The World Health Report 2000, prepared by theWorld Health Organization, presented performancerankings of 191 nations’ health care systems.These rankings have been widely cited inpublic debates about health care, particularly bythose interested in reforming the U.S. health caresystem to resemble more closely those of othercountries. Michael Moore, for instance, famouslystated in his film SiCKO that the United Statesplaced only 37th in the WHO report. CNN.com,in verifying Moore’s claim, noted that France andCanada both placed in the top 10.
Those who cite the WHO rankings typicallypresent them as an objective measure of the relativeperformance of national health care systems.They are not. The WHO rankings depend cruciallyon a number of underlying assumptions—some of them logically incoherent, some characterizedby substantial uncertainty, and some rootedin ideological beliefs and values that not everyoneshares.
The analysts behind the WHO rankingsexpress the hope that their framework “will laythe basis for a shift from ideological discourse onhealth policy to a more empirical one.” Yet theWHO rankings themselves have a strong ideologicalcomponent. They include factors that arearguably unrelated to actual health performance,some of which could even improve in response toworse health performance. Even setting thoseconcerns aside, the rankings are still highly sensitiveto both measurement error and assumptionsabout the relative importance of the components.And finally, the WHO rankings reflect implicitvalue judgments and lifestyle preferences that differamong individuals and across countries.