Strengthening accountability of the global health metrics enterprise

• Published in: The Lancet (British edition) 2020-05, Vol.395 (10234), p.1452-1456
• Main Authors: Shiffman, Jeremy, Shawar, Yusra Ribhi
• Format: Article
• Language: English
• Subjects: Accountability; Automatic control; Benchmarking - methods; Betacoronavirus - isolation & purification; Coronavirus Infections - epidemiology; Coronavirus Infections - virology; Coronaviruses; COVID-19; Cultivation; Decision making; Global Burden of Disease - methods; Global health; Global Health - standards; Global Health - statistics & numerical data; Health problems; High income; Humans; Income; Information systems; Knowledge; Leadership; Low income areas; Low income groups; Pandemics; Pneumonia, Viral - epidemiology; Pneumonia, Viral - virology; Policy Making; Population; Poverty - economics; Poverty - legislation & jurisprudence; Quality Indicators, Health Care - ethics; Quality Indicators, Health Care - standards; SARS-CoV-2; Social Responsibility; Trends; United Nations - economics; United Nations - organization & administration; United States - epidemiology; United States Agency for International Development; World Health Organization - economics; World Health Organization - organization & administration
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(20)30416-5

The enterprise's proponents point to its emancipatory effects, arguing that global health metrics uncover health problems and bring greater objectivity and accountability to policy making.1–3 Critics challenge the enterprise's merits and are worried, among other concerns, that the enterprise transfers power from institutions in low-income countries to ones based in high-income countries, hampers the development of national health information systems, and privileges certain forms of knowledge over others.4–6 We contend that there are strong reasons to accept global health metrics as a public good. [...]the global health metrics enterprise deserves the same kind of critical scrutiny that its backers seek of the policy makers whose decisions they hope to shape. In the 2000s, tensions emerged between IHME and WHO over leadership in the global health metrics field.9 In 2018, however, the two organisations signed a memorandum of understanding to collaborate to produce a single set of GBD studies.10 IHME leaders and researchers specify several aims for GBD studies.1,11–13 By providing policymakers with up-to-date information on disease trends and drivers, they seek to help to improve population health through the facilitation of evidence-based decision making. The power of organisations in high-income countries might come less from direct control—such as the provision of financial and other resources—than through the cultivation of self-regulation: countries pursue these goals to avoid international shame.19,21,26 An uneven playing field If the playing field were level, there would be less reason to worry about the potentially adverse effects of the enterprise.