Ignorance and the paradoxes of evidence-based global health: the case of mortality statistics in India’s million death study

ABSTRACT Quantitative evidence and metrics play a central role in contemporary global health. Mortality statistics, for example, are considered essential for improving health in the global South. Yet, many observers lament that reliable cause of death data is not available for many low- and middle-income countries. The Million Death Study (MDS) in India forms an effort to address this issue, seeking to reduce ignorance around mortality by generating representative statistics by combining an existing, representative demographic sample with an innovative diagnostic method called verbal autopsy. Yet, ignorance is more than the absence of reliable mortality statistics in this study. Social science perspectives on institutionalized ignorance can help unpack how certain paradoxes of evidence-based global health manifest through three different articulations of ignorance in the MDS. First, the study’s simultaneously national and global ambitions intersect in arguments that present ignorance as legitimation for the study. Second, ignorance is presented as instrumental in balancing the need for expertise with the risk of bias in diagnosing causes of death. Third, MDS researchers dismiss remaining ignorance or uncertainty about diagnoses, by claiming it is relative compared to the ‘actionability’ of study results for improving public health. In exploring these various manifestations of institutionalized ignorance, several paradoxes of the MDS as an evidence-based global health project become visible. By exploring these paradoxes, this analysis suggests that studies of institutionalized ignorance can provide novel perspectives on how deliberate articulations and mobilization of ignorance helps constitute evidence-based global health.