Neil's question is more interesting than simply asking, "What are the top 10 causes of death?" He is asking about the *marginal value of reliable health information*: for which major causes of death could better information, if it actually reached the people who need it and could act on it, plausibly prevent the most death or serious disability?
That suggests a useful distinction among several kinds of knowledge-translation gaps:
1. *Knowledge gap* — the relevant evidence does not yet exist or is uncertain.
2. *Access gap* — good evidence exists, but people cannot obtain it.
3. *Comprehension gap* — information exists but is not understandable to its intended users.
4. *Trust gap* — people receive information but do not trust it.
5. *Application gap* — people understand it but cannot translate it into action.
6. *System gap* — the individual may know what to do, but the health system cannot provide the necessary service, drug, diagnostic test, or follow-up.
7. *Continuity gap* — information reaches people at one point but is not sustained through diagnosis, treatment, and monitoring.
That last distinction is especially important for HIFA because *"information" can be thought of as a health intervention only when it can connect knowledge to an achievable action.*
A potentially powerful research question
I would sharpen Neil's proposal slightly:
*For each of the world's leading causes of death, what proportion of preventable mortality could plausibly be reduced through improved generation, translation, dissemination, accessibility, trustworthiness, and use of reliable health information — and where are the principal knowledge-translation bottlenecks?* [*see not below]
That makes the project considerably more than a literature review.
*Maynard*
*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*
*Maynard S. Clark*, MS (Management: Research Administration)---
*Maynard.Clark@GMail.com* <Maynard.Clark@GMail.com> *Google
HIFA profile: Maynard Clark works in global health and bioethics at the Harvard Medical School, Harvard School of Public Health, USA. Maynard.Clark AT GMail.com
[*Thanks Maynard, this is a really valuable contribution. I look forward to developing this further with you and others, and invite HIFA members to comment. I have added 'Preventable mortality and reliable healthcare information' to the subject line to indicate this new direction. Neil PW]