The science and politics of targeting: Who gets what, when, and how

Targeting has been defined as a method by which goods, services, or other programmatic actions are delivered to groups or individuals who have specific characteristics. Similarly, politics refers to the social processes that determine who gets what, when, and how. This similarity suggests there may be utility in undertaking an explicit analysis of how the science and the politics of targeting relate to one another. Accordingly, this article outlines a technical/scientific framework regarding targeting and, using one element of this framework [sensitivity and specificity analysis], demonstrates that recent shifts in politics and policy in the United States can be more clearly understood when viewed from this angle. Then, the article outlines a basic framework on politics and uses it to demonstrate that one of the most fundamental features of our training, practices, and outlook (specialization) holds obvious benefits for advancing research but has three undesirable effects in the realm of policy: 1) it directly or indirectly encourages narrow, partial solutions to complex problems, some of which may have unintended effects on health or well-being for the very people we seek to help; 2) it creates a cumulative demand for research dollars, specialized interventions, and policy attention that far exceeds available resources and capabilities; and 3) it often prevents us from developing and advancing the common agendas and mutual support required to be effective in political and policy realms. The article concludes that more explicit analysis along these lines could strengthen our effectiveness in the policy realm.