INTRODUCTION

Summary measures of population health combine information about morbidity and premature mortality within a single ‘metric’. Particularly prominent at the international level is the Global Burden of Disease (GBD) study, which uses disability-adjusted life-years (DALYs) to quantify the disease burden resulting from different health conditions across the world. The study aims to provide an objective assessment of the state of global health, capturing not only premature mortality but also the burden of non-fatal health conditions. Moreover, the measure can – and was explicitly designed to – inform policy decisions relating to global health, particularly about priority-setting and resource allocation. For example, the Disease Control Priorities Project uses GBD data to make health policy recommendations for developing countries.

From the beginning of the project, the salience of normative questions in designing an appropriate measure of global health was apparent. These questions were addressed explicitly in the development of the GBD approach and were the focus of much of the criticism voiced against the GBD and its methodology. This chapter focuses on the influence that concerns about the effects of global health measures on health policy have had on the development of the GBD methodology. The GBD researchers emphasise that when health indicators gain prominence, they inevitably have an influence on policy debates and decisions. It is incumbent on those developing such indicators to recognise this ‘normative shadow’ and to design health measures in such a way that their influence on policy is unproblematic.