Thinking back to five years ago, during the height of the COVID-19 pandemic, I was living around the corner from the Brooklyn Hospital Center. Each day, I’d take a walk through the neighborhood, but those walks became hauntingly different as I started passing refrigerated trucks parked outside – temporary morgues, there to handle the overwhelming number of lives lost to the virus. This sight became a constant, sobering reminder of the scale of the loss just a few steps away from where I lived.

As the virus surged and deaths spiked, news reports and government communications started using the public health term to capture what was happening with those trucks: “excess mortality”. 

This measure reflects the increase in the number of deaths during a period of time compared to what would be normally expected and was often presented as graphs displaying large peaks in deaths. While the term itself can sound cold or even morbid, its purpose is to convey the full scale of a tragedy that individual case counts often fail to capture.

Unlike official COVID-19 death tallies, which only included those who tested positive and were formally diagnosed, excess mortality accounted for all deaths, including those who may have died from COVID-19 without being tested, as well as those who succumbed to other causes indirectly linked to the outbreak, such as overwhelmed health systems or delayed care. 

Clearer picture

By digging deeper into these data by age, location, race and ethnicity, public health decision-makers saw a clearer picture of the pandemic’s toll. They saw that nursing homes were especially hard hit, or that certain neighborhoods in New York were suffering from higher death rates. Using mortality data, policymakers could develop the most effective plans to target the spread of COVID-19 and save as many lives as possible. 

But the value of mortality data doesn’t end with COVID-19. If we’re serious about addressing the world’s most pressing health challenges, mortality data must remain a global priority. During the pandemic, excess mortality estimates exposed the staggering scale of loss—over 14 million excess deaths by the end of 2021, according to the WHO—laying bare the limits of health systems and the deep inequities between and within countries. 

Importantly, this figure wasn’t derived from official death counts alone. In many countries, especially those with limited reporting infrastructure, deaths weren’t recorded in real time or at all. 

As a result, these global estimates relied heavily on statistical modeling to fill the gaps left by weak or incomplete data. The most reliable and sustainable source of mortality data is a country’s civil registration and vital statistics (CRVS) system, which records life events like births and deaths.

 Yet despite its critical role, investments in CRVS systems remain fragmented, and political attention is waning. Without sustained commitment, we risk losing the very evidence needed to guide policy, target resources, and save lives.

Lessons from Peru, Shanghai and Colombia

Take Peru, for example. In 2018, the Ministry of Health published a groundbreaking national mortality report analyzing 30 years of data , exposing stark inequalities across socioeconomic and geographic groups. 

One critical finding—a high number of fatal lower respiratory infections among older adults—led to the launch of a nationwide pneumococcal vaccine campaign. Without these mortality data, the program might never have been implemented, leaving seniors at risk of a deadly but preventable disease.

Similarly, in Shanghai, officials became concerned about the rising number of e-bike collisions in 2017. By turning to mortality data, they discovered the alarming extent of the problem—road deaths and injuries among e-bike riders were on the rise, and only 11% of riders wore helmets. In response, the city passed a helmet law in 2021.

By the end of the year, local police reported that over 90% of riders were wearing helmets, a dramatic shift in behavior that is helping to save lives and make the roads safer for everyone.

These life-saving interventions would not have been possible without robust mortality data. Yet too often, ministries of health rely solely on data from those who passed away in health facilities. 

While useful, this approach misses a critical truth: in many parts of the world, a large share of deaths happen beyond the reach of the formal health system. In some low- and middle-income countries, 70% or more deaths occur outside of hospitals, often in rural or underserved areas, where they risk being uncounted, unregistered, and ultimately invisible. This gap is especially dangerous in countries with weak CRVS systems. 

In Colombia, over 90% of deaths are registered in the CRVS system but among the unregistered, most occur in rural, indigenous and poor communities. In 2021, the government launched an initiative to engage hard-to-reach tribal communities with varying cultural practices and languages in the Amazonas. 

Through this effort, the government is now able to provide a more complete picture of the population, including the number and causes of deaths, and can develop more inclusive health and social policies. Investments in mortality and CRVS systems are starting to show progress across the globe. In the Asia-Pacific region, more than 1 million additional deaths are recorded each year through improved systems. 

Data-driven interventions

As seen in Colombia, Peru, Shanghai and beyond, mortality data serve as a powerful compass, guiding life-saving interventions and exposing the true toll of public health crises. 

Yet despite its vital role, mortality data are not always easy to obtain.  Although it may seem like a simple measure, recognizing when someone has died and understanding why is a complex process that depends on strong systems and sustained investment. 

To build healthier futures for all, we must prioritize and invest in strengthening mortality and CRVS systems around the world. 

A robust CRVS system includes timely and universal registration of deaths, accurate certification of causes of death by trained professionals, digitized systems for timely collection and analysis of the data, and the integration of this information into national databases for analysis and policymaking. It also requires coordination across government agencies, legal frameworks that mandate registration, and public trust and accessibility, especially in marginalized communities. 

Without these building blocks in place, many deaths go uncounted, leaving gaps in the data that hinder effective health planning. As funding for alternate sources of mortality data are reduced or under threat, strengthening mortality data systems in the health and civil registration sector is a smart choice. This isn’t just an investment in infrastructure—it’s an investment in dignity, in visibility, and in making every life count.  

Farnaz Malik is a Senior Technical Advisor at Vital Strategies working under the Bloomberg Philanthropies Data for Health Initiative. She partners with country governments in Asia and sub-Saharan Africa using evidence-based policymaking to improve population health. Malik holds an MPH in Epidemiology from the University of Michigan School of Public Health and a BA in Integrative Biology from the University of California, Berkeley.

Image Credits: Vital Strategies, Vital Strategies.