EPILOGUE
What Counts in Good Global Health?
VINCANNE ADAMS
If the essays in this volume make us question the assumption that the use of
global health metrics will invariably and inevitably lead us to better health
outcomes, then we have done our job. We are not alone in calling atten-
tion to this problem, but the concerns that now circulate about how we use
metrics, what they mean, and what they inadvertently do are concerns that
run deep in and through these chapters. What I hope we have shown is not
that we should throw the baby out with the bathwater when it comes to
using metrics. Metrics can be and often are useful. At the same time, how-
ever, it is important to understand how the use of metrics can also inter-
rupt and derail efforts to improve health, no matter what scale we are talk-
ing about: local, global, near or far. We need to recognize the limitations
of these counting exercises, the use of the kinds of metrics that are being
deployed (and to what end), and we need to recognize what other kinds
of work metrics do far beyond their rhetorical claims to improving health.
This volume is intended to help us think productively about how metrics
create new possibilities and alliances that are changing things in rather dra-
matic ways for those on the ground, deep in the trenches, trying to achieve,
trying to provide, and trying to promote global health. The alliances made
possible my metrics are productive in ways that reach far beyond the gen-
eration of numbers and facts. Metrics enable certain kinds of medical prac-
tices while impeding others. They generate forms of knowledge and cer-
tainty about some things even while effacing others. They can authorize
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