Current position: Visiting Research Fellow at Duke University Population Research Institute and Duke Global Health Institute
Experience: Ten years of quantitative research experience using econometrics, demographic methods, and GIS on pooled surveys and demographic data. Over 30 peer-reviewed articles in medical, public health, and demography journals since 2019.
Skills: Expert user of Stata. Experienced user of JavaScript (D3), Python, R, and Excel. Excellent written and verbal communication skills. I emphasize readability and accessibility to make my research assessable and applicable across disciplines and by decision-makers. I have participated in many successful interdisciplinary collaborations, locally and abroad.
Research interests: I study life expectancy, child health, living standards, and social determinants. Life-course perspectives and the human development framework motivate my research: we advance wellbeing by enhancing the capabilities of individuals which are, in turn, strengthened through promoting opportunities and limiting adversity. This view is inspired by the work of Isaiah Berlin, James Heckman, and Amartya Sen.
Global health 2050: the road to halving premature death by mid-century.
By Jamison DT, Summers LH, Chang AY, Karlsson O, Mao W, Norheim OF, Ogbuoji O, Schäferhoff M, Watkins D, Adeyi O, Alleyne G, Alwan A, Anand S, Nigatu Belachew R, Berkley S, Bertozzi S, Bolongaita S, Bundy D, …, & Yamey G
in The Lancet, 2024.
Halving premature death and improving the quality of life at all ages.
By Norheim OF, Chang AY, Bolongaita S, Barraza-Lloréns L, Fawole A, Gebremedhin LD, González Pier E, Jha P, Johnson E, Karlsson O, Kiros, M, Lewington S, Mao W, Ogbuoji O, Pate M, Sargent J, Tang X, Watkins D, Yamey G, Yip W, Jamison D & Peto R
in The Lancet, 2024.
Data Dashboard for the Lancet Commission on Investing in Health
I created (using JavaScript D3) and host an interactive dashboard displaying visualizations of key metrics, trends, and projections for the Lancet Commission on Investing in Health. This allows commissioners to explore data layers and generate displays as needed.
• Priority health conditions and life expectancy disparities
Authors
Omar Karlsson, Angela Y Chang, Ole Frithjof Norheim, Wenhui Mao, Sarah Bolongaita, Dean T Jamison
Abstract
Identifying conditions behind health disparities can guide policy, planning, and financing to battle the most urgent health problems. This study examined the impact of 145 causes of death on life expectancy disparities, highlighting the impact of two sets of “priority conditions”—eight infectious and maternal and child health conditions (“I-8”) and seven noncommunicable diseases and injuries (“NCD-7”)—across 184 countries and nine geographic regions, 2000–2021. Western Europe and Canada (the “North Atlantic”) were used as a benchmark for life expectancy achievable with advanced health care and living standards. Life expectancy gaps were decomposed by cause of death using Pollard’s decomposition on the Global Health Estimates from the World Health Organization. The priority conditions accounted for over 70% of the life expectancy gap compared to the North Atlantic in most regions and countries. Outside sub-Saharan Africa, the NCD-7 accounted for the largest share (eg, 82% in China and 49% in India). Only a few conditions not considered priority conditions had any substantial impact, and only in specific contexts. However, COVID-19 increased disparities. The varying impact of specific priority conditions can help focus health policy and guide interventions to reduce risk factors and treat conditions.
First published: 2024-01-01 Version date: 2024-11-11
• Probability of death before age 70: progress as years behind or ahead of the global average trend
Authors
Omar Karlsson, Dean T Jamison, Gavin Yamey, Sarah Bolongaita, Wenhui Mao, Angela Y Chang, Ole Frithjof Norheim, Osondu Ogbuoji, Stéphane Verguet
Abstract
Advances in health technology and living standards have reduced mortality worldwide but geographic disparities remain. This study examined uneven decline in probability of premature death (PPD)—before age 70 years—across regions, benchmarking progress as years behind or ahead of 1) global average PPD and 2) expected PPD given level of economic development, and 3) years behind PPD in the best performing country each year—the frontier. Global PPD fell from 67% to 32% 1950–2019. Sub-Saharan Africa, Central Asia, and India were behind the global PPD, both in 2000 and 2019. Sub-Saharan Africa’s PPD in 2019 was 52%, corresponding to the 1975 global PPD, suggesting that sub-Saharan Africa had a combination of health-enhancing technologies and living standards observed for the world average 44 years earlier. Sub-Saharan Africa was 100 years behind the frontier PPD, suggesting its 2019 PPD was already achievable in 1919 among those with access to the best available health-enhancing technology and living standards. India converged somewhat towards the global PPD, being 20 years behind in 2000 and 13 years behind in 2019. The North Atlantic was the furthest ahead, 44 years, achieving the 2019 global PPD in 1975. Given GDP, in 2019, the United States had a PPD expected in 1974, which suggests that per capita GDP reflected health-enhancing technologies and living standards to the same extent as in the average country 45 years earlier. International cooperation should ensure that technological and medical advancements lead to universal health benefits that are rapidly and fairly disseminated.
First published: 2024-01-01 Version date: 2024-11-11
Projects
• Lancet Commission on Investing in Health
Global health 2050: the path to halving premature death by mid-century
The third report of the Lancet Commission on Investing in Health (CIH) emphasizes that by 2050, all countries can halve the probability of premature death—defined as dying before the age 70 years—through targeted investments in health systems and interventions. This goal, referred to as "50 by 50," is both ambitious and achievable, demonstrated by impressive mortality declines in countries as diverse as Bangladesh, Ethiopia, Iran, Türkiye, Norway, and South Korea.
The report identifies 15 priority health conditions: eight infectious diseases and maternal and child conditions and seven non-communicable diseases and injuries, such as cardiovascular disease, diabetes, and tobacco-related cancers. In the countries with the highest mortality rates, infectious diseases and maternal and child health need to be addressed. All countries need to combat non-communicable diseases and injuries.
The report stresses the importance of strengthening health systems, particularly primary care and first-level hospitals, to manage the 15 priority conditions, by packaging health interventions into 19 modules, such as childhood immunization and cardiovascular disease prevention and treatment, which will help countries tailor their health investments to their specific needs.
Achieving the 50 by 50 goal also requires systemic changes in how countries allocate their health budgets. Many countries fail to direct sufficient resources toward priority interventions. Governments need to redirect budgets toward essential drugs, vaccines, diagnostics, and other commodities needed to reduce mortality from the 15 priority conditions. Procurement systems should be centralized and scaled to ensure that these health products are always available. Tobacco control is highlighted as a critical area, with the report recommending high excise taxes on tobacco and other policies to curb tobacco-related deaths and (initially) raise important revenue.
In addition to national reforms, the report calls for renewed commitments from the international development community. Development assistance should primarily provide financial and technical support to countries with limited resources, to help develop their health systems. It should also finance global public goods, such as combating antimicrobial resistance and preparing for future pandemics. The report stresses that significant advances in health technology—such as vaccines for malaria and tuberculosis—are on the horizon, and scaling up investments in these and other innovations will be crucial to achieving the 50 by 50 goal.
Jamison DT, Summers LH, Chang AY, Karlsson O, Mao W, Norheim OF, Ogbuoji O, Schäferhoff M, Watkins D, Adeyi O, Alleyne G, Alwan A, Anand S, Nigatu Belachew R, Berkley S, Bertozzi S, Bolongaita S, Bundy D, … & Yamey G (2024). Global health 2050: the road to halving premature death by mid-century.The Lancet, 404(10462), 1561-1614.
Norheim OF, Chang AY, Bolongaita S, Barraza-Lloréns L, Fawole A, Gebremedhin LD, González Pier E, Jha P, Johnson E, Karlsson O, Kiros, M, Lewington S, Mao W, Ogbuoji O, Pate M, Sargent J, Tang X, Watkins D, Yamey G, Yip W, Jamison D & Peto R (2024). Halving premature death and improving the quality of life at all ages.The Lancet.
Improving nutrition and survival for the youngest and most vulnerable children
For this project, I led four scientific studies on the age distribution of important child health outcomes. These studies resulted in four journal publications and a workshop with UNICEF staff.
The first two years after birth are a critical period for growth and development, when malnutrition and infections have the most detrimental impact on child health, as well as human development more broadly. During the first two years, children's bodies and brains are developing rapidly, and they are more susceptible to stunting (low height-for-age) and wasting (low weight-for-height), which significantly increases their risk of death. Malnutrition during this period weakens the immune system, making children more prone to infections, which in turn can exacerbate undernutrition.
The project demonstrated that most child deaths and malnutrition cases are concentrated in children under two years of age. This suggests that prioritizing nutrition programs for this age group could have the greatest impact on reducing child mortality and improving health outcomes. However, the coverage of essential nutrition interventions remains far from complete and highly inequitable, with children from poorer households or rural areas often deprived of the nutrition and care they need. This calls for better strategies to reach the most vulnerable children through well-resourced nutrition programs.
Various measures of socioeconomic status exist, such as education, occupation, and income, which reflect different underlying attributes that vary in the ways and degree to which they translate into health. In low- and middle-income countries that lack reliable income data, socioeconomic status is commonly measured by wealth indices, constructed from data on ownership of assets (refrigerator, TV, car, etc) and amenities (electricity, toilet, water, etc). Many of these assets and amenities appear to merely reflect aspects of socioeconomic status (or living standards) without direct links to child health. However, my colleagues and I identified assets related to food preparation and storage as well as water and sanitation, as potential direct determinants of child health.
To further establish linkages, I started a project funded by the Swedish Research Council, to study whether and when household technology can improve nutrition, reduce infections, and reduce child labor, thereby improving child health and education in low- and middle-income countries. For example, refrigerators may improve nutrition by increasing the consumption of protein-rich perishable foods and reduce sickness due to food contamination from improper food storage. Electricity, appliances, and piped water can also reduce the burden from household work, allowing parents to augment incomes from other work, improve the quality of household work (eg, hygiene), and increase direct supervision of children, as well as reducing the need for child labor, enabling children—especially girls—to attend school.
This project advanced understanding of whether household technology can improve child health and education in low- and middle-income countries. A large increase in electricity access and appliance ownership was found. At the population level, both increases in electricity access and refrigerator ownership were suggested to be linked to improved child health and nutrition. Further, by analyzing an extensive data set from 66 countries, one study established that children in households with refrigerators exhibited notable improvements in physical growth, a key indicator of nutrition and infections. Although the effect size was modest, it is significant enough to suggest that refrigerator ownership can play a role in reducing undernutrition and infections by enabling increased consumption and safer storage of perishable foods. Further, another study from the project found tentative evidence that household electricity access positively affects child growth, which appears to be mediated by appliance ownership to an extent.
Another paper resulting from this project unveiled a strong association between washing machine ownership and school attendance among girls and not boys, but only in specific contexts. This underscores the importance of contextual factors in assessing the impact of household technology on educational outcomes. Similarly, another study found that time spent on household work is negatively associated with girls' school attendance in most countries, which further explained a substantial part of the female disadvantage in school attendance. However, the relationship of appliance ownership with household work and school attendance was overall unclear and highly context dependent.
Evidence from this project highlight the potential of refrigerators to improve child nutrition and reduce exposure to infections, as well as time-saving appliances to improve girls' school attendance. These findings can be leveraged to advocate for the financing of trials on the effects of appliance ownership on child health and schooling (eg, through provision or subsidization) across low- and middle-income countries, for gathering further evidence.
• Advanced Insights in Anthropometric Health Metrics
In this project I led several studies on height (and co-authored others), investigating what underlies this common measure of health. For example, physical growth, a common measure of child health and development, reflects different processes (eg, diet, infections, and parental height) that may vary in the extent to which they reflect health. My colleagues and I find that at the population level, the prevalence of child growth deficit signals health considerably better after factoring out the influence of maternal height (which is determined by her childhood exposures and genetics and is the strongest observable determinant of child growth). Further, maternal height appears to be linked directly with neonatal mortality while the link between maternal height and mortality later in childhood appears to be related to material living standards and unobserved father characteristics, suggesting that pregnancy and birth related factors are important underlying mechanisms.
CV (pdf)