Better records will save lives – a new approach to helping the world’s poor
Worldwide 230 million people are invisible, as their births have not ever been recorded. Worse than that, this number is just those who are under 5 years old and almost all are in the poorest countries of Africa and Asia. The total figure of “lost souls” is probably over a billion. Conventional methods of recording people’s birth are failing – a new approach using the internet and big data has the potential to sweep these people into official existence with all the advantages that this will bring: much better coverage in vaccination programmes and more effective health policies. For millions of children this could also protect them from being trafficked, forced into manual labour and into child marriage.
In Europe and America we take registration of births and deaths for granted using systems developed over hundreds of years. Birth certificates are virtually universal, being passports to protection: without this paperwork a person is severely disadvantaged. However, for reasons of culture and history the fastest-growing regions have not got effective registration systems. War-torn countries such as Somalia and Liberia are among the worst with fewer than 4% of their births recorded. The problem is not new – the Romans forced people to assemble for the purposes of recording and, as the Bible describes, Mary and Joseph trekked to Bethlehem where Jesus was born to register for a population census. Modern day efforts to increase the registration of new births have struggled to make much impact, especially in rural areas and in regions where governments are weak. Ignorance, expense, religious opposition, and lack of infrastructure have all contributed to the problem.
This failure to record people’s existence costs lives and brings great suffering. Eradication of disease through vaccination requires “herd immunity” and that needs 90-95% coverage, especially for highly transmissible diseases. In order to target individuals, authorities need a record of the age of individuals, where they live and their age and gender. So knowing about the existence of individuals can protect them individually and can also make health programmes effective. Enclaves of unregistered people allow outbreaks of fatal diseases amongst unvaccinated individuals. This has been one of the major set backs against the eradication of Polio with small outbreak and resurgences of the disease in unvaccinated regions.
Effective health policy also requires knowing about deaths as well as births – without this epidemics will be spotted too late, patterns will go unnoticed, and supplies of drugs will be inadequate. In the Ebola epidemic of 2014-16 this was a major problem as the disease was partially spread by people moving back home from diseased areas and infecting their families. With better records these people could have been identified and isolated to prevent the spread of the disease. The impact of health policy cannot be determined without data on deaths by cause, age, gender and location. Children of poorer and uneducated parents are particularly likely to be unregistered, which matters because they are also most vulnerable to illness and exploitation.
Traditional approaches of exhortation and filling in of paper forms have not significantly increased registrations, even when President Obama put the full weight of the State department and US agencies into promoting birth registration systems, and President Trump may do less. At least policymakers and aid agencies have been able to obtain enough data through samples and surveys to work out some general information. This has been no substitute for proper coverage of the whole population.
What is needed is to harness the power of phone-technology and big data to create new and electronic registers of populations. Edward Snowden claimed that technology allows governments to make a record of every phone conversation and text message that is sent, adding, “we have sensors in our pockets that track us everywhere we go”. Why shouldn’t we harness this data to save lives and improve health equality.
The power of technology could be used to make it much easier for parents to register births by phone. Today almost every community in the world has access to technology and there are over 2 billion smart phones and more mobile phones than people. Alibaba of China launched a bank in 2015 called MYBank which uses camera technology to identify customers. This technology could be exported into an identification system for birth registration. Because different technology has different hardware a simplistic certificate could be made or a more comprehensive one depending on the technology at hand. Some would use fingerprints and cameras (from smartphones), others would be basic using an app to fill in details or texts. A quick, universal and free system would allow millions more birth registrations as it would remove some of the barriers faced by traditional approaches such as cost, time, effort and isolation. This simple birth certificate using as many metrics as possible could be used to roll out immunisation programmes to remote corners of the world to eradicate diseases such as Polio.
Phone registrations would help, but not solve, the problem so in addition governments or agencies could create a “shadow” register entry for all the births and deaths which they can infer from big data sources – phone calls, messages, movements of phone holders. This would not require additional data collection as security agencies such as the NSA and GCHQ already collect this information. In effect the electronic fingerprint would be reverse-engineered to construct a profile of the owner of that fingerprint. This would be used to give governments and NGOs a better prediction of demographics and might one day include health information and become more comprehensive as technology becomes more universal around the world.
This twin-barrelled approach could create very full record of populations and allow much more effective delivery of healthcare and better public health policy. Even if this system captured a fraction of those unregistered the health implications to herd immunity could be very significant. In principle millions of lives could be saved and improved through harnessing big data to record people’s existence.