Throughout the world, people are born, they live, get sick and die, but in many countries, there's no official record of their existence. This is especially true in poor countries. And there's no international agency that ensures that people are getting counted. Philip Setel calls that a '"candal of invisibility."
Setel is an epidemiologist from the University of North Carolina. He says this lack of information can have a profound effect on how governments plan health and social services for their citizens, and decide on how to allocate money. It can also affect foreign aid.
"We spend an awful lot of money on development assistance, fighting diseases like AIDS and malaria and tuberculosis around the world," he points out. "Without actually counting the numbers of people who are dying and figuring out that they're dying from (these diseases or from something else), we don't have a good way — or a really strong evidence-based way — of figuring out whether those big investments are having the desired impact."
In last week's issue of the British journal The Lancet, Setel and other authors call attention to this lack of hard data in many countries.
Setel says some places have made efforts to collect information on what's happening in their populations. He cites an example from Tanzania, where data showed that children getting treated for malaria at government clinics were still dying from the disease.
"And what that led to was a change in the use of the drugs that were being given to children to treat them for malaria," he says. "It also alerted the government to the fact that an awful lot of kids were dying of malaria, and they were never getting formal healthcare in the first place."
In response, he says, the government scaled up the distribution of insecticide-treated bed nets to prevent children from being bitten by the mosquitoes that carry the malaria parasite.
But Setel says only a handful of African nations have systems in place for counting events such as births, deaths and illness. He says this is more than a statistical problem; it's also a human rights issue.
Setel says if people aren't being registered, in essence, they don't exist. "You don't exist from the standpoint of the kinds of social protections that are available to you if you have your birth certificate," he says. "That birth certificate gives you a name and a nation, as the UN says. It protects you from exploitation as a child, it helps reunite you with your family in times of crisis."
Death certificates, he says, are also important, "because they help establish a family's rights to inherit property and land, which is often the only social safety net that they have in these developing countries."
Setel and the other Lancet authors are calling for establishment of a new international body to improve civil registration efforts.