World Health Report Rankings Driven by Ideology, Skewed Data

New Cato Institute study questions methodology behind WHO rankings

February 26, 2008

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WASHINGTON – The two remaining Democratic presidential candidates take the stage tonight in what could be the final debate before the nominee is decided, and health care is all but certain to be a topic of discussion. But as the two senators trade dire statistics about the uninsured, and spin grim tales of people (invariably swing state residents) encountered on the campaign trail being “forced to choose between food and medicine,” a new study released today by the Cato Institute questions the accuracy of at least one source of those gloomy statistics – the World Health Report 2000.

First published in 1995, the WHO report presents the performance rankings of the health care systems of 191 nations. The findings of the report are frequently cited in debates about health care, particularly by those whose goal is to reform the U.S. health system to resemble more closely those of other countries. In “SiCKO,” his 2007 lambasting of the U.S. health system, activist filmmaker Michael Moore stated that the U.S. placed only 37th in the WHO report – one of many examples of statistics called into the service of ideology.

“Those who cite the WHO rankings typically present them as an objective measure of the relative performance of the national health care systems,” states Whitman. “They are not. The WHO rankings depend crucially on a number of underlying assumptions — some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.”

So what of the United States placing 37th – behind Slovenia – in the WHO rankings? WHO rankings result from an index of five health-related statistics: health level, health distribution, responsiveness, responsiveness distribution and financial fairness. Only health level and responsiveness, Whitman writes, are justifiable measures of a health system. The remaining rankings, he argues, fail to take into account differences in health outcomes not explained by spending or literacy, and instead attribute them to health care performance, creating a fertile ground for demagoguery and selective citation.

“The WHO health care ranking system does not escape ideology,” concludes Whitman. “On the contrary, it advances ideological assumptions under the guise of objectivity. Those interested in objective measures of health system performance should look elsewhere.”