a clash with powerful governments and an institute funded by Bill Gates. Along the way, it gives anyone who manages by numbers a sharper eye for where those numbers come from, whom they serve and what they leave out.

A family hospital in the Sahara was making its own patients sicker, and nobody could see why. The way a ten-year-old’s parents tracked down the cause became the habit that shaped his whole career.

Two people can both live to 80 and have nothing in common. In the 1980s, the world’s health statistics could not tell them apart, and they could not even agree on how long anyone lived.

One health agency’s figures for just four diseases added up to more infant deaths than another agency’s entire count. The reason lies in how its teams were organized, and the same setup shows up in many workplaces today.

Weighing a child’s death against hearing loss or a heart attack at 70 sounds impossible. Murray needed one number for all of them, and building it meant asking ordinary people as well as experts.

The first full count of the world’s illness put teeth, injuries and mental health in an unexpected light. It also suggested that most of one agency’s staff were working on the wrong problems.

A single ranking placed the United States 37th and helped cost Murray his department. What he did next gave him more reach, more detail and more freedom than he had ever had inside.

Trillions are spent on health every year, and fixing one problem can create the next. Murray’s answer was to trace causes and then hand the evidence to anyone with an internet connection.

Smith’s story adds up to a simple claim with large consequences: the way we count decides whom we help. A boy in a desert hospital saw a well-meant vitamin spread malaria. The grown man found the world’s health agencies funding the diseases they happened to be organized around, while tuberculosis, injuries and depression went largely unseen. The DALY put a child’s lost decades and a lifetime of hearing loss on one scale. Twenty years of work and more than 500 collaborations later, the Global Burden of Disease study is a tool any country can use to identify its risks and shape its health system around them. The deeper argument is that care should follow people and their changing problems rather than single diseases.

The same data speaks to each of us. The leading causes of disability are much the same everywhere, and lower back and neck pain top the list. The book’s advice is modest: take regular breaks, stretch, strengthen your core and consider having an expert check your posture. At work, before spending anything on a number, ask who produced it and what it leaves out.

Good intentions choose what we want to fix. Honest counting decides whether we fix it.

About this book

What is this book about?

For decades, the money spent on the world's health was steered by numbers that were incomplete, unchecked or inflated. Life-expectancy estimates for the same country could differ by more than a decade, and disease departments counted the same deaths more than once to defend their budgets. Jeremy N. Smith tells the story of Christopher Murray, the doctor who set out to fix that. The story starts in a hospital in the Sahara, where a young Murray helped his parents fight malaria in Niger. It moves on to the World Health Organization and then to an institute of his own backed by Bill Gates. Along the way Murray built the disability-adjusted life year, a single unit that counts both early death and years lived with illness. His Global Burden of Disease study exposed neglected problems like injuries, and a later report ranking national health systems angered governments that disliked their rankings. Readers get a clear account of how global health is measured, why the old measures failed and what better data changed. Any manager can also use its lessons: question where numbers come from, compare options on one scale and look for the problems nobody owns.

Book Information

Rating:

Genre:

Biographies & Memoirs, Science

Topics:

Data & Analytics, Global Development, Medicine, Public Policy

Publisher:

HarperCollins

Language:

English

Narrator:

Caleb

First published:

April 7, 2015

Pages:

368

Length:

14 min 48 sec

Get the book:

Amazon

Who it's for

  • Deciding by the numbers

    Analysts, managers and founders who make decisions from metrics and want to know when numbers mislead.

  • Curious about health data

    Students and professionals in medicine, public health or policy who want the story behind global health data.

  • Curious about disease funding

    Readers curious about how the world decides which diseases get money.

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About the Author

Jeremy N. Smith

Jeremy N. Smith is a writer and journalist. His journalism has run in Discover, the Atlantic and the New York Times, and CNN, NPR News and Wired have featured him and his work. He studied at Harvard College and the University of Montana. Besides Epic Measures, he is the author of Breaking and Entering and of Growing a Garden City, a book about local gardens and farms as community builders.

Ratings & Reviews

Ratings at a glance

3.8

Overall score based on 19 ratings.

What people think

Listeners find the book superb for gaining perspective on global health and consider it essential for anyone interested in the subject. Furthermore, the quality of the writing is well-regarded, and they value how the work measures health data. However, the narrative quality draws a mixed response from listeners.

Top reviews

Art

Picked this up because I’ve always been curious about how organizations actually decide where to send aid. Jeremy Smith does a stellar job of turning what could be a dry history of spreadsheets into a narrative that feels urgent and vital. The story of Chris Murray and his quest to calculate the Global Burden of Disease is mind-blowing when you realize how much guesswork was involved before he came along. It’s wild to think that many countries weren't even tracking basic birth and death data accurately until very recently. While some of the biographical details about Murray’s childhood in Niger go on a bit long, they provide necessary context for his relentless drive. I left this book with a much deeper appreciation for the big data that keeps our world functioning. If you care about social justice or medical ethics, this is mandatory reading.

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Ethan

This is the kind of book that makes you want to quit your job and go do something that actually matters for humanity. Smith managed to make a story about health metrics read like a high-stakes political thriller, which is no small feat given the subject matter. Seeing the transition from Murray being an outsider to gaining the support of people like Bill Gates was incredibly satisfying to follow. I found the account of the 2010 study particularly moving, as it finally brought a level of scientific rigor to global aid that had been missing for decades. Some might find the level of detail about the internal politics of the WHO a bit much, but I think it’s crucial for understanding why this work was so difficult. It’s a brilliant portrait of how grit and genius can intersect to save millions of lives through the power of data.

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Lars

Finally got around to reading this after hearing it compared to The Immortal Life of Henrietta Lacks, and it certainly lived up to the hype. Smith transforms the abstract concept of big data into a human story about the cost of ignorance and the power of evidence. It is shocking to realize that just a decade ago, the WHO’s estimates of deaths from different causes actually added up to more than the total number of people who died. Murray’s journey from a childhood pharmacy in Niger to the heights of global health policy is inspiring, even if his methods ruffled a lot of feathers along the way. The book quantifies health metrics in a way that feels accessible and urgent rather than academic or distant. If you’re at all interested in how we can improve equality of access to healthcare, you need to pick this up immediately.

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Laor

The chapter on Murray’s time in Niger really set the stage for his lifelong obsession with fixing a broken system. You can see how those early experiences with resource scarcity fueled his desire to ensure every dollar spent on health is backed by the best possible data. Smith captures the tenacity and grit required to take on established international organizations that were comfortable with the status quo. It’s an excellent read for anyone who enjoys seeing how disruptive thinking can lead to massive, positive changes on a global scale. In my experience, some readers might find the focus on numbers a bit overwhelming, but the human stakes are always kept front and center. I finished the book feeling incredibly impressed by the scale of what Murray and his team achieved. It’s a rare book that manages to be both intellectually stimulating and emotionally resonant.

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Orawan

As a data geek who works in a completely different field, I found the methodological struggles described here to be surprisingly relatable. Smith illustrates the massive resistance Murray faced from the WHO and other bureaucratic titans who were essentially protective of their own flawed metrics. The introduction of DALYs—disability-adjusted life years—is explained with enough clarity that even a layperson can grasp why it was such a revolutionary concept for public health policy. Truth is, the middle sections of the book get a little bogged down in the minutiae of different conferences and academic infighting. However, the payoff of seeing the Institute for Health Metrics and Evaluation finally take shape makes the slower chapters worth the effort. It’s a compelling look at how one person’s stubbornness can literally change the way the entire planet addresses human suffering.

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Pranee

Wow, what an eye-opener regarding the sheer invisibility of disease in the developing world before the late 20th century. Before reading this, I assumed that global health stats were always relatively accurate, but the reality of ghost populations with no death certificates is haunting. Smith balances the cold, hard numbers with the story of a man whose personality seems designed to break things in order to fix them. Murray isn't always likable, yet his obsession with accuracy is clearly what the world needed to move past political posturing in healthcare. The writing quality is top-notch, though I’ll admit the frequent jumps between statistical theory and biographical anecdotes occasionally broke my concentration. Still, it’s a powerful testament to the idea that you can't fix what you can't measure. Not gonna lie, I’ll never look at a health report the same way again.

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Sukit

Ever wonder why certain diseases get all the funding while others are ignored? Jeremy Smith provides the answer by following Dr. Chris Murray’s career as he attempts to quantify human suffering on a global scale. The book does a fantastic job of explaining DALYs and why they are a more compassionate way to measure health than just looking at mortality rates alone. While the narrative flow is generally strong, there are moments where the technical jargon becomes a bit dense for a casual reader. Look, the story quality is a bit hit-or-miss depending on whether you enjoy reading about bureaucratic struggles, but the overall perspective on world health is invaluable. It’s a solid read for anyone who wants to understand the intersection of medicine, economics, and international policy. I particularly liked the sections describing the logistical nightmares of gathering data in conflict zones.

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Frida

After hearing about the Global Burden of Disease study in a college course, I wanted to know more about the man behind the curtain. Smith delivers a well-researched biography that highlights both the genius and the controversy surrounding Chris Murray’s work. The writing is crisp and manages to keep the momentum going even when discussing the finer points of statistical weighting and data sets. Personally, I was most fascinated by the descriptions of the various technical challenges the team faced, such as rectifying inconsistent hospital records from around the world. My only minor gripe is that some of the personal anecdotes about Murray’s collaborators felt a bit like filler to pad out the page count. Despite that, the book offers an essential perspective on how we can use information as a tool for social justice and better governance.

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Gai

This book is certainly informative, but it suffers from a serious case of bloat that makes the reading experience feel like a bit of a slog. Smith has a knack for explaining complex health statistics, yet he repeats the same points about Murray’s intensity and the flaws of the WHO far too many times. I appreciate the massive scale of the Global Burden of Disease project, and I think Murray is a fascinating, if prickly, figure to center a narrative around. But did we really need over three hundred pages to explain that better data leads to better health outcomes? To be fair, the descriptions of Murray's family hospital in Niger were evocative and helped ground the technical aspects in human reality. It just felt like the core message was stretched thin to fit a book-length format when a long-form essay might have sufficed.

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Noo

Not what I expected at all, and frankly, I struggled to stay engaged past the halfway mark. While the underlying goal of the Global Burden of Disease project is noble, the book feels more like a hagiography of Chris Murray than a balanced look at global health. We get endless descriptions of his abrasive personality and his high salary, which started to grate on me after a while. I was hoping for more stories about the actual patients or the ground-level impact of these policies, but instead, it’s mostly math and institutional infighting. The writing is technically fine, but the repetitive nature of the chapters made the whole thing feel like an endurance test. Unless you are deeply invested in the history of epidemiology or public health administration, you might find this to be a bit of a dry and self-indulgent slog.

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Questions about this book

Jeremy N. Smith tells the story of Christopher Murray, a doctor who found that global health spending rested on unreliable data. United Nations life-expectancy estimates could differ by up to 15 years, and WHO disease departments inflated their own figures. Murray created the disability-adjusted life year, which counts both early deaths and years lived with illness, and used it in the Global Burden of Disease study to show where health loss really occurs.

A DALY combines two measures. The first counts years lost to early death against expected lifespan, so a five-year-old dying of pneumonia where people live to 80 loses 75 years. The second rates non-fatal illness from 0 to 1; hearing loss scores 0.2, or two healthy years lost for every ten lived. Combined, they yield a single number that works somewhat like a gross domestic product for a country’s health.

First published in 1993, it showed priorities badly out of line with need. Dental problems in Sub-Saharan Africa did as much harm as anemia, injuries in the Middle East caused four times the health loss of cancer, and neuropsychiatric conditions in Asia outweighed malnutrition. Injuries made up 12 percent of global health loss, yet WHO had a single person working on them.

At work, check whether data was ever verified, ask teams for their second-best solution, compare options on one shared unit and look for problems nobody owns. Keep watching after a success, since progress against hunger in some countries was followed by rising obesity. Personally, the book notes that lower back and neck pain lead disability worldwide, and suggests regular breaks, stretching, core exercise and expert advice on posture.

It suits readers interested in public health, medicine or policy who want the human story behind global health statistics, and managers or analysts who rely on metrics. Murray’s clashes with the World Health Organization, including a 2000 ranking that put the United States 37th, also make it a study of what happens when honest data embarrasses powerful institutions.

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