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The uncounted: Politics of data in global health, by Sara L. M. Davis, Cambridge, UK,
Cambridge University Press, 2020, 310 pp., US$35.99 (paperback), ISBN 9781108704830
The politics that shape data creation and utilisation hold the power to construct visibility in global
health. This visibility through data or lack thereof not only inuences what programmes and
populations receive support, but ultimately plays a role in shaping who lives and who dies. This
is the message at the heart of The Uncounted, which interrogates how quantitative evidence is devel-
oped and implemented in global health. Following from an initial article written under the same
title three years ago, Sara Davis examines the global ght against HIV/AIDS to both acknowledge
the necessity of data in global health and thoughtfully critique how data are gathered, transformed,
and operationalised. The resulting book intended for both scholars and practitioners nds new
meaning against the backdrop of the COVID-19 pandemic, which has underlined the limitations of
data utilization in public health policy. In responding to the COVID-19 crisis, some have developed
mathematical models that ignore or underestimate on-the-ground health realties; others have failed
to communicate public health data eectively and consistently. Undermining the response, policy-
makers have taken the absence of evidence as a justication to sit idly by and do nothing, costing
precious time and leaving lives in the balance. Yet despite these limitations, data are ubiquitous in
global health. Numbers and indicators are the language through which disease burden is commu-
nicated and interpreted, benchmarks informed, progress assessed, priorities conceptualised, and
global strategies realised. While these data are often created and used with good intentions to
mobilise progress toward shared global health goals The Uncounted analyzes how the existing glo-
bal health machinery leaves people behind because of the ways in which data are understood.
Where the absence of evidence is taken as evidence of absence (p. 48), the operationalisation of
data leads to blind spots in global health pockets of invisibility, groups whose plight is denied,
individuals whose needs are left uncounted.
Building from scholarly work on the politics of indicators in global health governance, Davis
examines both multilateral and non-governmental spaces to contextualise data systems within
their political development and practical implementation. The book applies an anthropological
lens to study the experiences of communities, with vignettes highlighting those aected by data-dri-
ven decisions in global health. From counting key populations in the Caribbean to assessing inti-
mate partner violence in Africa, Davis draws from her own professional experiences,
ethnographic work, and academic research to analyze how purportedly objective data are subject
to social, political, and economic pressures. Data are frequently imbued with implicit assumptions
and intentional omissions, subjectively reecting what concepts, qualities, and communities are
valued in global health. This power dynamic imposes global categories on local contexts. Where
local communities are often excluded from the conceptualisation, collection, and use of global
health data, Davis argues that community engagement is vital for making visible the realities
that are otherwise ignored. This engagement creates an opportunity to mobilize to convene
diverse social forces, and to reveal hidden truths(p. 92), allowing for the co-creation of evidence
and the design of programmes that are applicable to population health, rather than designed to
meet political imperatives.
In meeting the challenges of new and unprecedented global health threats, Davis considers the
lack of inuence of human rights on the politics of data gathering and utilisation. Global health can-
not be advanced without human rights progress, and human rights cannot be realised without glo-
bal health advancement. Despite being lauded in global health rhetoric, Davis laments how human
rights have become decoration on top of data-driven systems of prioritization(p. 236), frequently
left as an afterthought in global health planning, nancing, and implementation. She recognises that
the eld of health and human rights has fallen short in advancing measurement methodologies,
concerned (as a human rights practitioner herself) that this has allowed human rights to become
part of the unquantied remainder(p. 122) forces that shape health but are dicult to measure
and are therefore left uncounted. Amid the contemporary push to mainstream human rights in glo-
bal health governance, Davis argues that these data concerns are paramount. There remains no
standardised way to understand or measure human rights in global health, with ongoing debates
around the conceptualisation and utilisation of various human rights measures. Where the
human rights system has faced challenges in monitoring government health eorts, such measure-
ment challenges provide an opportunity to consider how best to integrate human rights in global
health through the harmonisation of data systems.
Data remain necessary for assessing global health and human rights progress, framing how to
utilise nite resources and facilitating accountability for improvement. The Uncounted highlights
unique opportunities through community-driven data and inclusive strategy development that
can and should be harnessed in forging a path to advance health and human rights. Yet, Davis
acknowledges that these approaches will not work everywhere, with her research exploring the
limits of how far our current systems can take us. These limits are particularly salient in the current
moment, as countries out human rights in their domestic responses to the COVID-19 pandemic,
impacting billions globally. Given rising pressures to more meaningfully create, monitor, and
review data in global health, there is a risk that improvements become little more than a numbers
game a matter of optics rather than meaningful dedication to the advancement of global health
and human rights. Davis follows the substantive content of the book with a series of reection ques-
tions to push those in global health governance to reect on how data are selected and examined.
This is a suitable conclusion in these uncertain times, oering not a neatly packaged set of solutions
but instead an inclusive opportunity to contest and remake data to be people-centered and to exam-
ine what is counted and what is left uncounted.
Hanna E. Huffstetler
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
Benjamin Mason Meier
Department of Public Policy, University of North Carolina, Chapel Hill, NC, USA
© 2021 Hanna E. Huffstetler and Benjamin Mason Meier
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