The IHME in the Shifting Landscape of Global Health Metrics
| DOI | http://doi.org/10.1111/1758-5899.12605 |
| Date | 01 January 2019 |
| Published date | 01 January 2019 |
| Author | Manjari Mahajan |
The IHME in the Shifting Landscape of Global
Health Metrics
Manjari Mahajan
New School University
Abstract
The rise of the Institute for Health Metrics and Evaluation (IHME) has augured profound changes in the landscape of global
health metrics. Primarily funded by the Bill and Melinda Gates Foundation, the IHME has offered donors a platform for assess-
ing many health-related Sustainable Development Goal (SDG) indicators and a toolkit to measure the progress of different
countries. The IHME’s increasing influence reveals the relative sidelining of international agencies and especially the World
Health Organization which has long been central to global health metrics production. This shift reflects a growing conflict
between the expertise and norms of national and intergovernmental statistical production on the one hand, and the distinct
epistemologies and logics of new non-state data actors. These transitions –from an international world of statistics to a more
plural, global realm of data –have acute implications for the politics and accountability of knowledge production related to
the SDGs and development writ large. Even as the SDGs embrace the rubric of ‘no one left behind’, the emerging data politics
might be eroding the ability of poorer states to know and act upon their development problems on their own terms.
In the world of development, as indeed in other realms,
measurement is never an innocent matter where as it were,
the facts speak for themselves. What is measured, who
finances and does the measuring, how data are collated,
interpreted, and disbursed, how they are harnessed to deci-
sion-making and program implementation, and how other
measures and ways of collecting information are displaced –
all these are contested matters because they are linked with
the specific orientation of institutions and policies, the out-
comes that they aspire to, and the forms of knowledge that
they privilege. In many ways, this was the simple and pro-
found insight that led Amartya Sen and Mahbub ul Haq to
transform the understanding of development and poverty
by the introduction of new measures as alternatives to GDP
per capita and which led in the 1980s to the transformative
HDI approach. This article details a significant shift in metrics
that has been taking place in the world of international
public health, and which has decisive implications for the
Sustainable Development Goals (SDGs).
Global goals processes such as the SDGs and the Millen-
nium Development Goals (MDGs) are, almost by design,
heavily reliant upon quantitative metrics. They are anchored
to measurable goals, targets, and indicators which are
understood to be central to evaluating progress and ensur-
ing accountability. Much social science commentary, in this
special issue and beyond, has highlighted how the emphasis
on quantitative metrics has narrowly conceptualized devel-
opment and erased complex social and political processes.
1
Other work, including under the label of ‘statactivism’, has
countered that statistics have been used more variably and
often have been effectively mobilized by social movements
to address contentious inequities around health, gender,
and poverty.
2
The emphasis of this article, however, is
somewhat different. It focuses less on the perils or merits of
quantification, and more on how the world of metrics for
development is itself changing from within. There are new
actors, new techniques, and new platforms of measurement
that animate the contemporary ecology of global health.
This shifting landscape of global health metrics has implica-
tions for the politics of knowledge production, which in turn
undergird inequalities in development that the SDGs aim to
address. In this, the article joins other work that takes global
health and development metrics not as self-evident facts
but rather as the object of inquiry, examining the institu-
tions and processes through which metrics are produced
and gain credibility.
3
The changes in what is measured and which metrics are
deployed, while underway in many sectors, are the most
starkly evident in the arena of global health. These shifts are
vividly illustrated in the rise of the Institute for Health Metrics
and Evaluation (IHME) at the University of Washington, Seat-
tle, USA. Primarily funded by the Bill and Melinda Gates Foun-
dation, the IHME and its signature product, the Global Burden
of Disease (GBD) study, have become enormously influential
in global health in a short period of time. The IHME is becom-
ing the default source for a range of different estimates for
global health, edging out older established actors that were
central to measurement and modeling health and disease.
This article specifically examines the rise of the IHME and its
increasing dominance in the arena of health metrics. While
the institute was not initially involved in the SDGs, the impor-
tance of the institute has only been heightened by the global
goals’exercise because it potentially satisfies the SDGs’insa-
tiable demand for measurement, audits, and forecasts.
The rise of the IHME challenges the long-standing central-
ity of international agencies such as the World Health
©2019 University of Durham and John Wiley & Sons, Ltd. Global Policy (2019) 10:Suppl.1 doi: 10.1111/1758-5899.12605
Global Policy Volume 10 . Supplement 1 . January 2019
110
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