The tragedy of spurious micro-targets

In the absence of broad, explicit goals that are meaningful to ordinary people, we get narrow, short-term goals that mean a great deal to those who devise them, but nothing to everyone else. A UK Government investigation into the maternity care provided by Shrewsbury and Telford Hospital to 1486 families, mostly between 2000 and 2019. It found that 131 stillbirths, 70 neonatal deaths and nine maternal deaths might have been avoided, had care been better over two decades. The Economist concludes its column:

When one woman pregnant with twins requested a Caesarean, a doctor is said to have replied: “We’ve got the lowest Caesarean rate in the country and we are proud of it and we plan to keep it that way.” One of her twins died. A report castigates the National Health Service, 'Economist', 2 April

Our large, complex societies need to target aggregated indicators of well-being. But I think we should as far as possible target meaningful outcomes themselves, rather than indicators that are not strongly correlated with well-being. In particular we need to avoid targeting spurious measures, such as Caesarean rates, that are too narrow to reliably measure anything that we really want to achieve. 

I have written about applying the Social Policy Bond principle to health here. In summary: in the rich countries we could use broad health indicators such as longevity and infant mortality. In the poorer countries we might encounter problems gathering reliable longevity data, but objective sample data on, for instance, infant mortality, weights of young children, nutritional intake, could be available and useful. Refinement by experts, and aggregation into something like the Human Development Index, would see the creation of much targets that would be both more sound and more meaningful than the current array of indicators ranging from such narrow targets as local Caesarian rates to GDP per capita the latter of which, in the absence of sensible targets has, unfortunately, become the de facto over-arching target of governments everywhere.