Following the algorithm: How epidemiological risk-scores do accountability

Abstract

Epidemiological risk scores are calculative devices that mediate and enact versions of accountability in public health and preventive medicine. This article focuses on practices of accountability by following a cardiovascular risk score widely used in medical counselling in Germany. We follow the risk score in the making, in action, and in circulation to explore how the score performs in doctor-patient relations, how it recombines epidemiological results, and how it shapes knowledge production and healthcare provision. In this way, we follow the risk score’s various trajectories – from its development at the intersection of epidemiology, general medicine and software engineering, to its usage in general practitioners’ offices, and its validation infrastructures. Exploring the translations from population to individual and back that are at work in the risk score and in the primary prevention of cardiovascular disease, we examine how versions and distributions of accountability are invoked and practiced as the score is developed and put to use. The case of a simple risk score used in everyday counselling brings into relief some key shifts in configurations of accountability with emerging versions of ‘health by the algorithm’. While there is an increasing authority of algorithmic tools in the fabric of clinical encounters, risk scores are interwoven with local specificities of the healthcare system and continue to be in the making.