From washington DC to washington state: The global burden of diseases data basis and the political economy of global health

Abstract

This chapter takes the origins, development and uses of the Global Burden of Disease database as lens to interrogate the political economy of global health, focusing on the intended logic of this massive accumulation and manipulation of epidemiological data, and the ways in which it informs the management of public health programs and activities. Following the GBD’s journey from its first embodiment as a World Bank tool in the early 1990s to its present day development at the Institute for Health Metrics and Evaluation helps understand how epidemiological data travel to become actionable data, revealing the complex interactions between data gathering on political purpose and their effective uses (or non-use) in specific contexts. The GBD database was first conceived following an accounting logic closely linked with planning: by aggregating epidemiological as well as financial data, the aim was to achieve triage, i.e. balance health budgets and prioritize investments. Nevertheless, as we argue, the specific context of global health and its mode of government have given way to different and contrasting uses of the database. GBD data are now most referred to as indicator: in global “donors” discourses they figure as numerical pictures of suffering distribution across the globe and signs of emergency.