Science or ideology? A response to Murray and Frenk.

The WHO's World Health Report 2000, entitled Health Systems: Improving Performance, and Christopher Murray and Julio Frenk's replies to Vicente Navarro's critique of that report, reproduce an unawareness of the errors inherent in using a synthetic indicator such as overall health systems performance: the complexity and difficulty in selecting and weighting the many individual indicators that are to be included in the final, overall indicator. Decisions about how to weight the importance of the various components of the overall indicator and the sources used to select information on those components reproduce a set of highly questionable assumptions and heavily loaded ideological choices that weaken the scientific credibility of the overall indicator and of the WHO report itself. This transforms the report into a political ideological document that simply conveys and perpetuates the current conventional wisdom in health policy.