Population health in practice: towards a comparative historical ethnography of the Demographic Health Survey
Introduction
Perhaps the most prolific and influential health surveillance programme ever developed, since 1984 the DHS programme has run more than 400 surveys in over 90 countries across the Global South. Despite this, there is no critical academic research on the DHS itself, either in terms of its history or its social emplacement within national healthcare programmes and international health research. Our project will fill this gap by comparing the history and current implementation of the Demographic Health Survey (DHS) in Malawi, Tanzania, and Ghana.
Content
Primarily funded by the United States Agency for International Development (USAID) and implemented by the global consultancy firm ICF in collaboration with national administrations, DHS datasets are freely available to researchers and include information on everything from household size to ethnicity, level of literacy to television ownership. Epidemiological variables include the self-reportage of symptoms and diagnoses, tobacco and alcohol use, and contraceptive history. Specially trained surveyors collect anthropometric data and biomarker data for HIV, malaria, and anaemia. The remarkable breadth of this data offers epidemiologists and demographers the opportunity to correlate these diverse variables across both time and space. The epistemic value of the DHS, therefore, lies in its accessibility and comparability. This utility has made the DHS, as with other cross-sectional surveys, such as the World Bank’s Living Standards Survey (LSS), a vital tool in the administration and analysis of international development programmes and initiatives, including the Sustainable Development Goals (SDGs).
However, assumptions of comparability and universality are prone to ignore the variable social and material conditions which culture the creation of scientific data in practice. By exploring the differences in the way that DHS data is made, our project intends to begin a process of critical, qualitative self-reflection within population health research. Until now, approaches to population health in the humanities and social sciences primarily focused on understanding the social determinants of disease and demographic change. However, this tends to overlook both the quantitative methods employed in these fields, and the data produced and utilised by population health researchers. By contrast, our historical-ethnography aims to understand how data is variously made and used in contemporary population health, and in what ways these present practices reflect or reproduce past principles and old ideas. In this respect, our research will allow policy makers to come to see what is and is not knowable via cross-sectional surveillance, and how it might be made otherwise.