Abstract
The global burden of disease study-which has been affiliated with the World Bank and the World Health Organisation (WHO) and is now housed in the Institute for Health Metrics and Evaluation (IHME)-has become a very important tool to global health governance since it was first published in the 1993 World Development Report. In this article, based on literature review of primary and secondary sources as well as field notes from public events, we present first a summary of the origins and evolution of the GBD over the past 25 years. We then analyse two illustrative examples of estimates and the ways in which they gloss over the assumptions and knowledge gaps in their production, highlighting the importance of historical context by country and by disease in the quality of health data. Finally, we delve into the question of the end users of these estimates and the tensions that lie at the heart of producing estimates of local, national, and global burdens of disease. These tensions bring to light the different institutional ethics and motivations of IHME, WHO, and the World Bank, and they draw our attention to the importance of estimate methodologies in representing problems and their solutions in global health. With the rise in the investment in and the power of global health estimates, the question of representing global health problems becomes ever more entangled in decisions made about how to adjust reported numbers and to evolving statistical science. Ultimately, more work needs to be done to create evidence that is relevant and meaningful on country and district levels, which means shifting resources and support for quantitative-and qualitative-data production, analysis, and synthesis to countries that are the targeted beneficiaries of such global health estimates.
Highlights
At the 71st World Health Assembly in Geneva in May 2018, a political alliance was struck between Chris Murray, Director of the Institute for Health Metrics and Evaluation (IHME), and Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO)
Since IHME started putting out the results of its Global Burden of Disease (GBD) study in 20122,3, there have been controversial differences between IHME’s estimates of disease burden and those of WHO4,5, around malaria[6], tuberculosis[7], causes of child death[8,9], and maternal mortality[10]
The explicit agreement by IHME and WHO to produce a single GBD study—“a series of capstone papers summarizing high-level findings would be published in The Lancet11” before being used in official WHO documents—raises important questions about what an alliance of global burden of disease estimates means for global health governance and health policy in the Global South
Summary
Any reports and responses or comments on the article can be found at the end of the article. This article is included in the The World Bank in Global Public Health collection
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