Web Extra: Marion Ritchey Vance ’60

Marion Ritchey Vance ’60

Marion Ritchey Vance ’60 believes that we need to change our values—and our expectations. She tells the story of Father Javier Giraldo, a Jesuit priest and human rights activist who, in addition to his work on other causes, helps homeless children escape the streets of Bogotá, Colombia.

Listen to a clip from the Voice's interview with Marion Ritchey Vance:  

My name is Marion (Ritchey) Vance ’60. This is the year of our 50th reunion at Carleton. Post Carleton, I wandered around for quite a bit figuring out what I wanted to do with my life and ended up spending 30 years in grassroots development in Latin America. By the time I ended that career I was director of learning and evaluation for Inter-American Foundation [an independent agency of the United States government that provides grants to nongovernmental and community-based organizations in Latin American and the Caribbean for innovative, sustainable, and participatory self-help programs]. I retired about 15 years ago, and am back in my native Colorado. My husband and I live north of a little place called Woodland Park on 35 acres with two horses.

The legislation that underwrites the Inter-American Foundation was passed in 1969, when everybody was questioning the United States’s approach to foreign aid. A little book came out, written by two ex-Peace-Corp volunteers, called We Don”t Know How. The thesis of that book was that many zillions of dollars that the United States had poured into foreign aid, particularly into Latin America under the Alliance for Progress, not only had not done what they hoped—which was to eliminate poverty in Latin America—but in the long run might do them more harm than good. Foreign aid tended to make the rich richer and the poor poorer because we chose to deal with high government officials or big institutions who thought they knew what was best for people; and you simply had a lot of failed projects. Not just failed projects, but ones that might have left people worse off than they were to begin with.

So a few progressive people at that time decided to put together an institution that would take the exact opposite direction, that would say, “Let’s start at the grassroots. Let’s start by talking to people. They know their own problems and let’s see what they think would be solutions to those. Then we’ll simply support them to do what they’ve either tried to do or know they can do themselves.” That was the simple—some might say simplistic—underpinning of the foundation and, to a lot of peoples’ astonishment, it worked.

The foundation’s first publication played off the title of that book We Don’t Know How, and was titled, They Know How. It was a compilation of stories about how little bootstrap groups throughout Latin America had proposed a project, gotten it funded by the foundation, made it work, and had it be successful. I don’t mean to say 100 percent by any means. There were some pretty spectacular flops along the way, too. But by and large, the concept worked. At the Inter-American Foundation, we weren’t the organizers. When we decided to fund a program, it’s because we had confidence that local leadership was in place. They’re the ones who know what they’re doing. Of course we made some bad bets too, but the idea was to fund the people who are on the local level.

We get on an airplane and go back to D.C. We have no business doing the organizing ourselves. I already had been working in Latin America for a long time in one kind of foundation or another. So when I started, I already had a pretty good idea of what it was like out in the field. In fact, the foundation went out of their way to only hire the “savvy” Latin hands who had a lot of experience, who were supposed to know what we were doing, and who had almost-native-speaker language skills.

I started out as a field rep for Colombia, South America, which in ways is the best job I ever had. You couldn’t have paid me to work that hard, but on the other hand I was getting paid to spend time with the most interesting people in that country; and I had absolutely free rein. I could follow up any lead that came in. My job was to find out: Is the proposal legitimate? Is it just chasing money that they know is available? If it’s legitimate, is it feasible? Can it keep going when our funding ends? Is it sustainable in some way or not? And then to give them a grant and follow up on what they did with it.

I became regional director for the Andes region—countries from Venezuela on through Bolivia—and that continued to be a lot of fun, but it was more administrative than field work. We just kept testing the thesis that you could give people at the grassroots of society the support they need to do things for themselves. Plenty of stories say, “Yes it worked.” In some cases, spectacularly. In other cases, as I said, not well at all. I ended up as the director of learning and evaluation, trying to figure out how the dickens you measure success in that business; and I think that was the failure of the foundation. The whole idea was that we were supposed to learn lessons about foreign aid for development and then transmit those to the larger agencies that worked with much bigger budgets. There are some small successes, not a lot. People said, “Isn’t this lovely? They’re doing a great job, and they didn’t change a thing.”

That was and is still my struggle. The foundation had me write an article for the 40th anniversary issue of their journal, Grassroots Development, on how to measure the intangible elements of that kind of development. The tendency is to try to put a number on everything, and to only think something is real if you can measure it or it’s tangible. Many of the benefits couldn’t be put on a scale to see how much they weighed. They were things like self-esteem, cooperation, strengthening of organizations, gaining clout with the powers that be, having a voice in how things operated. Well, how do you put a number on that? How do you measure it? That’s still an obsession of mine.

When you first called, you mentioned that these interviews were about peace in any way that one wanted to look at it. I discovered after the conversation that I’ve been thinking about this, for the last few months anyway, on the level of world peace, global peace. And not just peace, but whether there’s any prospect for it or not. To my surprise, I found that I’m a little pessimistic about it, and I hope to get over that by the end of this interview. I was surprised, because by nature I’m an optimist.

I realize that on this question of prospects for world peace, I see it as pretty bleak. So that started me thinking, “Well, why am I uncharacteristically pessimistic here?” I think it got kicked off with news about armament sales. I don’t know how you foster peace when the business of arms trafficking is as lucrative as it is. It doesn’t matter whether it’s a tribal war in Africa or it’s a drug war on the Mexican border, or it’s a cold war—war is lucrative. It makes a lot of money for a lot of people, and there are a lot of vested interests in keeping some kind of conflict going.

That’s a big worry. Then I started thinking, “How would the world become peaceful?” And this is where I started to link global peace with personal or inner peace, because I started to think, “Well, why is there always conflict?”

No matter how far back you look in history, it seems that there’s always conflict, there’s always war, there’s always somebody invading somebody. Have we ever had a time of peace? I can’t think of one right offhand. I mean there was Pax Romana, but that’s because the Romans had an army that enforced the Pax.

To me it boils down to two basic human instincts. One is a basic instinct for survival, to keep yourself safe, to keep yourself alive. The other instinct is the drive to always be better, to constantly improve. If it weren’t for those instincts, obviously we wouldn’t have society and civilizations and progress.

On the other hand, I think conflict is caused by those two instincts basically running amuck. It’s easy for the instinct for survival to turn into fear, into defending yourself against a real or imagined enemy. That survival instinct is also part of the herd instinct, and it’s easy for that to turn into mob psychology and patriotism in its least flattering sense of “them versus us” and “we gotta go out and get them.” And it’s the same with the instinct to always improve and progress, which is the hallmark of the human species. It’s easy for that to get carried away, too, and all of a sudden everybody wants more—more money, more power, more territory, more possessions—and that leads to all kinds of problems.

Marion Ritchey Vance ’60I’m not sure that the same thing doesn’t happen at an individual level. The instinct to survive can turn you into somebody who is “me first” all the time. And the instinct to improve or get more easily crosses the line into greed. All that, at least in our day, is fed by a consumer society that depends on convincing people that they need to buy more, be more, be perfect. You’ve got to buy something that gives you perfect teeth or a perfect figure or perfect children or whatever.

I think that’s an impediment to inner peace. People get to the point where they don’t feel they’re ever good enough—their house doesn’t look like the house on TV or it’s not the biggest one on the block. This constant hole inside needs to be filled with something, whether it’s buying possessions, or overdoing alcohol, or taking drugs—whatever fills that gap that’s left in you because you’re never satisfied.

The same is true with religion. It’s an integral part of the human spirit to believe in something greater than one’s self. But that spills over the limit into fundamentalism, where “I know what I believe in and it’s the only truth,” and “I’m right and you’re wrong, and therefore my job is to convert you or eliminate you or whatever.”

Once our human instincts, which are good in and of themselves, become exaggerated, they disturb the peace on all levels—individual, national, global.

I don’t want to sound totally pessimistic. I look at all the things that I think work against peace and I think, “Well, what have we come to value in this world?” If you look at what people now think is good, it’s the tough guy, the people who kick-back-side, the strong man, and the super power. What are the things that are denigrated in our society? Look at the words we use—wimps, people who compromise on things—negotiation is seen as being soft on communism or soft on crime or whatever. So soft things are looked down on and tough things are good.

What our society seems to think of as entertainment, the percentage of so-called entertainment that is violence, really worries me. Kids are seeing so much of it. I don’t know how much of it you can see until you become inured to it, until it becomes normal, expected. That worries me.

And here I get to my favorite topic of civil or uncivil discourse. What do you see on TV? You don’t see thoughtful dialogue where each person is willing to look at the other side. You see the most extreme, the most outrageous, and unfortunately that’s what sells. Rude, loud, and outrageous sells. Now I’m being pessimistic again. . . .

So is there any hope? What do I think might change that? I do believe that it’s instincts run rampant that get us into problems. I don’t think the instincts are going to change. Those are hard-wired into us. So the only thing you can change if you could would be your values. If striving is built into the human character, then the only thing you could change is, “What is it you think is good to strive for?”

At the moment, our measure of success is pretty unilateral. It’s the almighty dollar, or the equivalent of it. As long as the only measure of success is money and how much of it you make, then anything goes. The end justifies the means. As long as you’re rich it doesn’t matter how many bloody bodies you trampled to get there; you’re rich and you have a big beautiful house.

So if you’re going to change anything it seems to me it has to be in a question of, “What is of value? What do we think of as having worth in the world?” If you could begin to change the definition of success, you’re successful if you raise happy children, or you’re successful if you put your energies into betterment of the community or public service of some kind. If you can’t change the instinct, you have to change what we perceive as worth driving at.

In a way, that’s what’s gotten me re-engaged with Carleton. I walked off campus and I didn’t go back for 40 years. And now over the last five years, I’ve been much more involved. I don’t begin to know what all goes on there, but I see a lot of little bright lights out there on a pretty grim landscape, particularly in the way Carleton encourages students to define success—that it is often more cooperative than competitive.

I see a real effort at Carleton toward encouraging civil discourse and encouraging thoughtful approaches to problems. It’s really neat to see the school harness the intensity and the competitiveness of the Carleton students to conserve energy. The new halls have panels in the lobbies that measure how much energy you’re using floor by floor, hour by hour. And so now the competition is, “How little of all that can you use?” You know, “How much can I save Mother Earth by unplugging my computer or not letting the water run in the shower?”

So it’s using the traits for something that is good for the planet. If you go back to my 30-year career, I guess a lot of what I did I saw as related to that old song, “No Justice, No Peace.” In a way, what we were trying to do was help some of the people on the lower end of the totem pole feel that they had a little more justice in their lives—in being able to have a voice in their own affairs, in getting fair prices for products, in not being harassed by the local army or police—all kinds of things as you go across the spectrum of poverty in the world.

There is injustice on just about every account you can imagine. And the more you can help people feel just a little bit that they’re on a playing field that’s not totally tilted against them, that contributes to peace. It really is true—no justice, no peace—if people are feeling downtrodden, at some point you’re going to hear from them. That was the thread that ran through the whole of my work, and I tried to write about it as much as I could, in foundation publications, to get the word out.

I’ll give you two examples. One is in the mountains to the east of Bogotá in Colombia, between the capital Bogotá and the border with Venezuela. It’s a mountainous area, a lot of little tiny family farms where people had very little opportunity to organize or to improve their lives through education or better production or whatever. And the foundation funded several grants there—and actually this was under the auspices of the Catholic church—that set up a couple of organizations to help people organize first at the community level and then at the regional level. Under the auspices of a larger, overarching institution that could get a hold of money and that had some sway in politics and over a series of maybe four or five years, the advantages of organization and collective bargaining strength began to show up in better prices.

Now, every little family wasn’t at the mercy of the middleman. They could get together, have their own truck, market things, sell them at a price that gave them a little bit of profit. They had enough sway to get a member of the peasant group named to the board of the Agrarian Reform Institute. So now you’ve got somebody from the grassroots who has a voice in how land is distributed.

They began to get better prices for the things you need to run a farm: fertilizer, seeds. So in other words, by not being 1,500 isolated little farm families, now they had an organization, now they had a body that could speak for them on a level that had to be listened to.

Anytime you see people getting organized in a way that begins to threaten the livelihoods of people who’ve made a good living by charging them more and paying them less, you have resistance. That is the reason that most of those organizing efforts need to have some kind of umbrella organization that they’re affiliated with that has enough clout in the System—with a capital “S”—to be able to resist the efforts to stop it. There almost always is resistance from somewhere; somebody’s ox gets gored whenever you shift the balance. So that’s the organizational model that I’ve seen work. Not without its problems, God knows, but it did help people improve their lives.

Another one that has been replicated, never as successfully, was in Bogotá, Colombia; and that was with the gamines, the notorious street kids of Bogota. These are tough little characters; some are as young as six years old. Colombia’s a rough place if you’re poor and living in the slums of the big cities. A lot of kids, because of mistreatment, abuse, and hunger, choose to leave their families and live on the streets. Once they’re on the streets they form—I don’t want to use the word “gangs” because that’s such a loaded word in English—groups of boys who live together and have their sleeping quarters together. They pile up their cardboard under the same bridge. The tendency always was to look at them as the dregs of society. People were content with cursing them and thinking they should be locked up.

Along came a priest, Father Javier de Nicolo, from one of the Catholic orders that is famous for working with children—the Salesians—who said, “Wait a minute. These kids are not the scum of the earth. These kids are some of the best. They’ve got the gumption to get out of a bad situation. They’ve got the smarts to live on the streets. They’ve developed a real communal culture whether we like what they do or not. They have a lot of solidarity, and by golly they’re gonna get ahead and they’re not afraid of anything.” He said, “Let’s assume that these are the cream of the crop and let’s see if we can harness that energy toward a more constructive end.”

His idea was, “You cannot force them off the streets, they’re smarter than you are. You’ve got to attract them. You’ve got to set up something where it looks like more fun to be in a program than out on the street.” And he co-opted a lot of the things that the kids do. I mean this was just a big kid himself in a way and he knew how to set up an environment that captured kids imagination, and when he went to build an educational facility, instead of doing what most people do for delinquent kids, which is, “Let’s build it of cinder block and concrete, and let’s make it indestructible and it’s ugly and it’s functional, but that’s all they deserve.” And he said, “No, no, no. We are going to create beauty and cleanliness and light and flowers, and the kids will rise to the circumstances.”

And so the main educational facility, La Florida, doesn’t look a whole lot different than Carleton College campus. Beautiful brick buildings and lawns and flowers; and by golly, the kids are organized by house. They don’t live in any huge institution, they live in townhouses and those townhouses are organized. Each one has its leadership. That leadership went into an overall council and the place has a mayor and the kids are in charge of a lot of the discipline themselves.

And sure enough, a lot—I’m not saying all—of those kids rose to the occasion. When they were treated with dignity, when they were assumed to be smart and creative, when they were allowed to have fun and even be pranksters sometimes, they thrived.

One kid who’d left his home at the age of eight, stowed away on a bus on the way from Medellín to Bogotá, slept on the motor of the bus that night because it was warm and it’s freezing cold in Bogotá. He went through the program, was found to have leadership qualities, and ended up getting a scholarship to Brattleboro School of International Studies in the United States. He got a master’s degree and was hired by a Dutch agency to be head of their Latin American foreign aid program, so he ran that for a while throughout most of South America. He got married and had a son.

Part of the whole idea of [Father Javier’s] program was to break that cycle of poverty. Father Javier’s idea was to stop the cycle of abuse, because abused kids become abusive parents. He felt that if these kids learned the values of home and love and opportunity, they would be more likely to pass that on to their kids. As far as I know, he has been successful.

On some days I say, “By golly, look at this. You’ve got all of these different kinds of organizations working toward what I was talking about before.” Different kinds of values where you look at, “Are your energies devoted to improving your community, to giving kids educational opportunities, to doing all kinds of things that I think of as good works?” rather than, “How can I get a bigger house and how can I make more money?”

Those organizations are isolated little pockets in many cases. So sometimes I think, “Oh boy, we’re really turning the corner here,” and then I look at the power of the vested interests that are arrayed against them, and I get pretty discouraged. There are an awful lot of people who are doing well in the system as it is now, be they in the financial industry or the arms trade or wherever. Change isn’t going to benefit them, so I don’t know, I don’t know . . .

We have to change what we see as values in this country. As long as your value or self-worth is measured by how much money you make, by how big your house is, by how many boats you can buy, I don’t think there’s much hope. But if those things suddenly become not goals to be worked toward but things that people are revolted by, oh boy! You know, why does so and so really need 8 houses and 14 boats and $600 million a year?

Instead of seeing that as the pinnacle of success, if that begins to be seen as self-serving, then maybe people will start to strive for something else. If we measured worth by, “What did you do today to begin to crack the problem of homelessness,” or “What did you do today to make sure that all children get an even start when they go into school?” We have to change how we define success. It’s a question of definitions.

We’re getting a lot better about that, actually, as a society. In my school days, everybody took it for granted that you went to four years of high school and you went to four years of college. If you were a woman you got married, if you were a man you got the best paying job you could and that’s what you did. And if you took time off for something, you were a slacker, a dilettante.

If your aim was to live peacefully in the mountains somewhere, you were lacking in ambition, you were lazy, you were whatever; and that’s changing. The values are changing. We tend to admire people now who take a different path that’s more suited to their personalities and their sense of things that are good in the world.

I mentioned that the only hope I can see lies in changing the definitions of things. One of the things I would love to see the definition change for is “hero.”

In the first place, I think we’ve cheapened the word because every day there are four or five heroes in the newspaper. It’s not that the ones we pick haven’t done wonderful things, but maybe we don’t look deeper to see who are the real heroes in life.

The real heroes in my mind are third-world women and women living in poverty in this country, as well. These women are amazing. You see women living in conditions that you can’t imagine a human being living in. They’ve got five or six children. They’ve got a husband who is absent or abusive. They keep going, day after day after day, and they do it with a smile; and they work long hours, they work two jobs.

I think of the maids in some of the big cities in Latin America. They’re unfailingly cheerful little souls, and then you find out that because it was a transportation strike, they got up a 2 a.m. and walked for four hours to get to that job, because if they didn’t get there they’d be fired. And that meant, they get no sleep, they’re walking in shoes that you and I wouldn’t go to the mailbox in, and then they’ve got to take care of their children. They’re probably also the ones who contribute to the community organization. It’s people like that that who are real heroes as far as I’m concerned.

I don’t mean to just slide it toward women. There are plenty of men who are in the trenches day after day after day, working to improve conditions of migrant laborers or whatever, who sacrifice a whole lot in their own lives to try to better the condition of their fellow man. Those are heroes to me.

Nowhere do they appear in the history books. We read about the generals and the movie stars and all those. You never read about the “little people” who are out there in the trenches day after day after day in conditions that would discourage me in a week. That is one thing that I’d like to see change.

Some solutions I know aren’t possible, but I think we have to start at the level of young children. I’m afraid we’ve got an adult population who have been brought up to think that a discussion means who can yell the loudest at whom; and what we think of as discourse or discussion has become entertainment that masquerades as news. The trick is to get better ratings, and the better ratings are the things that make everybody sit up and pay attention.

Somehow we’ve got to turn down the volume on that. Again, it’s a question of, “What do we value?” Do we value the guy who can talk in the most intransigent terms or do we value the person who’s willing to listen and think about what the other guy just said. Unfortunately, that doesn’t make for good entertainment, so that’s a real problem.

How do you achieve civil discourse? Someone tried it here in Colorado Springs. A wonderful woman set up an interesting series of conversations with good facilitators called “Civil Discourse,” and she invited people she knew. It was difficult to get people to attend. The series was held at the University of Colorado in Colorado Springs, and it was half way to Kansas for me, but I went because I wanted to support her. The conversations were well facilitated, but the audience just wasn’t there.

To moderate these forums, you have to have skilled people who can, without putting people down, suggest that they take a different tone and that maybe they spend as much time listening as they do talking. If we’re going to get anywhere, we have to start with school-aged kids. From the time they go into school or into the grade school, get them accustomed to getting together at elementary levels, or working up to where you get as many brownie points for listening to the other guy and trying to understand what he’s saying as you do for winning your own point. I told you I was obsessed with this!

“How do we measure things? How do we give grades out for things?” A bright spot is Carleton—Carleton and, I presume, other colleges of its sort are doing the same thing: trying to set up situations where people from different points of view and different disciplines come together and try to work on common solutions. The new dorms are set up so that you’re encouraged to get out into public spaces and interact with people, rather than holing up in your own dorm room and listening to your own version of the news, whatever that is.

And lots of cross-disciplinary kinds of things, so that people from very different slants come together and say, “Well, here’s a common problem, how can we all contribute to the solution here?” Instead of saying to people, “Your job is to defend, tooth and nail, your position,” maybe you say, “Okay, you’re going to be graded, or your peers will respect you, for seeing how you can soften a little bit and come to common ground. Your job is not to defend to the death what you think, but to try to understand what the other guy thinks and why he thinks that; and if you don’t agree, you don’t agree. But at least you haven’t pounded the table and yelled.’

This is a subject on which I’ve been thinking and writing—about the need for new yardsticks on all kinds of levels. And by yardstick I mean what are the elements, the values against which we’re going to measure somebody? As long as the yardstick is measured dollar by dollar, I think we’re in trouble; if the yardstick has a different measurement, maybe there’s hope.

Marion Ritchey Vance ’60

I’m about to read a little essay that I wrote almost as postscript to a more formal treatment that I did as an article for the Inter-American Foundation. They asked me to write something on my experience with trying to set up a new system for evaluation of social projects. I had to submit that for a different purpose, but I got to thinking that the article itself didn’t quite say all I had wanted to say about the subject, so I wrote this as a more informal postscript. The title of this little essay is: “Measurement Matters Mightily: Why the way we assign value is so critical”

I’ve been thinking about this for two decades or more. Initially it was in relation to Inter-American Foundation–supported projects in the field, but then on a larger scale. In 1988, I wrote a somewhat tongue-in-cheek memo to my boss when the powers that be were demanding numbers. This is an excerpt from that memo:

“I know it’s frustrating to people when we appear to hedge and fudge on beneficiary figures. Why can we never give a straightforward answer to a simple question of numbers? Because it’s not a question of numbers, it is a question of values and definitions. Take OCBA, that’s the acronym for a folk arts and traditions project in Colombia.

“Depending on whether you count the craftsmen directly benefited, or the impact of spinoff programs, the number of beneficiaries works out to somewhere between 120,000 and 250,000. We’d be hard-put, of course, to substantiate the benefits that are intangible. That doesn’t mean they are not real, especially to a kid whose culture becomes a building block, not a millstone around his neck. That’s our problem. We deal with a lot of things that don’t have a numerical value, which, ironically, is why we’re widely recognized in Latin America as ‘understanding development.’

“One of the catalysts that got me thinking on a larger scale than this was a counterculture book on economics called something like Barefoot Economics. The book profiled a number of instances in which the fixation on gross domestic product, the way GDP is calculated, has been so counterproductive for third-world nations and devastating for the environment on our planet.

“An example that stuck in my mind was Brazil, where the GDP rose impressively in the early 1970s. One big element was timber. Every tree felled in the Amazon basin and turned into lumber or pulp counted toward Brazil’s gross domestic product. Clear-cutting the rainforest was profitable. It boosted GDP and that was good for the image of a country concerned with breaking out of the ‘underdeveloped’ category. The value assigned to trees left standing in the rainforest was zero. I’ve since become sensitized to how often the selection of results to be tabulated leads to perverse incentives and undermines the real purpose of an endeavor.

“For example, the war on drugs and guerillas in Colombia as reported by NPR in April 2008. At some point, the government of Colombia began measuring its success against the long-running revolutionary army, the FARC, by counting the number of FARC guerillas killed. The more dead bodies produced by a regular army unit, the greater the prestige and rewards for its commander. Effect in the field—shoot peasants, outfit them in guerilla garb, plant weapons, and photograph the bodies as proof. The tactic meets the government’s stated criterion for winning battles—i.e. number of bodies. In the process, it exacerbates the very resentment in alienation that is causing it to lose a war.

“Another example: Fighting crime. A similar story was recently reported by MPR in connection with the Baltimore Police Department. Considering officers for promotion, apparently the statistic that matters is ‘number of arrests or convictions,’ thereby rewarding the officer who racks up large numbers of small arrests for minor offenses and discouraging those who would take on major crimes that require time, effort, and risk to win a single but critical conviction.

“Let’s look at public agencies. Less dramatic, but corrosive, nonetheless. The purpose of OSHA is to promote safety in the workplace, but in many workplaces OSHA is an object of ridicule: why? Because evidently its standards for job performance and promotion are based on the number of infractions reported. Hence what behooves an investigator is to seek out as many technical violations as possible because that’s what’s measured, not whether the workplace is in fact made ‘safer.’

“Return on investment in higher education. In a recent conversation on the subject, it came out that certain universities or departments gauge their success by the level of income attained by graduates. Enrichment is defined by personal gain. Contribution to society, positive or negative, doesn’t fit in the equation.

“Why does all this matter? Because the way we grade performance is critical to the way people and organizations do their job. A shortcut reward system based on immediate ‘objective’ results that are easy to count can subvert the underlying purpose of the enterprise. In our short-term bottom-line society, should we be surprised that businesses cook the books to meet Wall Street and will set expectations for those do-or-die quarterly reports. If the financial industry’s heavy bonuses and stratospheric compensation are tied to the volume but not the soundness of loans and mortgages that go out the door, should it be any wonder that a lion-share of money that went out doesn’t come back?

“The question of what is valued and how value is calculated goes to the heart of past problems and future dilemmas in our society caused by the toxic wastes, polluted air and water, and chronic illness left over from mining and manufacturing. They were not weighed against private profits because no value was attributed to the public domain or the public health—which, by the way, are still being restored at public expense.

“As the nation wrestles with healthcare, it will face a fundamental choice between salvaging a system geared to treating illness and creating one in which the highest value is maintaining health—and incentives are provided accordingly. That is proven devilishly hard to do, not only because of vested interests, but because wellness is difficult to define and evaluate. Surgeries, hospitalization, prescriptions, all can be tabulated objectively and all have a dollar value.

“By what measure do we account for the prevention of diabetes or other illnesses warded off by routine checkups, early diagnosis, and healthy lifestyle? The stock answer is “You can’t prove a negative.” But we can transform our expectations and rethink our goals. If the health system were a partnership between patient and physician with responsibilities and rewards on both sides for maintaining or achieving good health, surely we’re creative enough to devise credible benchmarks of success in pursuit of these goals. It may mean less reliance on the object and the clinical, and more on communication, caring, and plain common sense.

“Footnote: I’ve remembered for years the comment of a Chinese friend. He said, ‘It’s very strange here in the West. When you get sick you call a doctor. When we get sick we fire our doctor because it’s his job to help us stay well.’ ”