What Counts in Global Health


Critical Global Health: Evidence, Efficacy, Ethnography

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Book Pages: 264 Illustrations: Published: March 2016

Anthropology > Medical Anthropology, Medicine and Health > Global Health, Science and Technology Studies

This volume's contributors evaluate the accomplishments, limits, and consequences of using quantitative metrics in global health. Whether analyzing maternal mortality rates, the relationships between political goals and metrics data, or the links between health outcomes and a program's fiscal support, the contributors question the ability of metrics to solve global health problems. They capture a moment when global health scholars and practitioners must evaluate the potential effectiveness and pitfalls of different metrics—even as they remain elusive and problematic.
Contributors. Vincanne Adams, Susan Erikson, Molly Hales, Pierre Minn, Adeola Oni-Orisan, Carolyn Smith-Morris, Marlee Tichenor, Lily Walkover, Claire L. Wendland


"[T]his volume is insightful, engaging and impressive. . . . I highly recommend this enlightening and ethnographically rich book. It is a must read for both medical anthropologists and global health practitioners, and would make an excellent addition to the reading list for graduate classes in medical anthropology or global health." — Lauren Wallace, Anthropology Book Forum

"[T]his volume will hopefully help stimulate policymakers and researchers to think seriously about whether playing the numbers game is sufficient, either for patients or their clinicians." — Thomas Christie Williams, LSE Review of Books

"Metrics is a thoughtful book that powerfully maps some of the problems that accompany the effort to ground GH in metrics. It is obligatory reading for anyone trying to understand contemporary world health." — Tobias Rees, Bulletin of the History of Medicine

"Metrics offers a lucid, revealing, and sometimes unnerving tour of global health’s quantitative terrain. Its authors take pains to emphasize that they are not opposed to measurement. Rather, they argue for the need to recognize the limits of numbers and the continuing significance of other forms of knowing. From the perspective of medical anthropology this is a vital book." — Peter Redfield, Medical Anthropology Quarterly

"Metrics offers a thoughtful analysis of the metrics and material infrastructures behind the production of this kind of data, highlighting the ways a data-driven Global Health system has affected the concrete experiences of practitioners, patients and communities." — Oscar Javier Maldonado Castaneda, Theory, Culture & Society

"Adams’ edited book makes a crucial contribution not only to those debates but also to the anthropology and sociology of evidence and measurement and to the social studies of science and medical humanities. Quite importantly, Metrics opens up a new field of inquiry and prompts us to think about how other kinds of metrics and ‘storied numbers’ are produced, experienced and valued and how they could be (re)imagined in the future." — Angela Marques Filipe, Sociology of Health & Illness

"Taken together, this volume offers a useful primer on the role of metrics in shaping the work of global health actors at the macro, meso, and micro levels. The individual case studies offer theoretically and empirically rich examples that would be useful for scholars working in this area and for inclusion in an upper-level undergraduate class." — J. Lynn Gazley, Contemporary Sociology

"A bracing collection, Metrics reminds us how and why many efforts to measure sickness, injury, and suffering—like some attempts to address them—are often illusory in their alleged precision. Vincanne Adams's withering critique of the confident claims made for 'evidence-based global public health' shows how such cramped understandings miss many other ways of knowing. Drawing on rich case histories from Senegal, Haiti, Malawi, Nigeria, and Alaska, Adams and her colleagues have assembled a portable epistemology that both humbles and inspires. Required reading for anyone interested in global health—and especially for those holding its purse strings." — Paul Farmer, Partners in Health, Harvard Medical School

“Timely, incisive, and of immense importance, Metrics is the first volume to bring together ethnographic perspectives to critically assess the increasingly outsized role that audit cultures now play in determining the form, content, and politics of global health research and practice. Adding new specificity to the expanding literature on critical studies of global health, Metrics will resonate well beyond the field of anthropology, impacting history, sociology, policy, ethics, epidemiology, and economics."  — Jeremy A. Greene, author of Generic: The Unbranding of Modern Medicine

"A stunning benchmark volume, in measured tones of 'applause and caution,' about the statistical methods that increasingly govern and provide investment opportunities for health interventions, poverty reduction, and much else in the postcolonial world. These new biopolitical economies displace national decision making and often their own humanitarian goals, using tropes of 'suffering individuals' as 'residuals' as symbolic capital to be reinvested and to give numbers affective credibility. But such stories can also expose the fabrications and distortions that the drive for statistical certainty produces, and explain why so many well-intentioned 'evidence-based' interventions fail. Lucidly explaining global health financialization, the volume calls for alternative metrics, complementary methods, and less reliance on abstracted indices and proxies."  — Michael M. J. Fischer, author of Anthropological Futures


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Author/Editor Bios Back to Top

Vincanne Adams is Professor of Medical Anthropology in the Department of Anthropology, History and Social Medicine at the University of California, San Francisco. 


Table of Contents Back to Top
Introduction / Vincanne Adams  1

1. Metrics of the Global Sovereign: Numbers and Stories in Global Health / Vincanne Adams  19

Part I. Getting Good Numbers

2. Estimating Death: A Close Reading of Maternal Mortality Metrics in Malawi / Claire L. Wendland  57

3. The Obligation ot Count: The Politics of Monitoring Maternal Mortality in Nigeria / Adeola Oni-Orisan  82

Part II. Metrics Politics

4. The Power of Data: Global Malaria Governance and the Senegalese Data Retention Strike / Marlee Tichenor  105

5. Native Sovereignty by the Numbers: The Metrics of Yup'ik Behavioral Health Programs / Molly Hales  125

Part III. Metrics Economics

6. Metrics and Market Logics of Global Health / Susan Erikson  147

7. When Good Works Count / Lily Walkover  163

Part IV. Storied Metrics

8. When Numbers and Stories Collide: Randomized Controlled Trials and the Search for Ethnographic Fidelity in the Veterans Administration / Carolyn Smith-Morris  181

9. The Tyranny of the Widget: An American Medical Aid Organization's Struggles with Quantification / Pierre Minn  203

Epilogue: What Counts in Good Global Health? / Vincanne Adams  225

References  231

Contributors  253

Index 255
Sales/Territorial Rights: World

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