Metrics: What Counts in Global Health
This chapter explores how the legitimacy conferred by health metrics enters into the efforts of Yup’ik residents of southwestern Alaska to secure sovereign rights and recognitions. By making funding for Yup’ik behavioral health programs contingent on the production of health metrics, the post/colonial settler-state perpetuates relationships of financial and intellectual dependency. This is one way global health “aspirations toward a contemporary global sovereign” dovetail with long-standing colonial histories to ensure the perpetuation of colonial dependencies in indigenous communities. Yet metrics can also be mobilized by indigenous communities themselves. Even as they dispute the purported universality of health metrics, the directors of Yup’ik behavioral health search for creative ways to demonstrate evidence of efficacy. They are cognizant of the ways health metrics confer legitimacy to an international audience and may help instantiate their claims to sovereignty.