Gender Development Index
The Gender Development Index (GDI) is a composite measure developed by the United Nations Development Programme (UNDP) to assess gender disparities in human development achievements across three dimensions: health, measured by life expectancy at birth; education, measured by mean years of schooling for adults and expected years of schooling for children; and command over economic resources, measured by estimated gross national income (GNI) per capita.[1] Introduced in the 1995 Human Development Report, the GDI calculates separate Human Development Index (HDI) values for females and males, then applies a penalty to the average based on the degree of inequality between them, resulting in a value that reflects both average achievement and gender gaps, with values closer to 1 indicating lower disparities.[1] Unlike the HDI, which aggregates achievements without regard to distribution, the GDI explicitly accounts for gender-based inequalities, aiming to reveal how disparities reduce overall human development potential.[2] Countries are categorized into groups such as very high, high, medium, low, and very low GDI based on the ratio of female to male HDI, with Nordic countries like Norway and Finland typically ranking highest due to minimal gaps, while nations in sub-Saharan Africa often show larger disparities.[3] Despite its utility in tracking progress—such as global improvements in female life expectancy and education access—the GDI has faced methodological criticisms for its reliance on arithmetic means, equal weighting of dimensions, and failure to incorporate intra-gender inequalities or broader empowerment factors like political participation.[4][5] Academic reviews have highlighted misuse in policy contexts, where the index is sometimes misinterpreted as a direct measure of women's absolute achievements rather than relative gaps, potentially overlooking causal factors like cultural norms or economic structures that perpetuate disparities.[4]Origins and Purpose
Introduction and Conceptual Foundation
The Gender Development Index (GDI) is a composite statistic compiled annually by the United Nations Development Programme (UNDP) to quantify gender disparities in human development achievements. It evaluates inequalities between females and males in three dimensions: health, measured by life expectancy at birth; education, assessed via expected years of schooling for children and mean years of schooling for adults aged 25 and older; and a decent standard of living, proxied by estimated earned gross national income per capita.[1] The index, with values ranging from 0 (indicating substantial inequality) to 1 (denoting parity), adjusts the standard Human Development Index (HDI) downward to penalize gender gaps, reflecting the view that such disparities reduce aggregate well-being.[1][2] Conceptually, the GDI builds on the human development framework, which emphasizes expanding individual capabilities and opportunities as the core of progress, rather than focusing solely on economic output. By disaggregating HDI components by sex, it highlights how gender-specific barriers—such as restricted access to resources or education—limit potential, particularly for females in lower-ranked countries. The calculation involves deriving female and male HDIs using the geometric mean across dimensions, then expressing the GDI as the ratio of female HDI to male HDI, which inherently captures relative performance while assuming convergence toward equality enhances development.[1][6] This approach posits a causal link between reducing measured gaps and improved outcomes, though it relies on aggregated indicators that may not distinguish between discriminatory policies and endogenous factors like biological sex differences or individual preferences.[2] Empirically, global GDI values have risen from approximately 0.800 in 1990 to 0.951 in 2023, indicating narrowing disparities on average, driven largely by gains in female education and health longevity, where females often outperform males in life expectancy due to lower mortality risks unrelated to inequality.[1] However, persistent income gaps, with males typically earning more, reflect labor force participation patterns shaped by occupational choices, family roles, and risk tolerances rather than solely systemic discrimination, challenging the index's implicit causal attribution of all disparities to remediable inequities.[1] Critics, including methodological reviews, contend that the GDI's reliance on income as a welfare proxy and failure to weight dimensions causally oversimplifies complex dynamics, potentially leading to misguided policies that ignore trade-offs in gender specialization.[7][4]Relation to Human Development Index
The Gender Development Index (GDI) extends the Human Development Index (HDI) by disaggregating its three core dimensions—health (measured by life expectancy at birth), education (mean years of schooling and expected years of schooling), and standard of living (gross national income per capita)—separately for females and males.[1] While the HDI calculates an arithmetic mean of achievements across a population to assess average human development, the GDI computes distinct HDI values for each sex (HDI_f for females and HDI_m for males) before deriving a ratio: GDI = HDI_f / HDI_m.[8] This ratio, which ranges from 0 to 1 with values approaching 1 indicating near gender parity, quantifies the relative gender gaps in human development outcomes rather than absolute levels.[1] Unlike the HDI, which masks disparities by averaging male and female achievements, the GDI penalizes inequality by highlighting how gender differences diminish overall potential; for instance, a country with high HDI scores may exhibit a lower GDI if females lag significantly in income or education access.[9] The United Nations Development Programme (UNDP) introduced the GDI in 1995 as a direct complement to the HDI to address critiques that the latter overlooked sex-based inequalities, enabling cross-country comparisons of gender-sensitive development.[1] Methodological revisions, such as those in the 2010 HDI update adopting geometric means, were mirrored in GDI calculations to ensure consistency, though the GDI's focus on ratios introduces sensitivity to small disparities in high-achieving nations.[8] Empirical analysis shows that GDI values often correlate positively with HDI levels, as higher overall development tends to reduce gender gaps, but divergences occur where cultural, economic, or policy factors exacerbate inequalities—evident in regions like South Asia where female education deficits lower GDI relative to HDI.[1] Critics, including evaluations from UN Women, argue the GDI conflates absolute development levels with inequality measures, potentially overstating penalties in low-HDI contexts where both sexes face constraints, unlike pure disparity indices.[6] Nonetheless, UNDP maintains the GDI's utility in revealing causal pathways from gender inequities to broader human development losses, informing targeted interventions without supplanting the HDI's role in holistic assessments.[1]Historical Evolution
Inception in 1995
The Gender-related Development Index (GDI) was introduced in the United Nations Development Programme's (UNDP) Human Development Report 1995, subtitled Gender and Human Development, marking the first explicit integration of gender disaggregation into the framework of human development measurement.[10] Published in 1995 as the sixth annual installment in the series, the report centered on the theme that "Human Development, if not engendered, is endangered," arguing that persistent gender inequalities in capabilities and opportunities hinder broader progress in human well-being.[11] The GDI emerged as an innovation to address the HDI's oversight of intra-household and gender-specific disparities, shifting emphasis from aggregate averages to equity-sensitive assessments that penalize uneven distribution between sexes.[11] The index measures average human development achievements while adjusting downward for gender gaps, using the same core dimensions as the HDI: longevity (life expectancy at birth, with gender-specific goalposts accounting for biological differences, such as 87.5 years maximum for females versus 82.5 for males), knowledge (a composite of adult literacy rates weighted at two-thirds and combined primary, secondary, and tertiary enrolment rates at one-third), and command over resources (real GDP per capita in purchasing power parity terms, incorporating female-to-male wage ratios and labor force participation where data permitted).[11] Inequality is incorporated via the "equally distributed equivalent" (EDE) formulation, which applies an aversion parameter (set at E=2, akin to a harmonic mean) to female (Xf) and male (Xm) achievements weighted by population shares (pf and pm): Xed = [pf · Xf^(1-E) + pm · Xm^(1-E)]^(1/(1-E)).[11] This method ensures the GDI value is always less than or equal to the HDI, with the penalty reflecting the degree of disparity rather than absolute levels of achievement.[11] Applied initially to 130 countries using predominantly 1992 data (with some 1995 updates for enrolment), the GDI produced rankings highlighting stark variations, from Sweden at 0.919 to Afghanistan at 0.169, and an average value of approximately 0.6 across included nations, with 45 countries below 0.5.[11] Income estimates often relied on provisional adjustments, assuming a 75% female-to-male wage ratio in data-scarce contexts, sourced from UN agencies and national statistics.[11] Introduced concurrently with the Gender Empowerment Measure (GEM), which quantifies women's agency in political and economic spheres, the GDI underscored the report's call for policies promoting gender equity, including legal reforms and targeted investments in women's education and health.[10]Key Methodological Revisions
The Gender Development Index (GDI), introduced in the 1995 Human Development Report, initially calculated gender-adjusted human development by averaging male and female achievements within each dimension (health, education, and income), deriving dimension indices, aggregating via geometric mean to an unpenalized index, and then applying a penalty for inequality using a harmonic mean adjustment across genders.[2] This approach faced criticism for double-penalizing inequality—once within dimensions and again in the final adjustment—and for conflating overall development levels with gender disparities, leading to counterintuitive rankings where low-development countries with parity outperformed high-development ones with modest gaps.[12] In response, the 1999 Human Development Report revised the methodology to compute separate human development indices for males and females using dimension-specific indices, followed by aggregation into gender-specific HDIs, and then deriving the GDI as the ratio of the harmonic mean to the arithmetic mean of these gender HDIs: GDI = \frac{2 \cdot \mathrm{HDI}_m \cdot \mathrm{HDI}_f}{\mathrm{HDI}_m + \mathrm{HDI}_f} \div \frac{\mathrm{HDI}_m + \mathrm{HDI}_f}{2}, yielding a value between 0 and 1 where 1 indicates perfect parity and lower values quantify the relative loss due to disparities.[13] [14] This shift emphasized pure gender disparity over absolute levels, addressing aggregation inconsistencies by applying the inequality penalty after gender-specific HDI calculation.[12] Concurrently, the 1999 revision updated the income component, abandoning the Atkinson inequality-weighting method for female earned income—which had imputed non-market work using arbitrary parameters—and adopting direct estimates based on labor force participation rates, wage gaps, and GDP shares attributable to female labor, improving empirical grounding but relying on potentially inconsistent national data imputation.[2] [14] These changes stabilized GDI values across reports, with the methodology remaining largely intact until the 2010 Human Development Report's overhaul of the parent HDI, which replaced arithmetic means for dimension aggregation with geometric means to reduce substitutability bias between dimensions (e.g., compensating low health with high income). The GDI incorporated this by applying geometric means within male and female HDIs, enhancing sensitivity to imbalances across dimensions for each gender while preserving the post-1999 disparity ratio formula.[15] This alignment ensured methodological consistency but amplified the penalty for uneven gender gaps within dimensions, as geometric means penalize zeros or minima more severely than arithmetic.[16] Subsequent refinements, highlighted in the 2014 Human Development Report, focused on data harmonization and classification, introducing value-based groups (e.g., GDI ≥ 0.800 for very high equality) to interpret deviations from parity, though core formulas unchanged from 2010.[17] Critics note persistent issues, such as sensitivity to income imputation assumptions in low-data contexts and failure to capture causal factors like cultural norms affecting female participation, but UNDP maintains the approach for its transparency and alignment with HDI empirics.[18] No major computational overhauls occurred post-2014 through the 2023/2024 reports, with updates limited to data revisions and threshold adjustments for emerging economies.[1]Technical Methodology
Core Components: Health, Education, and Income
The Gender Development Index (GDI) evaluates gender disparities in human development through three core dimensions—health, education, and income—mirroring the structure of the Human Development Index (HDI) but with sex-disaggregated indicators to compute separate achievement indices for females and males. These dimension indices are normalized using goalposts that transform raw values into scales between 0 and 1, with the overall GDI derived as the ratio of the female HDI to the male HDI, where each gender's HDI is the geometric mean of its three dimension indices.[1][8] Health is measured by life expectancy at birth, reported separately for females and males. The dimension index for each sex is calculated as (actual value – minimum value) / (maximum value – minimum value), with gender-specific goalposts to account for biological differences: 22.5 to 87.5 years for females and 17.5 to 82.5 years for males, the latter reflecting an approximate five-year female advantage. Data are sourced primarily from the United Nations Department of Economic and Social Affairs (UNDESA, 2022 estimates). This approach highlights gaps such as lower male life expectancy in many countries due to factors like higher occupational risks and behavioral patterns, though it does not adjust for cause-specific mortality differences.[8] Education incorporates two indicators: mean years of schooling for adults aged 25 and older, and expected years of schooling for children of school-entering age, both disaggregated by sex. Each sub-indicator is indexed using goalposts of 0 to 15 years for mean years and 0 to 18 years for expected years; the education dimension index is then the arithmetic mean of these two sub-indices for females and for males separately. Sources include the UNESCO Institute for Statistics (2023), the World Bank's CEDLAS database (2023), and national household surveys, with imputations for missing data via regression models. This captures disparities in access and attainment, such as lower female mean years in regions with historical barriers to girls' education, though it overlooks quality or field-of-study differences that may affect economic relevance.[8] Income, representing command over resources, uses estimated earned income (EEI) per capita in 2017 purchasing power parity (PPP) dollars, computed separately for females and males from gross national income (GNI) per capita adjusted by sex-specific shares of the population, economically active population, and labor force participation rates, often incorporating observed female-to-male wage ratios from surveys. The dimension index applies a logarithmic transformation: [ln(actual EEI) – ln(100)] / [ln(75,000) – ln(100)], with goalposts of $100 to $75,000. Data derive from the International Labour Organization (ILO, 2023), IMF estimates (2023), and national accounts, with assumptions for non-market work or informal sectors. This method reveals persistent gaps favoring males in most economies, attributable to labor market segregation and productivity differentials, but critics note potential underestimation of female contributions via unpaid care work and overreliance on parity assumptions in data-scarce contexts.[8]Calculation Process and Formulas
The Gender Development Index (GDI) is computed as the ratio of the female Human Development Index (HDI) value to the male HDI value, where GDI = \frac{HDI_f}{HDI_m}.[8] This approach requires first deriving gender-disaggregated HDI values using the standard HDI methodology, but with sex-specific indicators and, in the case of health, adjusted goalposts to account for biological differences in life expectancy.[8] To calculate the female and male HDIs, achievements are assessed across three dimensions—health, education, and standard of living (income)—with dimension indices normalized relative to fixed goalposts and then aggregated via the geometric mean: HDI_f = (I_{Health}^f \cdot I_{Education}^f \cdot I_{Income}^f)^{1/3} and similarly for males.[8] For health, the index uses life expectancy at birth, normalized linearly: I_{Health} = \frac{\text{actual value} - \text{minimum}}{\text{maximum} - \text{minimum}}, with female goalposts of 22.5–87.5 years and male goalposts of 17.5–82.5 years to reflect an average 5-year female biological advantage.[8] The education dimension index is the arithmetic mean of two normalized sub-indices: mean years of schooling (goalposts: 0–15 years) and expected years of schooling (0–18 years), both using linear normalization.[8] For income, gender-specific estimates of earned gross national income (GNI) per capita in 2017 purchasing power parity (PPP) dollars (goalposts: $100–$75,000) are derived first: the female share of the total wage bill is S_f = \frac{(W_f / W_m) \cdot EA_f}{(W_f / W_m) \cdot EA_f + EA_m}, where W_f / W_m is the female-to-male wage ratio and EA_f, EA_m are the numbers of economically active females and males; the male share is S_m = 1 - S_f.[8] Female earned GNI per capita is then GNIpc_f = GNIpc \cdot S_f / P_f (divided by female population P_f), and analogously for males, with the income index using logarithmic normalization: I_{Income} = \frac{\ln(\text{actual GNIpc}) - \ln(100)}{\ln(75,000) - \ln(100)}.[8] This process yields a GDI value approaching 1 for gender parity, with values below 1 indicating relative male advantage and above 1 indicating female advantage, though global data typically show values less than 1 due to persistent disparities in income and education access.[8] The methodology has remained consistent since the 2010 HDI revision, emphasizing the geometric mean to penalize imbalances across dimensions.[8]Data Sources and Adjustments
The Gender Development Index (GDI) relies on gender-disaggregated data for life expectancy, educational attainment, and gross national income (GNI) per capita, primarily sourced from international agencies and household surveys compiled by the United Nations Development Programme (UNDP) Human Development Report Office (HDRO). For the health dimension, female and male life expectancy at birth is drawn from the United Nations Department of Economic and Social Affairs (UNDESA) population estimates and projections, based on vital registration systems, censuses, and sample surveys where direct data are unavailable.[8][19] Educational components use mean years of schooling for adults aged 25 and older, sourced from Barro-Lee datasets (covering 1950–2010 with projections), UNESCO Institute for Statistics (UIS), OECD adult education surveys, Demographic and Health Surveys (DHS) by ICF Macro, and Multiple Indicator Cluster Surveys (MICS) by UNICEF; expected years of schooling for children of school-entering age draws from similar sources including CEDLAS-World Bank databases.[8] These surveys often involve self-reported or administrative data from national statistical offices, with coverage varying by country due to differences in survey frequency and quality. For the income dimension, aggregate GNI per capita in purchasing power parity (PPP) terms comes from the International Monetary Fund (IMF), World Bank, and United Nations Statistics Division, while gender-disaggregated estimates are derived by HDRO using labor force participation rates and wage bill shares from the International Labour Organization (ILO).[8][19] Adjustments to these sources address data gaps and methodological inconsistencies inherent in cross-national comparisons. Missing values for GNI are imputed by applying real GDP growth rates from World Bank or IMF data to the last observed GNI figure, potentially introducing interpolation errors in volatile economies.[8] Gender-specific earned income is estimated via the formula incorporating female-to-male population shares, labor force participation ratios, and non-agricultural wage shares, with a default global female-to-male wage ratio of 0.8 applied when country-specific data are absent, an assumption criticized for oversimplifying diverse labor market structures.[8][15] Normalization for index construction uses gender-differentiated goalposts—female life expectancy bounded at 22.5–87.5 years and male at 17.5–82.5 years—to reflect observed biological differences of approximately 5 years in favor of females, alongside uniform bounds for education (0–18 expected years, 0–15 mean years) and income ($100–$75,000 PPP).[8] These adjustments prioritize comparability but may understate disparities in countries with incomplete gender breakdowns, as HDRO aggregates rely on modeled estimates rather than comprehensive direct measurements.[19]Empirical Data and Global Trends
Latest UNDP Publications (Up to 2023)
The Human Development Report 2021/2022, released by the United Nations Development Programme (UNDP) on September 8, 2022, provides the most recent comprehensive GDI data up to that point, based on 2021 figures for 170 countries and territories.[20] The statistical annex presents GDI values disaggregated by gender gaps in life expectancy at birth, education (expected and mean years of schooling), and estimated gross national income per capita. Countries are classified into five groups according to deviation from parity (GDI = 1.000): Group 1 (very low disparity, GDI ≥ 0.975 or ≤ 1.025, encompassing nations with minimal gaps); Group 2 (low disparity); Group 3 (medium disparity); Group 4 (high disparity); and Group 5 (very high disparity).[1] Despite global disruptions from the COVID-19 pandemic, which contributed to HDI declines in 90% of countries, GDI trends indicated relative stability in gender disparities, with progress in health and education offsetting some income-related setbacks.[21] For instance, female life expectancy advantages in many regions bolstered overall parity, though male advantages in income persisted, particularly in labor market participation and earnings estimates derived from non-labor surveys.[1] No dedicated UNDP GDI publication occurred in 2023; updates were deferred to subsequent reports, reflecting the index's integration into annual HDR statistical frameworks rather than standalone releases.[22] The 2021 data underscored regional variations, with Europe and North America predominantly in Groups 1 and 2, while sub-Saharan Africa featured higher concentrations in Groups 4 and 5 due to wider income and education gaps.[1] UNDP's methodology adjustments for data scarcity during the pandemic involved imputation techniques, potentially introducing minor estimation biases in low-data environments.[21] These figures serve as a benchmark for pre-2022 parity assessments, highlighting incremental global convergence toward 1.000 amid broader human development setbacks.[20]Patterns Across Countries and Regions
In the 2023 UNDP data, the global Gender Development Index (GDI) stood at 0.960, reflecting that female achievements in health, education, and income reached 96% of male levels on average.[1] Countries are classified into five groups based on the absolute deviation from gender parity (GDI=1), with Group 1 indicating very high equality (deviation ≤2.5%), Group 2 high equality (≤5%), Group 3 medium (≤7.5%), Group 4 low (≤10%), and Group 5 very low (>10%).[3] A majority of countries fall into Groups 2 and 3, with high-income nations predominantly in Group 1, such as Norway (GDI 1.016) and Finland (GDI 1.014), where female HDI slightly exceeds male due to longer female life expectancy offsetting male advantages in earned income.[9] In contrast, low-income countries like Burundi exhibit GDI values around 0.85, driven by wider gaps in education and income favoring males.[19] Regional patterns reveal stark variations, with Europe and North America achieving the highest parity, averaging GDI values above 0.98, as seen in the United States (GDI 1.009) and Canada.[9] East Asia and the Pacific show moderate to high equality, exemplified by countries like Slovenia (Group 1) and Kazakhstan (near parity), though some like Vietnam display slight female disadvantages in income.[19] Sub-Saharan Africa and Arab States lag with lower averages, often below 0.90, due to persistent educational enrollment gaps and labor market exclusions for women, as in Namibia (Group 3) and broader regional data indicating deviations exceeding 10% in some cases.[1] Latin America and the Caribbean, including Brazil (GDI ~0.97) and Trinidad and Tobago (Group 1), demonstrate intermediate performance, with improvements in health parity but lingering income disparities.[19] These patterns correlate strongly with overall HDI levels, where higher development enables narrower gender gaps through expanded access to education and economic opportunities, though biological differences in longevity contribute to GDI >1 in advanced economies.[1] In regions with cultural or institutional barriers to female participation, such as parts of South Asia and the Middle East, GDI remains suppressed despite economic growth, highlighting the index's sensitivity to component-specific inequalities rather than absolute development.[19] Global trends show gradual convergence toward parity since 1990, but progress has stalled in low-performing regions post-2010.[1]Interpretation and Measurement Scope
What GDI Captures: Disparities vs. Equality
The Gender Development Index (GDI) quantifies disparities in human development achievements between females and males across three core dimensions: health, measured by life expectancy at birth; education, encompassing mean years of schooling for adults and expected years for children; and a decent standard of living, proxied by estimated gross national income per capita adjusted for gender-specific labor force participation and earnings.[1] Unlike the Human Development Index (HDI), which aggregates average achievements without regard to gender distribution, the GDI explicitly incorporates gender-disaggregated data to reveal imbalances, calculating separate HDI values for females (HDI_f) and males (HDI_m) before deriving the GDI as the ratio HDI_f / HDI_m.[23] A GDI value of 1 signifies parity in these achievements, while values below 1 indicate female disadvantage relative to males, and values above 1 reflect male disadvantage, such as in life expectancy where females globally average higher figures.[1] This focus on relative disparities distinguishes GDI from broader conceptions of equality, as it does not assess absolute sameness of outcomes or societal equity in areas like political empowerment or reproductive health—dimensions addressed separately by the Gender Inequality Index (GII).[24] Instead, GDI penalizes deviations from parity irrespective of direction or underlying causes, embedding a "cost of inequality" that lowers the index below the country's HDI whenever gender gaps exist in any dimension, even if one gender outperforms the other due to non-discriminatory factors like biological differences in longevity or occupational choices affecting income.[1] For instance, countries with high overall development but persistent gaps in female education or income attainment receive lower GDI rankings, emphasizing uneven gender distribution over aggregate progress.[6] In practice, GDI classifies countries into groups based on the degree of disparity (e.g., low, medium, high, very high), with the metric highlighting how gender imbalances diminish the effective human development potential compared to a parity scenario, rather than endorsing equality as an end in itself or evaluating causal mechanisms behind the gaps.[1] This approach assumes that equalized achievements across genders enhance overall development, though it has drawn critique for conflating measurable disparities with prescriptive equality, potentially overlooking adaptive or inherent sex differences in preferences and risks that influence outcomes like labor participation or mortality rates.[25]Classification Groups and Parity Deviations
The Gender Development Index (GDI) categorizes countries into five groups according to the absolute deviation from gender parity in their Human Development Index (HDI) values, reflecting the magnitude of disparities between female and male achievements in health, education, and income. This classification, established by the United Nations Development Programme (UNDP), uses the formula for deviation as $100 \times | \text{GDI} - 1 |, where GDI is the ratio of female HDI to male HDI; values near 1 indicate near-parity, with deviations quantifying imbalance. Group 1 denotes the highest equality (deviation <2.5%), progressing to Group 5 with the lowest (deviation >10%), enabling cross-country comparisons of gender gaps independent of overall development level.[26][1]| Group | Absolute Deviation Range (%) | Equality Level | Characteristics |
|---|---|---|---|
| 1 | < 2.5 | High | Minimal disparities; common in high-HDI nations like Norway (GDI 0.993 in 2022 data) where female life expectancy exceeds male, offsetting slight male income edges.[9] |
| 2 | 2.5 to <5 | Medium-high | Moderate gaps, often in upper-middle-income countries; e.g., Poland with deviations around 3-4% driven by education parity but persistent income differences.[26] |
| 3 | 5 to <7.5 | Medium | Noticeable imbalances, prevalent in transitioning economies; income and labor participation gaps widen deviations. |
| 4 | 7.5 to ≤10 | Medium-low | Significant disparities, typical in middle-income regions like parts of Latin America and Asia; education access lags for females contribute heavily.[1] |
| 5 | >10 | Low | Severe inequalities, concentrated in low-HDI countries such as those in sub-Saharan Africa; profound deficits in female education and health metrics dominate.[26] |