Metric partnerships: global burden of disease estimates within the World Bank, the World Health Organisation and the Institute for Health Metrics and Evaluation

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.

<p>The Gap Between Global Tuberculosis Incidence and the First Milestone of the WHO End Tuberculosis Strategy: An Analysis Based on the Global Burden of Disease 2017 Database</p>

“…In this study, we used the data from the GBD database produced by the IHME, which provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. 16 The global TB incidence rates are mainly estimated by WHO and IHME. WHO uses four main methods to estimate the TB incidence: (1) results from TB prevalence surveys, (2) notifications in high-income countries adjusted by a standard factor, (3) results from inventory/capture-recapture studies, and (4) case notification data combined with expert opinions about case detection gaps.…”

Back to the future? Health and the World Bank’s human capital index

“…It contributes to the bank’s aspirations to measure not just economic growth but also global economic wealth 12. It spurs further data gathering efforts around health as it relies on country data rather than data estimates 21. Moreover, human capital, which started as a concept for analysing labour, enables the bank to make sense of ongoing changes in the global job market 22.…”

“…Are employers responsible for employee health, because it may boost company profits? Or should governments pay for healthcare because this may increase their stock of national wealth?312 In recent years, the World Bank has argued the last, holding that national wealth can enable macroeconomic growth 1721. Yet, historically, the idea of human capital has been used to render individual workers responsible for their health, and it has extended this responsibility from on-the-job behaviour into their private lives 82627.…”

Human capital, risk and the World Bank’s reintermediation in global development

“…Commentators also question the assumption that these tests are an accurate proxy for learning (liu 2018). Others have posed the question of why an additional index was necessary alongside those already produced by the Institute for Health Metrics and Evaluation (Tichenor and Sridhar 2019) and United Nations Development Programme (Ministry of Finance of India 2018). Indeed, the World Economic Forum has for several years produced its own Global Human Capital Index (World Economic Forum 2017).…”