What is thriving?: Pragmatists

Two people are alive

In 2017, a county health department in eastern Kentucky received a grant to reduce deaths of despair. The program director, a former ER nurse, had to choose: spend the money on screening instruments to track progress, or hire two community health workers to drive to hollows where the nearest clinic was forty minutes away.

She chose the workers. The grant was not renewed because she could not demonstrate measurable impact.

Two people are alive because she chose the workers. The data proving they are alive does not exist.

We use the quantifiers’ scales. We cite their studies in grant applications. We train our staff on the PHQ-9 and know the cutoffs by heart. We are not the people who refuse to measure. We are the people who measure on Monday, allocate on Tuesday, and bury someone on Wednesday whose score looked fine.

The phenomenologists describe something real. We have watched people come back from grief through processes no outcome measure captures — a woman in a talking circle saying the thing she never said. A teenager lighting a fire without matches and something shifting behind his eyes. These moments are real. They are also happening inside a system that will defund every one of them unless someone demonstrates results.

Bhutan’s failure was not measuring happiness. It was measuring and stopping listening for what the measurement missed. Finland measures aggressively and also responds to what people say in relationship. The measurement is the floor. You send the health worker to do the thing no measurement captures. Both steps. That order.

Where we concede ground: We have submitted outcome data that satisfied the funder and described nobody. The system often degrades into performance of accountability.

What would change our mind: Equivalent resources allocated through clinical judgment without metrics producing equal mortality and cohesion outcomes over ten years.

Read the full synthesis: What is thriving?