Summary Measures of Population Health: Controversies and New Directions

Abstract

This chapter offers a critique of summary measures of population health status (e.g., disability-adjusted life years and health-adjusted life expectancies) that have been promoted by the WHO and other bodies as tools for priority setting in health policy. The measurement of population health is a case study of globalization. Where the term “globalization” tends to stand as a marker of certain approaches to economic engagement and global trade, here it stands as a marker for the global management of an idea. The idea is that there exists a universally (i.e., cross-culturally) accepted notion of health as an attribute intrinsic to the individual based on loss of bodily function or structure that is unrelated to the social, cultural, or physical environment. This idea may seem self-evident, and the evidence supporting it is scant. It has, nonetheless, resulted in an intensive effort to develop measures of population health that are based on it, and to repudiate ideas that stand in opposition to it.