There is no blueprint for evidence-based policy, so what do you do?

In my speech to COPOLAD I began by stating that, although we talk about our hopes for evidence-based policy and policymaking (EBP and EBPM), we don’t really know what it is.

I also argued that EBPM is not like our image of evidence-based medicine (EBM), in which there is a clear idea of: (a) which methods/ evidence counts, and (b) the main aim, to replace bad interventions with good.

In other words, in EBPM there is no blueprint for action, either in the abstract or in specific cases of learning from good practice.

To me, this point is underappreciated in the study of EBPM: we identify the politics of EBPM, to highlight the pathologies of/ ‘irrational’ side to policymaking, but we don’t appreciate the more humdrum limits to EBPM even when the political process is healthy and policymakers are fully committed to something more ‘rational’.

Examples from best practice

The examples from our next panel session* demonstrated these limitations to EBPM very well.

The panel contained four examples of impressive policy developments with the potential to outline good practice on the application of public health and harm reduction approaches to drugs policy (including the much-praised Portuguese model).

However, it quickly became apparent that no country-level experience translated into a blueprint for action, for some of the following reasons:

• It is not always clear what problems policymakers have been trying to solve.
• It is not always clear how their solutions, in this case, interact with all other relevant policy solutions in related fields.
• It is difficult to demonstrate clear evidence of success, either before or after the introduction of policies. Instead, most policies are built on initial deductions from relevant evidence, followed by trial-and-error and some evaluations.

In other words, we note routinely the high-level political obstacles to policy emulation, but these examples demonstrate the problems that would still exist even if those initial obstacles were overcome.

A key solution is easier said than done: if providing lessons to others, describe it systematically, in a form that describes the steps to take to turn this model into action (and in a form that we can compare with other experiences). To that end, providers of lessons might note:

• The problem they were trying to solve (and how they framed it to generate attention, support, and action, within their political systems)
• The detailed nature of the solution they selected (and the conditions under which it became possible to select that intervention)
• The evidence they used to guide their initial policies (and how they gathered it)
• The evidence they collected to monitor the delivery of the intervention, evaluate its impact (was it successful?), and identify cause and effect (why was it successful?)

Realistically this is when the process least resembles (the ideal of) EBM because few evaluations of success will be based on a randomised control trial or some equivalent (and other policymakers may not draw primarily on RCT evidence even when it exists).

Instead, as with much harm reduction and prevention policy, a lot of the justification for success will be based on a counterfactual (what would have happened if we did not intervene?), which is itself based on:

(a) the belief that our object of policy is a complex environment containing many ‘wicked problems’, in which the effects of one intervention cannot be separated easily from that of another (which makes it difficult, and perhaps even inappropriate, to rely on RCTs)

(b) an assessment of the unintended consequence of previous (generally more punitive) policies.

So, the first step to ‘evidence-based policymaking’ is to make a commitment to it. The second is to work out what it is. The third is to do it in a systematic way that allows others to learn from your experience.

The latter may be more political than it looks: few countries (or, at least, the people seeking re-election within them) will want to tell the rest of the world: we innovated and we don’t think it worked.

*I also discuss this problem of evidence-based best practice within single countries