Nursing and Health Policy Perspectives


Lies, dammed lies and statistics

Mark Twain attributed the often-quoted saying ‘there are lies, dammed lies and statistics’ to Benjamin Disraeli, a former British Prime Minister. At the heart of the saying is the belief that statistics can be used to bolster weak arguments. I would like to highlight that even when the statistics look good and the evidence is sound, statistics can hide a multitude of problems.

UNICEF and the World Health Organization recently published a report titled Progress on drinking water and sanitation: 2012 update. The report discusses progress on global water trends from 1990 to 2010 and proudly announces that over two billion people gained access to improved water sources during the last two decades. Indeed the authors go on to state that only an estimated 11 percent of the world's population still use unimproved sources. Furthermore by 2015 the Millennium Development Goal (MDG) on access to drinking water will be met as a result of a further 3% improvement.

It is only when you delve into the substance of the report or read the forward by UN Secretary-General Ban Ki Moon that you realize that we are still some way from reaching a place that many of us take for granted – effective sanitation and safe drinking water. To put it bluntly, 780 million people still lack access to improved water.

As nurses, we know that effective sanitation and safe drinking water mean the difference between life and death. This is particularly the case for the most vulnerable in our societies such as the young, the elderly, the poorly nourished and those without shelter or with pre-existing conditions.

A quick glance at the statistics may look good. After all, the clear and well-ordered graph proclaims that the MDG drinking water target has been met. On more detailed inspection, the trend shows a steady 3% improvement every five years. However, as you might suspect, not all regions of the world are the same. Even within countries variations such as urban to rural and high to low-income families can occur. If you read far enough, you do discover that the MDG sanitation target will not be met. A stunning 2.5 billion people in 2010 were without improved sanitations.

I am not suggesting that the report does not provide all the facts or a balanced treatment of progress. Indeed it is quite specific about the countries that are making better than regional average progress, and also names those that are not on track. One third of the report includes detailed country-based tables. However, we do need to be far more careful about the high level messages that we communicate when, in our eagerness to aggregate data and find interesting ways of presenting the facts, we lose the real meaning.

In 2003 ICN collaborated with Procter and Gamble and the U.S. Centers for Disease Control and Prevention to educate the public on the importance of safe drinking water. At that time, a decade ago, we noted that those people who lack access to safe water receive health care overwhelmingly from nurses. Furthermore, 80% of the diseases that kill children and undermine the health of families worldwide are caused – not by shortages of food and medicine – but by drinking water. Whilst the numbers in need have been reduced, the basic facts remain the same: nurses have a major role to play in tackling the biggest threats facing humanity.

Nurses need to be aware of the facts. While we need to keep up-to-date with progress reports, we need to look deeper than the high level summaries. We need to advocate for those who are not simply statistics but are the people for whom public health interventions and access to basic services do make the ultimate difference – life or death.