I’m thinking of proposing an online panel (without paper presentations) that asks: what is essential reading in policy process research?
Put another way, if you were guiding students who were relatively new to public policy studies, what would you want them to know?
My motivation is fairly instrumental. I will be writing the third edition of Understanding Public Policy, reflecting on what is in there, what is absent, and what changes to make as a result (and thinking of how to update the 500 and 1000 word summaries). What do I need to discuss more, and what should I cut to make space? For example:
The book focuses on ‘mainstream’ policy theories and does not have much discussion of interpretive or critical approaches (although this series does more). If I were to shift the balance, what insights would be essential?
If I were to devote a lot more space to (say) the study of gender or race, should it be mainstreamed throughout every chapter (e.g. many chapters discuss a major policy theory) or consolidated in dedicated chapters (e.g. the chapter on power)?
The first edition’s conclusion focused on how to combine theoretical insights. The second focused on the dominance of the field by authors in a small number of Global North countries (especially in the US and Western Europe). What should be the concluding theme of the third?
From what approaches (e.g. to teaching public policy with the aid of written material) can I learn?
Are there better ways to foster learning than someone like me writing textbooks and explainers?
These are just some early (and perhaps self-indulgent) thoughts on what to discuss.
If you were thinking of proposing something with a similar theme, or would like to collaborate to design this panel proposal, please let me know.
Or, if you were to attend a panel like this, who else would you want to hear from? For example, it could be a panel composed of people who write introductory textbooks or (say) people who use them for teaching or read them during their studies.
Any ideas welcome (by August), either by commenting below or emailing me directly (p.a.cairney@stir.ac.uk).
Below is the introduction to an article that I wrote for a Special Issue paper on Teaching Policy Analysis for Gestión y Análisis de Políticas Públicas (GAPP).
When we teach policy analysis, we focus on how to be a policy analyst or how to situate the act of policy analysis within a wider policymaking context. Ideally, students would learn about both. This aim is central to Lasswell’s vision for the policy sciences, in which the analysis of policy and policymaking informs analysis for policy, and both are essential to the pursuit of human equality and dignity (Lasswell, 1951; 1956; 1971; see Cairney and Weible, 2017).
There is the potential to achieve this vision for the policy sciences. Policy analysis texts focus on the individual and professional skills required to act efficiently and effectively in a time-pressured political environment. Further, they are supported by the study of policy analysts to reflect on how analysis takes place, and policy is made, in the real world (Radin, 2019; Brans et al, 2017; Thissen and Walker, 2013; Geva-May, 2005). The next steps would be to harness the wealth of policy concept- and theory-informed studies to help understand how real-world contexts inform policy analysis insights.
First, almost all mainstream policy theories assume or demonstrate that there is no such thing as a policy cycle. It would be misleading to suggest that the policy process consists of clearly defined and well-ordered stages of policymaking, from defining problems and generating solutions to implementing solutions and evaluating their effects. If so, there is no clear route to influence via analysis unless we understand a far messier reality. In that context, how can policy analysts understand their complex policymaking environment, and what skills and strategies do they need to develop to engage effectively? These discussions may be essential to preventing the demoralisation of analysts: if they do not learn in advance about the processes and factors that can minimise their influence, how can they generate realistic expectations?
Second, if the wider aim is human equality and dignity, insights from critical policy analysis are essential. They help analysts think about what those values mean, how to identify and support marginalised populations, and how policy analysis skills and techniques relate to those aims. In particular, they warn against treating policy analysis as a technocratic profession devoid of politics. This rationalist story may contribute to exclusive research gathering practices, producing too-narrow definitions of problems, insufficient consideration of feasible solutions, and recommendations made about target populations without engaging with the people they claim to serve (Bacchi, 2009; Stone, 2012).
However, this aim is much easier described than achieved. Policy analysis texts, focusing on how to do it, often use insights from policy studies but without fully explaining key concepts and theories or exploring their implications. There is not enough time and space to do justice to every element, from the technical tools of policy analysis (including cost-benefit analysis) to the empirical findings from policy theories and normative insights from critical policy analysis approaches (e.g. Weimer and Vining, 2017 is already 500 pages long). Policy process research, focusing on what happens, may have practical implications for analysts. However, they are often hidden behind layers of concepts and jargon, and most of their authors seem uninterested in describing the normative importance of, or practical lessons from, theory-informed empirical studies. The cumulative size of this research is overwhelming and beyond the full understanding of experienced specialist scholars. Further, it is difficult to recommend a small number of texts to sum up each approach, which makes it difficult to predict how much time and energy it would take to understand this field, or to demonstrate the payoff from that investment. In addition, critical policy analysis is essential, but often ignored in policy analysis texts, and the potential for meaningful conversations between critical or interpretive versus mainstream policy scholars remains largely untapped (e.g. Durnova and Weible, 2020) or resisted (e.g. Jones and Radaelli, 2016).
In that context, policy analysis students embody the problem of ‘bounded rationality’ described famously by Simon (1976). Simon’s phrase ‘to satisfice’ sums up a goal-oriented response to bounded rationality: faced with the inability to identify, process, or understand all relevant information, they seek ways to gather enough information to inform ‘good enough’ choices. More recently, policy studies have sought to incorporate insights from individual human, social, and organisational psychology to understand (1) the cognitive shortcuts that humans use, including gut-level instinct, habit, familiarity with an issue, deeply-held beliefs, and emotions, and (2) their organisation’s equivalents (organisations use rules and standard operating procedures to close off information searches and limit analysis – Koski and Workman, 2018). Human cognitive shortcuts can be described negatively as cognitive biases or more positively as ‘thinking fast and slow’ (Kahneman, 2012) or ‘fast and frugal heuristics’ (Gigerenzer, 2001). However, the basic point remains: if people seek shortcuts to information, we need to find ways to adapt to their ways of thinking, rather than holding onto an idealised version of humans that do not exist in the real world (Cairney and Kwiatkowski, 2017).
While these insights focus on policymakers, they are also essential to engaging with students. Gone – I hope – are the days of lecturers giving students an overwhelmingly huge reading list and expecting them to devour every source before each class. This approach may help some students but demoralise many others, especially since it seems inevitable that students’ first engagement with specialist texts and technical jargon will already induce fears about their own ignorance. Rather, we should base teaching on a thoughtful exploration of how much students can learn about the wider policy analysis context, focusing on (1) the knowledge and skills they already possess, (2) the time they have to learn, and (3) how new knowledge or skills would relate to their ambitions. For example, if students are seeking fast and frugal heuristics to learn about policy analysis, how can we help?
To help answer this question, I focus on what students should learn, can learn, and how blog posts and coursework can contribute to that learning. First, I describe the valuable intersection between policy analysis, policy process research, and critical policy analysis to demonstrate the potential payoffs to wider insights. In other words, what should policy analysis students learn from mainstream policy process research and critical policy analysis? Second, I describe the rationale for the blog that I developed in tandem with teaching public policy. I taught initially at an undergraduate level as part of a wider politics programme, before developing a Master of Public Policy and contributing to shorter executive courses and one-off workshops. This range of audiences matters, since the answer to the question ‘what can people learn?’ will vary according to their existing knowledge and time. Third, I summarise the rationale for the coursework that I use to encourage the application of public policy theories and knowledge to policy analysis (as part of a wider degree programme), including skills in critical thinking about policymaking dilemmas, to accompany more specialist research and analytical skills.
Could policy theories help to understand and facilitate the pursuit of equity (or reduction of unfair inequalities)?
We are producing a series of literature reviews to help answer that question, beginning with the study of equity policy and policymaking in health, education, and gender research.
Each field has a broadly similar focus. Most equity researchers challenge the ‘neoliberal’ approaches to policy that favour low state action in favour of individual responsibility and market forces. They seek ‘social justice’ approaches, favouring far greater state intervention to address the social and economic causes of unfair inequalities, via redistributive or regulatory measures. They seek policymaking reforms to reflect the fact that most determinants of inequalities are not contained to one policy sector and cannot be solved in policy ‘silos’. Rather, equity policy initiatives should be mainstreamed via collaboration across (and outside of) government. Each field also projects a profound sense of disenchantment with limited progress, including a tendency to describe a too-large gap between their aspirations and actual policy outcomes. They describe high certainty about what needs to happen, but low confidence that equity advocates have the means to achieve it (or to persuade powerful politicians to change course).
Policy theories could offer some practical insights for equity research, but not always offer the lessons that some advocates seek. In particular, health equity researchers seek to translate insights on policy processes into a playbook for action, such as to frame policy problems to generate more attention to inequalities, secure high-level commitment to radical change, and improve the coherence of cross-cutting policy measures. Yet, policy theories are more likely to identify the dominance of unhelpful policy frames, the rarity of radical change, and the strong rationale for uncoordinated policymaking across a large number of venues. Rather than fostering technical fixes with a playbook, they encourage more engagement with the inescapable dilemmas and trade-offs inherent to policy choice. This focus on contestation (such as when defining and addressing policy problems) is more of a feature of education and gender equity research.
While we ask what policy theories have to offer other disciplines, in fact the most useful lessons emerge from cross-disciplinary insights. They highlight two very different approaches to transformational political change. One offers the attractive but misleading option of radical change through non-radical action, by mainstreaming equity initiatives into current arrangements and using a toolbox to make continuous progress. Yet, each review highlights a tendency for radical aims to be co-opted and often used to bolster the rules and practices that protect the status quo. The other offers radical change through overtly political action, fostering continuous contestation to keep the issue high on the policy agenda and challenge co-option. There is no clear step-by-step playbook for this option, since political action in complex policymaking systems is necessarily uncertain and often unrewarding. Still, insights from policy theories and equity research shows that grappling with these challenges is inescapable.
Ultimately, we conclude that advocates of profound social transformation are wasting each other’s time if they seek short-cuts and technical fixes to enduring political problems. Supporters of policy equity should be cautious about any attempt to turn a transformational political project into a technical process containing a ‘toolbox’ or ‘playbook’.
You can read the original research in Policy & Politics:
Paul Cairney, Emily St.Denny, Sean Kippin, and Heather Mitchell (2022) ‘Lessons from policy theories for the pursuit of equity in health, education, and gender policy’, Policy and Politicshttps://doi.org/10.1332/030557321X16487239616498
My contribution to this interdisciplinary academic-practitioner discussion is to present insights from political science and policy process research, which required me to define some terms (background) before identifying three cautionary messages.
However, note the verb/noun distinction, and common architectural metaphor, to distinguish between the (a) act of design, and (b) the output (e.g. the blueprints).
In terms of the outputs, tools can be defined narrowly as policy instruments – including tax/spending, regulations, staff and other resources for delivery, information sharing, ‘nudging’, etc. – or more widely to include the processes involved in their formulation (such as participatory and deliberative). Therefore, we could be describing:
A highly centralized process, involving very few people, to produce the equivalent of a blueprint.
A decentralized, and perhaps uncoordinated, process involving many people, built on the principle that to seek a blueprint would be to miss the point of participation and deliberation.
Policymaking research tends to focus on
(1) measuring policy change with reference to the ‘policy mix’ of these tools/ instruments, and generally showing that most policy change is minor (and some is major) (link1, link2, link3, link4), and/ or
(2) how to understand the complex policymaking systems or environments in which policy design processes take place.
These studies are the source of my messages of doom.
Three cautionary messages about new policy design
There is a major gap between the act of policy design and actual policies and policy processes. This issue led to the decline of old policy design studies in the 1980s.
While ‘new policy design’ scholars seek to reinvigorate the field, the old issues serve as a cautionary tale, reminding us that (1) policy design is not new, and (2) its decline did not relate to the lack of sophisticated skills or insights among policy designers.
In other words, these old problems will not simply be solved by modern scientific, methodological, or policy design advances. Rather, I encourage policy designers to pay particular attention to:
1. The gap between functional requirements and real world policymaking.
Policy analysts and designers often focus on what they need, or require to get their job done or produce the outcomes they seek.
Policy process researchers identify the major, inevitable, gaps between those requirements and actual policy processes (to the extent that the link between design and policy is often difficult to identify).
2. The strong rationale for the policy processes that undermine policy design.
Policy processes – and their contribution to policy mixes – may seem incoherent from a design perspective. However, they make sense to the participants involved.
Some relate to choice, including to share responsibility for instruments across many levels or types of government (without focusing on how those responsibilities will connect or be coordinated).
Some result from necessity, to delegate responsibility to many policy communities spread across government, each with their own ways to define and address problems (without the ability to know how those responsibilities will be connected).
3. The policy analysis and design dilemmas that cannot be solved by design methods alone.
When seen from the ‘top down’, design problems often relate to the perceived lack of delivery or follow-through in relation to agreed high level design outputs (great design, poor delivery).
When seen from the ‘bottom up’, they represent legitimate ways to incorporate local stakeholder and citizen perspectives. This process will inevitably produce a gap between different sources and outputs of design, making it difficult to separate poor delivery (bad?) from deviation (good?).
Such dynamics are solved via political choice rather than design processes and techniques.
You can hear my presentation below (it took a while to get going because I wasn’t sure who could hear me):
Notes on the workshop discussion
The workshop discussion prompted us initially to consider how many different people would define it. The range of responses included seeing policy design as:
a specific process with specific tools to produce a well-defined output (applied to specific areas conducive to design methods)
a more general philosophy or way of thinking about things like policy issues (compare with systems thinking)
a means to encourage experimentation (such as to produce a prototype policy instrument, use it, and reflect or learn about its impact) or change completely how people think about an issue
the production of a policy solution, or one part of a large policy mix
a niche activity in one unit of government, or something mainstreamed across governments
something done in government, or inside and outside of government
producing something new (like writing on a blank sheet of paper), adding to a pile of solutions, or redesigning what exists
primarily a means to empower people to tell their story, or as a means to improve policy advocacy (as in discussions of narrative/ storytelling)
something done with authoritative policymakers like government ministers (in other words, people with the power to make policy changes after they participate in design processes) or given to them (in other words, the same people but as the audience for the outcomes of design)
These definitions matter since they have very different implications for policy and practice. Take, for example, the link – made by Professor Liz Richardson – between policy design and the idea of evidence-based policymaking, to consider two very different scenarios:
A minister is directly involved in policy design processes. They use design thinking to revisit how they think about a policy problem (and target populations), seek to foster participation and deliberation, and use that process – perhaps continuously – to consider how to reconcile very different sources of evidence (including, say, new data from randomized control trials and powerful stories from citizens, stakeholders, service users). I reckon that this kind of scenario would be in the minds of people who describe policy design optimistically.
A minister is the intended audience of a report on the outcomes of policy design. You assume that their thoughts on a policy problem are well-established. There is no obvious way for them to reconcile different sources of policy-relevant evidence. Crucially, the fruits of your efforts have made a profound impact on the people involved but, for the minister, the outcome is just one of too-many sources of information (likely produced too soon before or after they want to consider the issue).
The second scenario is closer to the process that I describe in the main post, although policy studies would warn against seeing someone like a government minister as authoritative in the sense that they reside in the centre of government. Rather, studies of multi-centric policymaking remind us that there are many possible centres spread across political systems. If so, policy design – according to approaches like the IAD – is about ways to envisage a much bigger context in which design success depends on the participation and agreement of a large number of influential actors (who have limited or no ability to oblige others to cooperate).
Most governments have signed-up to improve the health of their populations and reduce health inequalities. Many governments made this commitment energetically and sincerely. Some describe the belief that ‘preventive’ action to foster population health is better than responding to acute health crises. Some are committed to get beyond the usual focus on individual lifestyles or healthcare, towards addressing (1) social influences on health inequalities (which relate to safe and healthy environments, education and employment, marginalisation, and economic inequality) and (2) commercial influence on policy and society.
Despite this high political commitment, there remains an unusually large gap between policy statements, practices, and outcomes. Why is this gap so large? Why does it endure despite often high commitment to promote population health? What can be done to close that gap, and end a dispiriting cycle of enthusiasm and disappointment?
We describe two – hopefully complementary – ways to address those questions, drawing on an informal academic-practitioner workshop we co-organised to discuss the future of health improvement policy in Scotland. The context is COVID-19, which necessitated a temporary shift of resources from health improvement to health protection (in other words, from longer-term work to prevent ‘non-communicable diseases’ – NCDs – including cardiovascular and respiratory diseases, cancer, and diabetes, towards an intense pandemic response). The transition, in 2022, towards an ‘endemic phase’ of health protection provides a new impetus to consider the immediate and long-term future of health improvement policies. Our aim was to focus on policy to prevent NCDs, including:
Specific policies, such as to address smoking, alcohol consumption, and diet.
A broader focus on collaborative policymaking, to recognise the fact that most health-relevant policies are not in the control of health departments.
We followed the format from previous workshops in Scotland and England, beginning with an academic overview (based on the paper Why is health improvement policy so difficult to secure?), followed by informal discussions on current challenges and next steps.
Please note that these are Cairney’s notes on proceedings. While we gave each participant the chance to comment on the draft, and made some changes as a result, Cairney still takes responsibility for the following text.
The academic argument
We describe a general problem with ‘preventive’ policies and ‘joined-up’ policymaking. On the one hand, the idea of prevention has widespread rhetorical appeal, suggesting that governments can save money and reduce inequalities by preventing problems happening or getting worse. On the other, there is a large gap between rhetorical commitment and actual practices (although Cairney and St. Denny show that these general prevention problems are less apparent in relation to specific agendas such as tobacco control).
We identify three main explanations for this gap:
Clarity: if prevention means everything, maybe it means nothing.
The language of prevention is vague. This ambiguity helps to maximise initial support (who would be against it?) but stores up trouble for later. People face more obstacles – including opposition to policy change – when they have to translate a broad aim into tangible policy instruments.
Congruity: prevention is out of step with routine government business.
Preventive policymaking focuses on relatively hard-to-measure, long-term outcomes. It competes badly – for attention and resources – with more-pressing issues with short-term targets. Its push for radically different, holistic, policymaking does not fit with well-established rules and norms. Attempts to ‘institutionalise’ health improvement either lead to public health agencies with very limited powers, or cross-government initiatives that remain unfulfilled.
Capacity: low support for major investments with uncertain rewards.
No policy can improves live, and reduces inequalities, while avoiding political and financial costs. Rather, preventive policies involve ‘hard choices’ with political costs, and are akin to capital investment: spend now, and receive benefits in the future. This offer of short term costs for uncertain long-term benefits is not attractive to governments seeking to avoid controversy and reduce state spending.
Story. Treat health as a human right, identify the ‘social determinants of health’ and the ‘upstream’ solutions to reduce inequalities, promote intersectoral action, and seek high political commitment.
‘Playbook’. For example, connect HiAP to current government agendas, focus on ‘win-win’ solutions, avoid the perception of ‘health imperialism’, and foster policy champions.
On the other hand, regular reports of slow progress relates to problems with:
Clarity. The HiAP terminology is abstract and subject to different interpretations. For some, it involves a radical plan to redistribute money and power to reduce health inequalities. For others, it is a vague ambition to encourage collaboration inside and outside of government.
Congruity. Advocates seek to ‘mainstream’ health into all policies, but find low or superficial interest from other sectors, or opposition to public health interference in other government business.
Capacity. Few advocates have made a winning economic case for HiAP investment. Most initiatives are about zero-cost cooperation (undermined by low clarity and congruity).
While these experiences are dispiriting, they were at least predictable, particularly in states that were not conducive to economic redistribution and high state intervention. However, COVID-19 added an ironic twist: it should have prompted governments to connect the dots between health improvement and protection strategies, to address the unequal spread of the NCDs that caused unequal illness and death. Instead, rapid and radical changes to foster health protection came at the expense of health improvement.
These experiences provide cautionary tales to underpin future strategies. They show that vague political agreement – to mainstream health across government – is no guarantee of substantial action, and the production of a new strategy is futile without knowing if it will dovetail with routine government business.
The workshop discussion: opportunities and challenges
There were many positive messages peppered throughout our discussions, suggesting that Scottish policy and policymaking is conducive to health improvement progress. Participants highlighted a lower tendency (than in Westminster) to focus on individual responsibility, in favour of more collectivist solutions. There is political leadership and cross party consensus behind the argument that we need to fix shameful health inequalities.
These positive factors could help to boost a current focus on ‘place’, to foster local collaboration to join-up services to improve wellbeing (such as via well maintained streets, good quality spaces, places to meet, and a sense of belonging and control). People care about what happens in local communities, which could bring together many different NCD-related aims – such as in alcohol, tobacco, gambling, diet, exercise – that would otherwise be siloed.
There is also some enthusiasm to extend a ‘public health approach’ to several policy problems – such as in criminal justice (including knife crime reduction), or housing – if it helps to break down silos (and if enough people know what a public health approach is).
Further, there is enough evidence of success in long-term thinking to think that it could be successful again. One key example is setting a target date of 2034 to produce a ‘tobacco free generation’). The 2034 goal has cross-party commitment and fits the current trajectory of government policy. Having this target allows organisations and the Scottish Parliament to hold the government to account for progress (regardless of the party in government), and allows the government to resist commercial pressure to soften key measures. Compared to ‘prevention’ in general, it comes with more tangible measures of progress that allow policy actors to know if they are on track towards long-term success.
However, our discussion began with general agreement about the challenges of health improvement when governments move from promise to practice, which we relate to three categories:
Clarity
The appearance of general agreement (on defining the policy problem) hides the many differences of perspectives and approaches across organisations and professions that undermine discussions of solutions.
There are unresolved debates about the policies to prioritise to reduce health inequalities (for example, not everyone favours economic redistribution).
It is disingenuous to build false consensus on the idea that health improvement policies reduce costs.
Congruity
Key Scottish Government policies have been consistent with HiAP and wider preventive aims. For example, the National Performance Framework is a genuine attempt to move from damaging short-term performance management and policymaking silos. However, it did not change the main drivers of the public sector or change the way that individual public sector players get measured. Short-term and silo-based accountability mechanisms remain within the Scottish Government (and the accountability measures of Scottish Parliament committees), producing contradictory incentives.
Policy should be about making health improvement everyone’s business, and changing performance management to be more conducive to prevention. However, acute services are always the priority.
Relationships and trust are at the heart of collaborative policymaking, but there is not enough respect for these skills. There is a tendency to produce ‘hard’ reforms at the expense of more valuable ‘soft’ skills.
Third sector organisations often struggle to justify cross-sectoral working if it departs from a narrow description of their activities.
A focus on individual activities – for example, smoking, drinking, gambling – takes attention from the interconnectedness of the causes of NCDs. While national level organisations have addressed this issue by focusing on NCDs, progress is more difficult at local community levels.
Commercial interests have the power to use existing rules to block policy progress.
Wider UK developments may undermine progress further. For example, when making impact assessments, is there a greater UK government focus on business than climate or health?
Capacity
Public health policies and organisation do not receive proportionate attention or resources.
Each experience of limited progress may undermine the belief that major change is possible.
These general problems are exacerbated by constitutional uncertainty. Constitutional debates take up political time and energy, at the expense of the capacity to think long term and design effective policies. Many supporters of Scottish independence want to focus on governing competence and stability, not policies that would court controversy.
Challenging questions for policymakers
We then invited some challenging questions for policymakers, such as to ask how and when will key organisations ‘reboot’ health improvement policies after the COVID-19 emergency response? Or, given there is such political will to support health improvement, would it make more sense to focus on ‘rethinking’ rather than ‘rebooting’ policy delivery?
Participants recognised that COVID-19 caused inevitable delays to the development of Public Health Scotland (PHS, which launched in April 2020). Health improvement work did not stop completely (in PHS or the Scottish Government), and a clear strategic plan – supporting a targeted list priorities (including child poverty, underlying causes of poverty and inequality, and place based approaches) will help to deliver a new programme of work.
However, when prompted to identify areas for concern, individuals provided the following answers from their perspective (in other words, their inclusion does not suggest that the whole group agreed with the following points):
Encourage the Scottish Government to be less directive.
Recognise that we are dealing with a very large system that is less directable in a local community environment. Political leaders need to let go more, to give space to local groupings of policymakers, citizens, and service deliverers. This change requires us to:
Get past the idea that only the Scottish Government can make the change (e.g. with legislation)
Take different accountability measures seriously (e.g. not focused so much on ministers).
Recognise the lack of trust between ministers and local authority leaders, and between many civil servants and council employees, and think about how to build it.
Also, reflect on what happens when the Scottish Government suddenly devotes higher attention and resources to a problem – such as drugs-related deaths – when it becomes a salient political issue. This heavy-handed approach produces immense pressure, unintended consequences, and the sense that you can get your issue higher up the agenda if you create a political storm.
We need to see the progress reports on delivery plans, and reboot the governance and accountability process. The wider agenda on public health reform, embedded across government, seems to have gone. Not all of the public health priorities enjoy the same support (e.g. healthy weight/ diet seems low priority).
The Scottish Government had a good tobacco strategy in 2013, and passed legislation in 2016. After some years of relative inactivity on tobacco, the Scottish Government is moving to enact provisions in legislation passed in 2016. PHS seems less active on tobacco control, such as in relation to: gaps in data on young people smoking and vaping, tracking changes in use of novel tobacco related products, including tobacco in place-based approaches to addiction, and connecting national third sector with PHS in-house expertise (although it has focused more strongly on wider tobacco issues, including how they relate to the underlying causes of poverty and inequality).
It seems – to some workshop participants – that the evidence threshold, required to bring about change, has shifted fundamentally over 10 years. There is a far higher bar to clear before governments will act (relating, in few cases, to anticipating the threat of litigation). Some recent inertia could relate to uncertainty around the (post-Brexit) UK Internal Market Act, but there are emerging signs of greater flexibility. Further, a current PHS focus – on working with stakeholders and citizens to understand the quantitative and qualitative evidence – could help to address that perception of inertia.
A focus on ‘place’ could allow public health professionals to situate evidence-use in a wider context, to reflect on powerful work from local communities on how people experience and describe the problems they face, to help prioritise issues without requiring loads of scientific evidence. This approach is a priority in PHS’s strategic plan.
Support capacity development.
People are so stretched, and the turnover of experienced people (with expertise and connections) is high. There is less opportunity for informal and serendipitous conversation, less capacity for reflection, less of a feeling of being part of something bigger than the day-to-day.
The cross-party commitment is there in principle, but to what extent will it be reflected in delivery? Where are the accountability mechanisms to support the changes associated with ‘whole system’ work (beyond the – often narrower – scrutiny in parliamentary committees)?
Reflections on these discussions
Academics often question the extent to which their engagement with practitioners is fruitful to both parties, or conclude that ‘little is known about what works’. In our case, the value is reflected in a fairly common academic-practitioner (a) focus on health improvement policy, and (b) language to describe the issues involved. Key examples of common topics include:
The search for clarity: how should we understand and frame the problem?
To define the problem is to draw attention to different perspectives that can have distributional consequences.
For example, we described the workshop in relation to ‘health improvement’ in general. Should we describe ‘health inequalities’ in particular? The latter concern is taken for granted by some, but not a priority for others (especially if it involves economic redistribution).
We focused on NCDs, which perhaps draws attention to medical interpretations of the problem and separates the agenda into component parts (e.g. tobacco, alcohol, diet). Do many people, outside of public health, use this language, or is it alienating to most? Would it be better to focus on people and places? Does a focus on ‘place’ (in which health improvement plays one part) solve this problem? Or, does it help to reduce public health as a priority?
The search for congruity: identifying limits to Westminster-style accountability and evidence-informed policymaking.
Policy agendas reflect and reinforce the contradictory pressures that encourage and discourage health improvement.
For example, governments want to pursue a preventive agenda, but also produce the policies that undermine it. They seek a long-term agenda with meaningful measures of change, but undermine it with short-term and narrow measures, producing unintended consequences. Our discussions related this problem to the dilemmas of accountability measures, in which Scottish Government ministers need to let go, to encourage decentralised policymaking, but know that they will still be held to account for whatever happens.
Governments may also seek evidence- or knowledge-informed policymaking, but struggle to connect very different elements. First, people present very different claims to knowledge (such as scientific and experiential) that cannot simply be added together or resolved during ‘co-production’ exercises. Second, they relate these claims to competing ideas on who should gather and use evidence to make policy (e.g. centralise and roll out the same policy versus decentralise and create policy diversity). Any selection of an evidence-informed model of policymaking is political and contested, and not amenable to simple technical solutions.
Finally, when we talk about the need for more health improvement capacity, what exactly do we mean? One answer is that most participants are not seeking more ‘political will’ or top-down direction. Some seek to avoid the sense that policy change requires major organisational upheavals. Rather, we need to assign more value to the ‘soft’ skills required to built trust and meaningful collaboration across (and outside) the public sector (as described by Carey & Crammond, and Holt et al).
Some use the language of complex systems in a suitably challenging way. Too often, people describe ‘systems thinking’ to highlight control: ‘If we engage in systems thinking effectively, we can understand systems well enough to control, manage, or influence them’. The alternative is to recognise that policy outcomes ‘emerge from complex systems in the absence of: (a) central government control and often (b) policymaker awareness. We need to acknowledge these limitations properly, to accept our limitations’, and act accordingly. Our discussions highlighted the expectation that these systems are less directable in local community environments, requiring a change in expectations and the need to let go. This advice makes sense, and is consistent with the usual advice in complexity studies. However, it will get nowhere as long as everyone expects Scottish Government ministers to be in charge and control of all policy outcomes.
Science and evidence are important to policy, and researchers can contribute to programmes that reduce social and economic inequalities. However, without understanding policy processes and how politicians process evidence, researchers will struggle to understand their – sometimes peripheral – role in the bigger picture. The following step-by-step list could help to better grasp and engage with these processes in democratic political systems:
STEP 1: Embrace the value and necessity of politics.
Politics should be at the heart of policymaking, helping to find non-violent ways to resolve diverse preferences held by people with different beliefs and interests through mechanisms such as electing people, parties or governments. Democratic mechanisms legitimise policy choices. Thus, trust in scientists – and the evidence they provide – is incomplete without trust in political systems. It is tempting to seek to replace choices by politicians with expert-driven technocracy, but the latter does not provide the same legitimacy.
STEP 2: Accept that public policy is not, and never will be, evidence-based.
Treat evidence-based policy as one of many contested phrases masquerading as self-evident aims. Others include follow the science or focus on what works. Each phrase suggests, misleadingly, that we can solve ideological debates with evidence.
STEP 3: Seek practical lessons from scientific studies of policymaking.
It is tempting to see scientists as the policy entrepreneurs that use their authority and powers of persuasion to prompt politicians to define and solve problems in better ways. However, policy theories highlight the wider contextual issues that limit politicians’ influence. Core insights include:
Most policy changes are minor. Major change is unusual.
Policymakers cannot pay attention to all issues and information. They use cognitive shortcuts – drawing on their trusted sources, beliefs, and emotions – to ignore most issues and evidence.
Policymakers do not fully understand or control the processes for which they are responsible. Their environments contain policymakers and influencers spread across multiple policymaking venues, each with their own rules, ways of thinking and networks.
STEP 4: Engage properly with political dilemmas.
The close analysis of politics and policymaking allows us to identify key dilemmas that cannot be resolved via additional evidence. These dilemmas span diverse aspects of policymaking and implementation procedures.
First, evidence cannot determine the role that the state plays (or should play) in addressing societal problems. Neoliberal approaches recommend low state intervention in favour of individual responsibility and market forces, while social justice approaches favour state intervention to address structural factors out of the control of individuals. Each approach produces major differences in the demand for evidence of a policy problem and assessment of what solutions work.
Second, questions on the delegation of state responsibilities are not addressed via traditional evidence-gathering mechanisms. Political systems are multi-centric, with different levels and types of government taking responsibility for parts of a larger programme. Some seek a technocratic or optimal distribution of these responsibilities. However, the process to determine responsibility is highly contested, relating more to demands for territorial autonomy (or turf wars). Governments also delegate tasks to other organisations, producing a distribution of policymaking that defies simple coordination. This delegation of responsibilities requires researchers to understand where the action is and how to engage effectively in relevant systems.
Third, there is no standard way to combine multiple sources of policy-relevant knowledge. Some scientists assert a hierarchy of knowledge: randomised control trials (RCTs) are gold, scientific expertise is bronze, and practitioner or service user experience would not make the podium. Other political actors prioritise the knowledge from people who deliver or receive services. Some seek compromise, to combine policy-relevant insights. However, their deliberations still involve choices, including whether policymaking should be centralised to roll out ‘evidence based’ solutions built on RCTs, or decentralised to allow local communities to draw on many knowledge sources in policy design.
Finally, evidence cannot settle the debate between the maintenance of science’s image vs. the development of science’s influence over policy. In some political systems, scientists face dilemmas when their principles contradict the rules of government. Science emphasises transparency and independence to foster institutional trust and the credibility of evidence. Governments often require secrecy and informal rule-following to foster trust in advisers. Researchers must navigate this perspective mismatch when engaging with policymakers.
Evidence-informed equity policies: two competing visions
The dynamics highlighted in these steps may vary across policy sectors. However, regardless of sector, a choice can be made between two methods of seeking evidence-informed policies to reduce inequalities. These methods are:
A non-confrontational, technocratic project: offering radical change through non-radical action, mainstreaming equity initiatives into current arrangements and using a playbook to make continuous progress. This method is attractive because governments often project a sincere-looking rhetorical commitment to reducing inequalities. Yet, we find a tendency for radical aims to be co-opted to serve the practices that protect the status quo.
A challenging political project: offering radical change through overtly political action and contestation, and translating rhetoric into substance by keeping the reduction of inequalities high on the agenda. In this case, there is no clear guide for action. Rather, participants accept that the impact of research-informed political action is uncertain and often unrewarding.
Overall, the implications of policy engagement for researchers are profound. Too many evidence-to-policy initiatives are built on the misplaced idea that scientists can remain objective when engaging in politics. This leads to the equally implausible focus on detailed playbooks to replace political problems with technocratic solutions. Embracing the value of politics, and the inescapably political nature of research engagement, is the first step in considering a more realistic alternative. It requires engagement with the policy processes that exist, not the ones that scientists would rather see.
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References
Cairney, P., 2016. The Politics of Evidence-based Policy Making. London: Palgrave Macmillan.
Cairney, P. and Oliver, K., 2017. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?. Health Research Policy and Systems 15(35). https://doi.org/10.1186/s12961-017-0192-x
These posts introduce you to key concepts in the study of public policy. They are all designed to turn a complex policymaking world into something simple enough to understand. Some of them focus on small parts of the system. Others present ambitious ways to explain the system as a whole. The wide range of concepts should give you a sense of a variety of studies out there, but my aim is to show you that these studies have common themes.
Paul Cairney: Politics & Public Policy 