The world’s health care systems are as challenging as they are diverse. Data are at the center of measuring that diversity and those challenges.
One person is renowned for looking beyond traditional public health, a leader who believes the truth must be told in a powerful way about the health and well-being of the world’s 7 billion people. That leader is Richard Horton, the editor-in-chief of the international medical journal The Lancet.
Dr. Horton’s use of data to promote health has been a hallmark of his career since he graduated from the University of Birmingham’s School of Medicine in 1986. He joined the journal’s staff in 1990 and five years later became editor-in-chief. He leads the flagship weekly Lancet publication and its 15 other medical journals, overseeing an integrated editorial mission for equity, the right to health, and social justice.
“The idea behind what we do is really going back to the age of the Enlightenment. The idea that the purpose of creating knowledge isn’t just to publish it, or to put it on a website, or be in a journal, but actually that knowledge needs to do some work,” said Dr. Horton. “Knowledge published in order to accelerate social progress.”
There is virtually no major policy debate or new health policy adopted over the past quarter century that has not first been championed in the pages of The Lancet, which was first published in 1823.
“At The Lancet, what we’ve tried to do is to use the science we publish in two ways. First, as a means for advocacy to try and draw attention to some of the most pressing health issues in the world and put them into the agendas of presidents and prime ministers,” said Dr. Horton. “Also, we want to hold those with political power accountable for their promises and commitments. We have leaders around the world who say one thing and do another. Science is an incredibly powerful tool to hold those political leaders to their promises and commitments.”
An issue on which Dr. Horton was an early champion is the health effects of climate change. A commission he convened more than a decade ago concluded, “When climate change is framed as a health issue, rather than purely as an environmental, economic, or technological challenge, it becomes clear that we are facing a predicament that strikes at the heart of humanity.”
“We spent 18 months with no money, just talking with lawyers, economists, geographers, philosophers, mathematicians. And we came up with our first commission. Which had at the time a very controversial title: The Greatest Global Threat of the 21st Century,” said Dr. Anthony Costello, a Lancet Countdown on health and climate change collaborator. “It attracted a lot of media, but you had certain people, quite senior people in the scientific community say, oh, you can’t justify that. It’s not true. And I don’t think anyone would do that today. So we were kind of 12, 13 years ahead of the time. And all of the things that we predicted have not only come true, but they’ve come through rather quicker than we expected. Richard had the foresight to see this. And ever since then he has tried to tie his commissions to policy actions.”
That foresight is reflected in Dr. Horton’s use of data to promote health – overseeing an integrated editorial mission for equity, the right to health, and social justice.
“For several decades now, Richard has truly been the megaphone for global health, for the use of data science, of big data, of smaller data, and evidence as the underpinning of policy. And that, combined with an overriding concern also for human rights, and for overcoming inequities,” said Dr. Peter Piot, Director of London School of Hygiene & Tropical Medicine (LSTHM).
“Richard Horton has quite an impact on global health research and advocacy, because he combines science with passion for justice and with this amazing ability of traveling here and there to get to know people and then pack groups together to produce something related to global health, but the core of which is justice. I think this is really, really important.” said Prof. Rita Giacaman, Director of the Institute of Community and Public Health at Birzeit University, located in the West Bank. “Richard is the kind of person who will not give up on issues if he understands that there’s a cause somewhere.”
Dr. Horton has been a tireless advocate for putting maternal and child health at the top of the global agenda. He admonished the international community to recognize the role of women as full and equal citizens – through education and economic, social, and political empowerment.
“Richard’s work that’s been published in The Lancet on maternal health has highlighted the fact that it’s really very complex. There’s no magic bullet in all of this. But Richard’s done much more than that,” said Dr. McKee. “He’s mobilized political attention on this issue, at a global level, bringing together some people that you wouldn’t normally expect to be sitting in the same room and to be addressing some of these issues. His ability to convene people, to bring people with quite different perspectives together, has been remarkable.”
“Our commitment to maternal and child health happened for three reasons,” said Dr. Horton. “First, a wonderful man called Eldryd Parry took me to Africa and opened my eyes to a world that I hadn’t seen before. Second, somebody called Jennifer Bryce showed me how we could use science as a means for advocacy, and to draw attention to a massively neglected issue in global health. Third, the birth of my daughter, Isobel, in the year 2000 showed me and gave me an insight into how vulnerable, how precious every single human life is, and how we needed to fight to protect those lives.”
Dr. Horton’s decision in 1996 to publish the Global Burden of Disease demonstrates his uncompromising commitment to promote the best science for better lives. That publication launched an international discussion and debate on health data that continues to this day.
“I joined The Lancet as an assistant editor in 1990. I first learned of the Global Burden of Disease from the World Development Report that was published in 1993,” said Dr. Horton. “I was immensely excited by what we now talk about as the GBD, because the GBD is nothing less than a human genome project for human health. It’s giving us the map, the spine, the skeleton to think about some of the most important predicaments that our species faces in this world. To me it informs everything that we do here at The Lancet.”
“By publishing the papers from The Global Burden of Disease, he’s addressed what one of the leaders of that project, Alan Lopez, once described as, ‘The scandal of ignorance,’” said Dr. Martin McKee, Professor at LSTHM. “The situation in which people are born, they live, they die, without that ever being recorded,” because some countries have no vital registration system to document these events. “Now those people are recognized. They have a voice. Their experiences can then feed into health policy.”
Dr. Horton is also one of the most committed and articulate advocates for population health in the world, relentlessly taking on issues beyond the traditional scope of “public health,” including the accountability of the medical profession, as well as human rights.
One of those issues beyond “traditional public health” has been “planetary health,” a discipline Dr. Horton argues transcends incorporating public health and the environment and examines “the unity of life and the forces that shape those lives,” according to an editorial published last year.
“For me, planetary health is about re-politicizing everything we do in science and human health. It’s not about publishing papers. It’s not simply about publishing a journal. What it’s about is taking that work and making sure that it has a political impact,” said Dr. Horton. “Unfortunately, over the past 200 years, we’ve de-politicized the work that we do. Science has become ever more enclosed, ever more about talking to itself within itself. We want to change the way science interacts with society: using science to bring out the very best of us in thinking about the idealism we can bring to improve the lives of the most vulnerable.”
His sponsorship of studies and myriad commissions on the vital issues of our day cannot be overstated.
“The Lancet has published a series of commissions on HIV/AIDS, and what we’ve seen there is that Richard has reminded us that the end of AIDS is not yet in sight. He’s reminded us that after the peak in funding there’s a danger that the world loses interest, and he’s tried to keep the attention of the world on HIV and AIDS. He’s highlighted the importance of linking in with global health. HIV/AIDS should not be in a silo. It needs to work with the rest of the global health community,” said Dr. McKee. “But perhaps more than anything else, and one area which I’ve been privileged to work with The Lancet on, has been giving a voice to some of the vulnerable, marginalized populations – sex workers, and in particular prisoners, who are at particular risk of both getting HIV and also having their needs overlooked.”
“For a period of now close to three decades, he has championed the less fortunate and given those individuals, those countries, important policies, a voice. He’s incredibly bright, witty, and captivating. That’s a rare combination in any individual, and even a rarer combination in a journal editor,” said Howard Bauchner, Editor-in-Chief of the Journal of the American Medical Association (JAMA). “But he provokes, he irritates, and most importantly, I think, he makes individuals think and reflect about their own life and the world in which we live. That’s a remarkable achievement for a single individual.”
Dr. Horton gave the opening address at the World Health Assembly in May 2019 in Geneva where he was also honored with the 2019 Global Health Leader Award from Dr. Tedros Adhanom Ghebreyesus, the World Health Organization Director-General, for his tireless, wide-ranging, and innovative contribution to global health.
“He has been outspoken in his support of women’s health and rights, and his focus on maternal and infant mortality has been very important. I will always admire Richard’s insight, his intellect, and his passion for global health,” said Dr. Tedros.
Dr. Horton personifies The Lancet’s manifesto, that improving lives is the only end goal and that research is only relevant when it has an impact on human lives.
“My job as an editor is to work with my team to make sure that the journal that we inherited, its values, its ideas, its vision about the future for human health grows and gets stronger during our term. So that when we hand the journal over to the next generation of editors, it will be stronger. It will be able to continue with its vision even more successfully, I hope, than we’re able to do now,” said Dr. Horton.
“What inspires me are the people I meet. The scientists who are working incredibly hard to solve some of the most difficult problems in human health. The health practitioners who are working on the front end of delivering health care in some extremely difficult settings. Health policymakers who are trying to link the evidence with practice in order to create social change. It’s the people who make the difference for us,” said Dr. Horton.
David and Barbara Roux established the Roux Prize in 2013 to award innovation in the application of Global Burden of Disease (GBD) research. The prize recognizes the person who has used burden of disease data in bold ways to make people healthier.
Mr. Roux is a founding board member of IHME and, over the past decade, he championed IHME’s most ambitious project, the updating of the Global Burden of Disease. And he encouraged IHME, as the coordinating center for researchers around the world, to find ways to make the information more useful, so that it would actually have an impact on the ground.
Since the first GBD publication in 1993, GBD data have been used in a wide variety of ways to inform better policymaking at the local and international levels. Mr. Roux wanted to reward that kind of evidence-based innovation and to encourage even bolder attempts to improve population health through better measurement of disease burden.
The Global Burden of Disease (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors. In 1993, the original GBD study was funded by the World Bank and featured in its landmark World Development Report 1993: Investing in Health. Co-authored by Dr. Christopher Murray, now Director of IHME, this study included estimates for 107 diseases and injuries and 483 nonfatal health consequences in eight regions and five age groups.
Now an ongoing enterprise with annual updates, GBD is an international, collaborative effort with more than 3,600 collaborators from 146 countries and territories. The Institute for Health Metrics and Evaluation coordinates the study. The GBD 2017 study was published in November 2018 and includes more than 38 billion estimates of 359 diseases and injuries and 84 risk factors in 195 countries and territories. For more information about GBD, visit IHME’s website.