More, please!

As a former special education teacher, one of my biggest jobs was undoing the damage my students incurred from standardized testing.  Beginning in third grade, the students are tested almost every year.  Their results share not only the student’s personal strengths and weaknesses but also how they compare to their peers.  Sometimes the scores are just about reflective of the student’s academic abilities.  Sometimes the scores are way off.  This might be due to a number of factors: mental or physical illness the day of testing, test anxiety, format of the assessment, assessment bias, lack of resources accessible to the student, or a difficult social year for the child.

The similarities between standardized testing for public school students and comparative assessments for health systems are profound.  The WHO’s 2000 World Health Report was right on with some of their conclusions.  A great example is of South Africa’s ranking in overall performance at 175 out of 191.  While their medical capabilities may be quite advanced, the disparity of health services between South Americans is quite large (1).  This seems to be a fair ranking.

There are valid concerns about the report, however, and many reflect the same concerns about standardized testing.  For example, Dr. Vincente Navarro criticized in his report that, because the test is written by an organization that is highly influenced by countries that value privatization and competition in their healthcare systems (2).  This tester bias is quite unfair to systems that operate differently but not necessarily worse.  Further, oversights or errors in thinking can cause skewed data results that do not accurately portray the functionality of a country’s system.  Lastly, health systems do not stand on alone.  They are influenced by various other systems and cannot be held 100% accountable for their results if the oversight of other systems is partially to blame.

Some critics of both standardized testing and measures of health system comparison surely argue that they should be done away with for these reasons.  I argue the exact opposite.  What we need is not less accountability.  What we need is increased variety and a less punitive view regarding results.  The WHO shouldn’t be the only organization receiving worldwide funding or attention for their standards of comparison.  Further, the purpose of any type of report is not to compare countries to one another for the purpose of pointing out winners and losers, nor is it to point out how individual countries are failing.  The purpose is to encourage countries to continue effective strategies, to prompt sharing of ideas amongst countries, and to point out areas of improvement, all while remembering that no test is perfect or definitive.  The distinction is in the outlook and, while it may seem minute, it makes all the difference in the world.


  1. Coyne, J.S. & Hilsenrath, P.  (2002).  The world health report 2000.  American Journal of Public Health, 92 (1), 30-32.
  2. Navarro, V.  (2002).  Can health systems be compared using a single measure of performance?  American Journal of Public Health, 92 (1), 31-34.

1 Comment

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One response to “More, please!

  1. Siobhan Loughman

    Quite interesting connection between two kinds of performance testing, students and health systems. As a former teacher of adult special ed students I understand the limitations, but also the value of having some measures of progress or success.

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