The second reflection in a two-part series on what we count and why.
This essay is the second in a two-part series about the role of counting in public health. Last week’s essay explored the role of metrics in strategic decision-making and the values that determine what we count and why. Today, I would like to consider the strengths and limitations of quantitative analysis itself.
Quantitative approaches seem to promise the possibility of true impartiality, a means of getting at the truth with pinpoint accuracy and using it to do the most good for the most people. In politics, for example, we can demonstrate quantitatively the general effectiveness of economic or social policies through a range of metrics, including GDP, the unemployment rate, healthcare utilization numbers, or changes in national life expectancy. We can see, for example, that after a certain number of years, national GDP has risen or declined by a certain amount and feel like we are seeing something definitive about the success or failure of the reigning economic policies, information we can then use to nudge policy towards doing the greatest possible good. This nudging reflects an ideal of utilitarianism, which is defined, notably by Jeremy Bentham, as that which does the greatest good for the greatest number of people.
I have long been drawn to utilitarianism as an idea. Doing the most good for the most people is, in many ways, a natural fit for those of us in public health. We want to create healthier populations. This is just another way of saying we want to make as many people healthy as possible, which is an essentially utilitarian statement (a statement which is, admittedly, complicated by public health’s foundational commitment to equity, which I will get to in a moment). This informed my call, in 2013, for a consequentialist epidemiology, in which the pursuit of the greatest good for the health of populations would guide our priorities in thinking and scholarship.
In recent years, utilitarianism has been embraced as a guiding philosophy for a new approach to philanthropy known as Effective Altruism. The Effective Altruist movement looks to use quantitative methods to maximize the effect of charitable giving, so that every dollar does the most good for the most people. In his book, Doing Good Better: How Effective Altruism Can Help You Make a Difference, William MacAskill, one of the originators of Effective Altruism, wrote of the movement:
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