Two contrasting topics this week have had me thinking about measuring change, which reminded me of the eloquent arguments given by Ben Goldacre* about the use of proxies in medical research, and have led me to think about their use in other areas.
Firstly, I saw a talk given about the inherent complexity in development activities and research. At a fundamental level, we really do not know what policies and activities work best to alleviate poverty, but institutions are so set in how they function, that it is hard to do things in new ways. So we identify problems that we can solve (e.g. the lack of bed nets for keeping out mosquitos) rather than face up to the ones that are more complicated (how to eradicate malaria). By focusing on targeted issues, we can feel that we are making progress, even though our ultimate goal (improved health and wellbeing) is too amorphous to measure.
Then I read this blog post about Rape Crisis Scotland promoting their Reclaim the Night march with banners saying “Women are not for sale”**. That post linked to this blog about the new model in Sweden which is aiming to eventually stigmatise the purchase of sex to the point of eradicating the sex industry. When I look around (the internet, mostly) it seems that many younger feminists (3rd/4th wave) are calling for less prohibition around sex-work, which is in direct opposition to the tide of policy. It occurred to me, again, that perhaps what we have here is an issue of proxies. All feminists want to end violence against women, but there is no known way to do that unilaterally. Women who are sex workers are at greater risk of violence, so prohibition seems like a way to reduce that violence. But really, the thing that we actually want to reduce is patriarchy (well, kyriarchy, but this is a very gendered issue), and violence against women is just one indicator of that. The prevalence of sex-work is a proxy indicator, used because of the correlation between sex-work and violence against women.
The use of proxy indicators is easy, and in some cases essential, when we cannot directly measure the thing that we want to change. But there is a real danger of actually changing our actions, in order to fit within the framework of what can be measured. The ONLY way to really know how to bring about change that we want is to come up with a bunch of ideas, randomise the end-points, try out the ideas, and see what works. This is much harder in social science than medicine of course, but it’s still the only way.
*We want to know about morbidity and mortality, but this takes too long to measure and is affected by too many things, so we measure proxy indicators like blood pressure. But drugs which affect those proxy measures still may not affect the thing we really want, in the way that we want.
**Not all sex-workers are women, obviously. But most violence in sex-work is against women, by men.