45 Million Deaths Go Unrecorded Each Year, Prompting Call to Invest in Vital Statistics Systems

At a panel during the World Health Summit, a group of public health experts laid out a problem that rarely makes headlines: a large share of the world's dead are never officially counted. Their estimate is that about 40 per cent of deaths worldwide go unregistered, a figure the campaign's headline translates to roughly 45 million deaths a year. More than 100 low- and middle-income countries, they said, do not have fully functioning systems for recording them.

The campaign comes from Data for Health, an initiative set up in 2015 and funded by Bloomberg Philanthropies and the Gates Foundation. It works with low- and middle-income countries to improve public health data and to put that data to use in policymaking. Its collaborators include the CDC Foundation, the Global Health Advocacy Incubator, the Johns Hopkins Bloomberg School of Public Health, Vital Strategies and the WHO.

The systems at issue go by the name CRVS, civil registration and vital statistics. In principle, CRVS is the continuous, universal, timely, inclusive and compulsory recording of births, deaths and causes of death. A fully functional system also records marriages, divorces and adoptions, which matter particularly for women and children. In most countries, registering a birth is what creates a person's legal identity.

The panelists argued that without good mortality data, policymakers struggle to see demographic trends or the causes of death and disease, and so find it hard to allocate resources well. Recording a death is not the same as understanding it: many registered deaths carry vague causes such as "stopped breathing" or "heart failure," or no cause at all. And where health data does exist, it is often underused, so it fails to guide policy and investment.

Betsy Fuller, who has worked on the public health team at Bloomberg Philanthropies, pointed to a mismatch. An estimated 70 per cent of deaths are caused by noncommunicable diseases, she said, yet only 30 per cent of government health funding in low- and middle-income countries goes toward them. She also made an economic case: for every $1 invested in strengthening data systems, countries see $32 in net benefits through better-targeted policies and stronger health systems. The campaign will showcase human-centred stories and technical successes from Bangladesh, the Philippines, Rwanda, Solomon Islands and Zambia.

Other speakers focused on how registration actually reaches people. Chloe Harvey, an associate statistician with the UN Economic and Social Commission for Asia and the Pacific, stressed taking registration to the village level and making it accessible to everyone, including people with disabilities. Internet connectivity remains a barrier in many areas, she noted, though efforts are underway to simplify registration platforms and make them friendlier to use.

Dr Hafiz Chowdhury of the CDC Foundation, who works with governments mostly in Asia and the Pacific, described Solomon Islands as a starting point. There was initially no organised data collection, he said, primary healthcare had not been established at the grassroots, and the usability of cause-of-death information was low. Introducing verbal autopsies and other strategies, he said, has improved the quality of death data.

Dr Alain Labrique, who directs the WHO's Department of Data, Digital Health, Analytics, and AI, called CRVS a foundation of health systems and said mortality surveillance is often not prioritised in national health information systems. During the Covid-19 pandemic, he noted, only 73 of 194 WHO member states could produce weekly death counts, which exposed gaps in registration, incomplete cause-of-death certification, fragmented data systems and limited analytical capacity.

What to watch is whether the campaign's argument, backed by the $32-per-dollar claim, persuades funders and governments to commit money to registration systems.