Outcomes

In 1960, when the CIA first embarked on its campaign to kill Fidel Castro, one of its first schemes involved slipping poison into el jefe’s rum-and-Coke. (They had a sense of poetry in the Eisenhower Administration; the drink is commonly known as a Cuba Libre.) To cook up an undetectable slow-acting poison, the CIA relied on an elite team of chemists from its Technical Services Division. CIA Director Allen Dulles designated this top-secret group the “Health Alteration Committee.”

I sometimes think of Alan Dulles whenever I see some well-meaning organization claim that it is improving the “health outcomes” of some favored group of people. I find the meaning of the phrase a little hard to pin down, though I suspect it’s probably close kin to what Dulles meant by “health alteration.” Usually, when anyone claims to have improved some people’s health outcomes, it means that fewer of the people died. (By that standard, almost no one has had a better health outcome than Fidel Castro, who has outlived Dulles, and practically everyone else, by something like 40 years and counting.)

But “health outcomes” aren’t always that final; sometimes the phrase refers to the incidence of malaria or diabetes or whatever the disease under discussion happens to be. Sometimes “improved health outcomes” just means that fewer people got sick at all, or when they did get sick they recovered faster. Or something like that. In any case, “health outcomes” is most often just the verbal equivalent of a rubber glove. It spares us the discomfort of having to touch on matters of disease, contagion, and death.

In recent years, though, “outcomes” has roamed far from the hospitals and clinics, and now is the approved word for anything that results from anything else. “Outcome measurement” is now the fancy term for the kind of evaluation that tells you what you accomplished, and how much of that accomplishment is specifically attributable to your work. “Outcomes-based funding” is a way of paying people and programs based on what they’ve achieved, rather than how much work they’ve done. Even though expressions like that tend to be overused and freighted with unearned importance — as if they contain depths of meaning never before plumbed — they’re not all that hard to understand. There are plenty of worse shibboleths in the public-interest world.

But the word is fast slipping even those tenuous moorings. I more and more often read sentences that refer simply to “outcomes” generically — no “health,” no “measurement,” no “funding,” just the unadorned, disembodied word hanging out there as if it meant something all by itself. Thus the following sentence, submitted by an exasperated reader: “We implemented a survey to collect research on best practices … so the school district could implement its findings into its most vulnerable sites in order to improve outcomes for young males.” That sentence is a miniature museum of public-policy-school shibboleths, all strung out for our admiration: “implement,” “best practices,” “vulnerable,” and then the crowning vacuity: “outcomes.”

And what does it mean in this case? It means “whatever happens.” Nothing more. The word is no longer even being used to refer to the “outcome” of anything in particular. Oh, yes, I guess we’re supposed to presume that those “best practices” will somehow contribute to all these “young males” becoming successful “old males” (no Health Alterations, please), and living lives that will be, in some completely unspecified way, better than the lives they would have led if they had been subjected to less-than-best practices. But what connection might there be between the “practices” and the “outcomes”? It’s anyone’s guess.

In the world of that sentence, everything that happens — every single thing — is an “outcome.” Once a word means everything, it means nothing.

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