Evidence & Policy insights during the COVID-19 Pandemic

Evidence & Policy Blog

Kat Smith and Paul Cairney

The COVID-19 pandemic is shining a light on the roles that evidence and expertise can play in policy and practice. Understanding the nature of these debates, and developing tools to help decision-makers navigate them, is the focus of the Evidence & Policy community. In this post, we consider how our reflections on the field’s key insights help us understand the role evidence is playing in the UK’s response to the current pandemic:


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Welcome to the Evidence & Policy blog: Our reflections on the field

Evidence & Policy Blog

Kat Smith and Paul Cairney

This new blog helps make the insights within Evidence & Policy accessible to all. In this opening post, the current Editors reflect on what they feel are some of the key insights about the interplay between evidence and policy:


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Coronavirus and the ‘social determinants’ of health inequalities: lessons from ‘Health in All Policies’ initiatives

Many public health bodies are responding to crisis by shifting their attention and resources from (1) a long-term strategic focus on reducing non-communicable diseases (such as heart diseases, cancers, diabetes), to (2) the coronavirus pandemic.

Of course, these two activities are not mutually exclusive, and smoking provides the most high-profile example of short-term and long-term warnings coming together (see Public Health England’s statement that ‘Emerging evidence from China shows smokers with COVID-19 are 14 times more likely to develop severe respiratory disease’).

There are equally important lessons – such as on health equity – from the experiences of longer-term and lower-profile ‘preventive’ public health agendas such as ‘Health in All Policies’ (HIAP).*

What is ‘Health in All Policies’?

HIAP is a broad (and often imprecise) term to describe:

  1. The policy problem. Address the ‘social determinants’ of health, defined by the WHO as ‘the unfair and avoidable differences in health status … shaped by the distribution of money, power and resources [and] the conditions in which people are born, grow, live, work and age’.
  2. The policy solutions. Identify a range of policy instruments, including redistributive measures to reduce economic inequalities, distributive measures to improve public services and the physical environment (including housing), regulations on commercial and individual behaviour, and health promotion via education and learning.
  3. The policy style. An approach to policymaking that encourages meaningful collaboration across multiple levels and types of government, and between governmental and non-governmental actors (partly because most policy solutions to improve health are not in the gift of health departments).
  4. Political commitment and will. High level political support is crucial to the production of a holistic strategy document, and to dedicate resources to its delivery, partly via specialist organisations and the means to monitor and evaluate progress.

As two distinctive ‘Marmot reviews’ demonstrate, this problem (and potential solutions) can be described differently in relation to:

Either way, each of the 4 HIAP elements highlights issues that intersect with the impact of the coronavirus: COVID-19 has a profoundly unequal impact on populations; there will be a complex mix of policy instruments to address it, and many responses will not be by health departments; an effective response requires intersectoral government action and high stakeholder and citizen ownership; and, we should not expect current high levels of public, media, and policymaker attention and commitment to continue indefinitely or help foster health equity (indeed, even well-meaning policy responses may exacerbate health inequalities). 

A commitment to health equity, or the reduction of health inequalities

At the heart of HIAP is a commitment to health equity and to reduce health inequalities. In that context, the coronavirus provides a stark example of the impact of health inequalities, since (a) people with underlying health conditions are the most vulnerable to major illness and death, and (b) the spread of underlying health conditions is unequal in relation to factors such as income and race or ethnicity. Further, there are major inequalities in relation to exposure to physical and economic risks.

A focus on the social determinants of health inequalities

A ‘social determinants’ focus helps us to place individual behaviour in a wider systemic context. It is tempting to relate health inequalities primarily to ‘lifestyles’ and individual choices, in relation to healthy eating, exercise, and the avoidance of smoking and alcohol. However, the most profound impacts on population health can come from (a) environments largely outside of an individual’s control (e.g. in relation to threats from others, such as pollution or violence), (b) levels of education and employment, and (c) economic inequality, influencing access to warm and safe housing, high quality water and nutrition, choices on transport, and access to safe and healthy environments.

In that context, the coronavirus provides stark examples of major inequalities in relation to self-isolation and social distancing: some people have access to food, private spaces to self-isolate, and open places to exercise away from others; many people have insufficient access to food, no private space, and few places to go outside (also note the disparity in resources between countries).

The pursuit of intersectoral action

A key aspect of HIAP is to identify the ways in which non-health sectors contribute to health. Classic examples include a focus on the sectors that influence early access to high quality education, improving housing and local environments, reducing vulnerability to crime, and reforming the built environment to foster sustainable public transport and access to healthy air, water, and food.

The response to the coronavirus also appears to be a good advert for the potential for intersectoral governmental action, demonstrating that measures with profound impacts on health and wellbeing are made in non-health sectors, including: treasury departments subsidising business and wages, and funding additional healthcare; transport departments regulating international and domestic travel; social care departments responsible for looking after vulnerable people outside of healthcare settings; and, police forces regulating social behaviour.

However, most (relevant) HIAP studies identify a general lack of effective intersectoral government action, related largely to a tendency towards ‘siloed’ policymaking within each department, exacerbated by ‘turf wars’ between departments (even if they notionally share the same aims) and a tendency for health departments to be low status, particularly in relation to economic departments (also note the frequently used term ‘health imperialism’ to describe scepticism about public health in other sectors).  Some studies highlight the potential benefits of ‘win-win’ strategies to persuade non-health sectors that collaboration on health equity also helps deliver their core business (e.g. Molnar et al 2015), but the wider public administration literature is more likely to identify a history of unsuccessful initiatives with a cumulative demoralising effect (e.g. Carey and Crammond, 2015; Molenveld et al, 2020).  

The pursuit of wider collaboration

HIAP ambitions extend to ‘collaborative’ or ‘co-produced’ forms of governance, in which citizens and stakeholders work with policymakers in health and non-health sectors to define the problem of health inequalities and inform potential solutions. These methods can help policymakers make sense of broad HIAP aims through the eyes of citizens, produce priorities that were not anticipated in a desktop exercise, help non-health sector workers understand their role in reducing health inequalities, and help reinforce the importance of collaborative and respectful ways of working.

An excellent example comes from Corburn et al’s (2014) study of Richmond, California’s statutory measures to encourage HIAP. They describe ‘coproducing health equity in all policies’ with initial reference to WHO definitions, but then to social justice in relation to income and wealth, which differs markedly according to race and immigration status. It then reports on a series of community discussions to identify key obstacles to health:

For example, Richmond residents regularly described how, in the same day, they might experience or fear violence, environmental pollution, being evicted from housing, not being able to pay health care bills, discrimination at work or in school, challenges accessing public services, and immigration and customs enforcement (ICE) intimidation … Also emerging from the workshops and health equity discussions was that one of the underlying causes of the multiple stressors experienced in Richmond was structural racism. By structural racism we meant that seemingly neutral policies and practices can function in racist ways by disempowering communities of color and perpetuating unequal historic conditions” (2014: 627-8).

Yet, a tiny proportion of HIAP studies identify this level of collaboration and new knowledge feeding into policy agendas to address health equity.

The cautionary tale: HIAP does not cause health equity

Rather, most of the peer-reviewed academic HIAP literature identifies a major gap between high expectations and low implementation. Most studies identify an urgent and strong impetus for policy action to be proportionate to the size of the policy problem, and ideas about the potential implementation of a HIAP agenda when agreed, but no studies identify implementation success in relation to health equity. In fact, the two most-discussed examples – in Finland and South Australia – seem to describe a successful reform of processes that have a negligible impact on equity.  

A window of opportunity for what?

It is common in the public health field to try to identify ‘windows of opportunity’ to adopt (a) HIAP in principle, and (b) specific HIAP-friendly policy instruments. It is also common to try to identify the factors that would aid HIAP implementation, and to assume that this success would have a major impact on the social determinants of health inequalities. Yet, the cumulative experience from HIAP studies is that governments can pursue health promotion and intersectoral action without reducing health inequalities.

For me, this is the context for current studies of the unequal impact of the coronavirus across the globe and within each country. In some cases, there are occasionally promising discussions of major policymaking reforms, or to use the current crisis as an impetus for social justice as well as crisis response. Yet, the history of the pursuit of HIAP-style reforms should help us reject the simple notion that some people saying the right things will make that happen. Instead, right now, it seems more likely that – in the absence of significantly new action** – the same people and systems that cause inequalities will undermine attempts to reduce them. In other words, health equity will not happen simply because it seems like the right thing to do. Rather, it is a highly contested concept, and many people will use their power to make sure that it does not happen, even if they claim otherwise.

*These are my early thoughts based on work towards a (qualitative) systematic review of the HIAP literature, in partnership with Emily St Denny, Sean Kippin, and Heather Mitchell.

**No, I do not know what that action would be. There is no magic formula to which I can refer.

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I was knocked off my motorbike in 1996

I was going at 60mph on the M8 East. Fast enough to be life threatening, but not fast enough to stop a car from overtaking and hitting my front wheel before it sped off. I broke my helmet and my wrist, which never fully recovered. Later on, the doctors gave me morphine and the nurses told me I was lucky to be alive.

For some reason, I thought of my baby daughter and vowed to give up the bike before deciding to crawl off the road. I still remember that split second to this day. If I wake up in the middle of the night to think about it, it’s mostly to relive that moment.

The rest is a blur. I remember the car’s motion but not the car. I remember that a man stopped traffic with his car, to give me time to move. I remember he took me to hospital, but not who he was or what he looked like. I don’t know if I thanked him, and thats the second thing I wake up to think about.

You see, I really want to make sure that I thanked him and that he knows I’m grateful. What are the chances that he might read this and remember, or that he told someone his story and they remember?

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Who can you trust during the coronavirus crisis?

By Paul Cairney and Adam Wellstead, based on this paper.

Trust is essential during a crisis. It is necessary for cooperation. Cooperation helps people coordinate action, to reduce the need for imposition. It helps reduce uncertainty in a complex world. It facilitates social order and cohesiveness. In a crisis, almost-instant choices about who to trust or distrust make a difference between life and death.

Put simply, we need to trust: experts to help us understand and address the problem, governments to coordinate policy and make choices about levels of coercion, and each other to cooperate to minimise infection.

Yet, there are three unresolved problems with understanding trust in relation to coronavirus policy.

  1. What does trust really mean?

Trust is one of those words that could mean everything and nothing. We feel like we understand it intuitively, but would also struggle to define it well enough to explain how exactly it works. For example, in social science, there is some agreement on the need to describe individual motivation, social relationships, and some notion of the ‘public good’:

  • the production of trust helps boost the possibility of cooperation, partly by
  • reducing uncertainty (low information about a problem) and ambiguity (low agreement on how to understand it) when making choices, partly by
  • helping you manage the risk of making yourself vulnerable when relying on others, particularly when
  • people demonstrate trustworthiness by developing a reputation for competence, honesty, and/ or reliability, and
  • you combine cognition and emotion to produce a disposition to trust, and
  • social and political rules facilitate this process, from the formal and well-understood rules governing behaviour to the informal rules and norms shaping behaviour.

As such, trust describes your non-trivial belief in the reliability of other people, organisations, or processes. It facilitates the kinds of behaviour that are essential to an effective response to the coronavirus, in which we need to:

  1. Make judgements about the accuracy of information underpinning our choices to change behaviour (such as from scientific agencies).
  2. Assess the credibility of the people with whom we choose to cooperate or take advice (such as more or less trust in each country’s leadership).
  3. Measure the effectiveness of the governments or political systems to which we pledge our loyalty.

Crucially, in most cases, people need to put their trust in actions or outcomes caused by people they do not know, and the explanation for this kind of trust is very different to trusting people you know.

  1. What does trust look like in policymaking?

Think of trust as a mechanism to boost cooperation and coalition formation, help reduce uncertainty, and minimise the ‘transactions costs’ of cooperation (for example, monitoring behaviour, or producing or enforcing contracts). However, uncertainty is remarkably high because the policy process is not easy to understand. We can try to understand the ‘mechanisms’ of trust, to boost cooperation, with reference to these statements about trustees and the trusted:

  1. Individuals need to find ways to make choices about who to trust and distrust.
  2. However, they must act within a complex policymaking environment in which they have minimal knowledge of what will happen and who will make it happen.
  3. To respond effectively, people seek ways to cooperate with others systematically, such as by establishing formal and informal rules.

People seeking to make and influence policy must act despite uncertainty about the probability of success or risk of failure. In a crisis, it happens almost instantly. People generate beliefs about what they want to happen and how their reliance on others can help it happen. This calculation depends on:

  • Another person or organisation’s reputation for being trustworthy, allowing people the ability to increase certainty when they calculate the risk of engagement.
  • The psychology of trust and perceptions of another actor’s motives. To some extent, people gather information and use logic to determine someone’s competence. However, they also use gut feeling or emotion to help them decide to depend on someone else. They may also trust a particular source if the cognitive load is low, such as because (a) the source is familiar (e.g. a well-known politician or a celebrity, or oft-used source), or (b) the information is not challenging to remember or accept.

If so, facilitators of trust include:

  • People share the same characteristics, such as beliefs, norms, or expectations.
  • Some people have reputations for being reliable, predictable, honest, competent, and/ or relatively selfless.
  • Good experiences of previous behaviour, including repeated interactions that foster rewards and help predict future risk (with face to face contact often described as particularly helpful).
  • People may trust people in a position of authority (or the organisation or office), such as an expert or policymaker (although perhaps the threat of rule enforcement is better understood as a substitute for trust, and in practice it is difficult to spot the difference).

High levels of trust are apparent when effective practices – built on reciprocity, emotional bonds, and/ or positive expectations – become the norms or formalised and written down for all to see and agree. High levels of distrust indicate a need to deter the breach of agreements, by introducing expectations combined with sanctions for not behaving as expected.

  1. Who should you trust?

These concepts do not explain fully why people trust particular people more than others, or help us determine who you should trust during a crisis.

Rather, first, they help us reflect on the ways in which people have been describing their own thought processes (click here, and scroll to ‘Limiting the use of evidence’), such as trusting an expert source because they: (a) have a particular scientific background, (b) have proven to be honest and reliable in the past, (c) represent a wider scientific profession/ community, (d) are part of a systematic policymaking machinery, (e) can be held to account for their actions, (f) are open about the limits to their knowledge, and/or (g) engage critically with information to challenge simplistic rushes to judgement. Overall, note how much trust relates to our minimal knowledge about their research skills, prompting us to rely on an assessment of their character or status to judge their behaviour. In most cases, this is an informal process in which people may not state (or really know) why they trust or distrust someone so readily.

Then, we can reflect on who we trust, and why, and if we should change how we make such calculations during a crisis like the coronavirus. Examples include:

  • A strong identity with a left or right wing cause might prompt us only to trust people from one political party. This thought process may be efficient during elections and debates, but does it work so well during a crisis necessitating so high levels of cross-party cooperation?
  • People may be inclined to ignore advice because they do not trust their government, but maybe (a) high empathy for their vulnerable neighbours, and (b) low certainty about the impact of their actions, should prompt them to trust in government advice unless they have a tangible reason not to (while low empathy helps explain actions such as hoarding).
  • Government policy is based strongly on the extent to which policymakers trust people to do the right thing. Most debates in liberal democracies relate to the idea that (a) people can be trusted, so give advice and keep action voluntary, or cannot be trusted, so make them do the right thing, and that (b) citizens can trust their government. In other words, it must be a reciprocal relationship (see the Tweets in Step 3).

Finally, governments make policy based on limited knowledge and minimal control of the outcomes, and they often respond with trial-and-error strategies. The latter is fine if attention to policy is low and trust in government sufficiently high. However, in countries like the UK and US, each new choice prompts many people to question not only the competence of leaders but also their motivation. This is a worrying development for which everyone should take some responsibility.

See also:

Policy Concepts in 1000 Words: the Institutional Analysis and Development Framework (IAD) and Governing the Commons

The coronavirus and evidence-informed policy analysis (short version)

The coronavirus and evidence-informed policy analysis (long version)

 

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El Coronavirus y el Análisis de Políticas Públicas Basado en Evidencia (versión corta)

Paul Cairney, Profesor de Política y Políticas Públicas en la Universidad de Stirling, Escocia. Enlace a texto original en inglés.

El coronavirus se siente como un nuevo problema público que requiere un nuevo análisis de política pública. El análisis debe basarse en (a) buena evidencia, que se traduzca en (b) buena política. Sin embargo, no se deje engañar y piense que estas partes son sencillas. Hay pasos que parecen simples que van desde definir un problema hasta hacer una recomendación, pero esta simplicidad enmascara el proceso profundamente político que se lleva a cabo. Cada paso del análisis involucra elecciones políticas para priorizar algunos problemas y algunas soluciones sobre otros y, por lo tanto, priorizar la vida de algunas personas a expensas de otras.

La versión larga de esta publicación (en inglés) nos lleva a través de estos pasos en el Reino Unido y los sitúa en un contexto político y de formulación de política pública más amplio. Esta publicación es más corta y solamente presenta superficialmente dicho análisis.

5 pasos para el análisis de políticas públicas

  1. Defina el Problema

Quizás podamos resumirlo como: (a) el impacto de este virus y enfermedad tendrá cierto nivel de muertes y enfermedades que podrían abrumar a la población y exceder la capacidad de los servicios públicos, por lo que (b) necesitamos contener el virus lo suficiente para asegurarnos de que se propaga de la manera correcta en el momento correcto, por lo que (c) necesitamos alentar y hacer que las personas cambien su comportamiento (esencialmente a través de la higiene y el distanciamiento social). Sin embargo, hay muchas formas de encuadrar este problema para enfatizar la importancia de algunas poblaciones sobre otras y algunos impactos sobre otros.

  1. Identifique soluciones técnica y políticamente factibles

Las soluciones no son realmente soluciones: son instrumentos de política que abordan un aspecto del problema, incluidos los impuestos y el gasto, la prestación de servicios públicos, el financiamiento de la investigación,  las recomendaciones a la población y la regulación o el fomento de cambios en el comportamiento social. Cada nuevo instrumento contribuye a un conjunto existente , con consecuencias impredecibles y no deseadas. Algunos instrumentos parecen técnicamente factibles (funcionarán según lo previsto si se implementan), pero no se adoptarán a menos que sean políticamente factibles (suficientes personas apoyan su  adopción). O viceversa. Este doble requisito descarta muchas respuestas.

  1. Use valores y objetivos para comparar soluciones

Los juicios típicos combinan: (a) una descripción amplia de valores tales como eficiencia, equidad, libertad, seguridad y dignidad humana, (b) metas instrumentales, tales como la formulación de políticas sostenibles (¿podemos hacerlo? y ¿por cuánto tiempo?), y viabilidad política (¿la gente estará de acuerdo con esto?, y ¿me hará más o menos popular o confiable?), y (c) el proceso de toma de decisiones, tal como el grado en que un proceso de política pública involucra a ciudadanos o partes interesadas (junto con expertos) en la deliberación. Se congregan para ayudar a los formuladores de políticas en la toma de decisiones de alto perfil (como el equilibrio entre la libertad individual y la coerción del Estado) y opciones de bajo perfil, pero profundas (para influir en el nivel de capacidad del servicio público y el nivel de intervención estatal y, por lo tanto, quién y cómo  las personas morirán).

  1. Anticipe el resultado de cada solución factible

Es difícil concebir una forma en la cual el Gobierno del Reino Unido publique todo el proceso detrás de sus elecciones (Paso 3) y predicciones (Paso 4) de una manera que fomente una deliberación pública efectiva. La gente a menudo demanda al Gobierno del Reino Unido que publique su asesoramiento experto y su lógica operativa, pero no estoy seguro de cómo lo separarían de su lógica normativa sobre quién debería vivir o morir, o proporcionar una franca explicación sin consecuencias imprevistas para la confianza o ansiedad públicas. Si así fuera, un aspecto de la política gubernamental es mantener implícitas algunas opciones y evitar un gran debate sobre las alternativas. Otra forma es tomar decisiones continuamente sin saber cuál será su impacto (el escenario más probable en este momento).

 

  1. Tome una elección o proporcione una recomendación para su cliente

Su recomendación o elección se basaría en estos cuatro pasos. Defina el problema con un marco de análisis a expensas de los otros. Idealice a algunas personas y no a otras. Decida la forma de apoyar a algunas personas y coaccionar o castigar a otras. Priorice la vida de algunas personas sabiendo que otras sufrirán o morirán. Hágalo a pesar de su falta de experiencia y de su conocimiento e información profundamente limitados. Aprenda de los expertos, pero no asuma que únicamente los expertos científicos tienen conocimiento relevante (descolonizar; coproducir). Recomiende opciones que, si son perjudiciales, podrían tomar décadas para solucionarlas después de que se haya ido. Considere si un formulador de políticas está dispuesto y puede actuar siguiendo su consejo, y si su acción propuesta funcionará según lo planeado. Considere si un gobierno está dispuesto y puede soportar los costos económicos y políticos. Proteja la popularidad de su cliente y confíe en él, al mismo tiempo que se protegen vidas. Considere si su consejo se modificaría si el problema pareciera cambiar. Si está escribiendo su análisis, quizás manténgalo en una cuartilla (en otras palabras, menos palabras que las escritas hasta este momento).

El análisis de políticas no es tan simple como sugieren estos pasos, y un análisis más detallado del contexto amplio de la formulación de políticas públicas ayuda a describir dos limitaciones importantes para la acción y el pensamiento analítico sencillos.

  1. Los formuladores de política pública deben ignorar casi toda la evidencia

La cantidad de información relevante para la política pública es infinita y la capacidad de análisis es finita. Por lo tanto, los individuos y los gobiernos necesitan formas de filtrar casi todo. Los individuos combinan cognición y emoción para ayudarlos a tomar decisiones de manera eficiente y los gobiernos tienen reglas equivalentes para priorizar solo cierta información. Esto incluye: definir un problema y una respuesta factible, buscar información disponible, comprensible y procesable, e identificar fuentes creíbles de información y consejo. En ese contexto, la vaga idea de confiar o no en expertos no tiene sentido. La versión larga de esta publicación destaca las muchas formas defectuosas en que todas las personas deciden de quién es la experiencia que toman en cuenta.

  1. Los formuladores no controlan el proceso de políticas.

Los formuladores de políticas públicas participan en un mundo desordenado e impredecible en el que ningún “centro” tiene el poder de convertir una recomendación de política en un resultado.

  • Hay muchos formuladores de políticas e individuos influyentes diseminados a lo largo del sistema político. Por ejemplo, considere el grado en que cada departamento gubernamental, organismos desconcentrados y organizaciones públicas y privadas toman sus propias decisiones que ayudan u obstaculizan la política del gobierno del Reino Unido.
  • La mayoría de las elecciones en el gobierno se toman en “subsistemas”, con sus propias reglas y redes, sobre las cuales los ministros tienen un conocimiento e influencia limitados.
  • El contexto social y económico, al igual que otros eventos, están en gran medida fuera de su control.

Mensajes para llevar a casa (si acepta esta argumentación)

  1. El coronavirus es un ejemplo extremo de una situación general: los formuladores de política pública siempre tendrán un conocimiento limitado de la problemática en la política pública y de control sobre el entorno de formulación de políticas. Toman decisiones para encuadrar problemas de manera estrecha, de manera tal que parezcan solucionables, descartan la mayoría de las soluciones como no factibles, hacen juicios de valor para intentar ayudar a algunos más que a otros, intentan predecir los resultados y responden cuando los resultados no coinciden con sus esperanzas o expectativas.
  2. Este no es un mensaje de fatalidad y desesperación. Más bien, nos alienta a pensar sobre cómo influir en el gobierno, y hacer que los responsables de las políticas rindan cuentas de una manera reflexiva y sistemática que no engañe al público ni exacerbe el problema que estamos viendo. Nadie está ayudando a su gobierno a resolver el problema diciendo estupideces en internet (bueno, esto último fue un mensaje de desesperación).

Para saber más:

La versión larga de este reporte [en inglés] expone estos argumentos con mucho más detalle, con algunos enlaces a otras ideas.

Esta serie de publicaciones de “750 palabras” [en inglés y en español]  resume textos clave en el análisis de políticas e intenta situar el análisis de políticas en un contexto político y de formulación de políticas más amplio. Tenga en cuenta el enfoque dentro de este conocimiento, el cual aún no es una característica importante de esta crisis.

Estas series de publicaciones de 500 palabras y 1000 palabras [en inglés] resumen conceptos y teorías en los estudios de políticas públicas.

Esta página sobre formulación de políticas basadas en evidencia (EBPM) [en inglés] utiliza esos conocimientos para demostrar por qué EBPM es un eslogan político en lugar de una expectativa realista. Algunas entradas de EBPM también están disponibles en español.

Estas conferencias grabadas [en inglés] relacionan esas ideas con preguntas comunes formuladas por los investigadores: ¿por qué los encargados de formular políticas parecen ignorar mi evidencia? [en inglés] y ¿qué puedo hacer al respecto? [en inglés] Estoy feliz de grabar más (como sobre el tema que acabas de leer) pero no estoy completamente seguro de quién querría escuchar qué.

Traductores

Anette Bonifant Cisneros anette.bonifant@york.ac.uk

Enrique García Tejeda cgarcia@up.edu.mx

 

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The coronavirus and evidence-informed policy analysis (short version)

The coronavirus feels like a new policy problem that requires new policy analysis. The analysis should be informed by (a) good evidence, translated into (b) good policy. However, don’t be fooled into thinking that either of those things are straightforward. There are simple-looking steps to go from defining a problem to making a recommendation, but this simplicity masks the profoundly political process that must take place. Each step in analysis involves political choices to prioritise some problems and solutions over others, and therefore prioritise some people’s lives at the expense of others.

The very-long version of this post takes us through those steps in the UK, and situates them in a wider political and policymaking context. This post is shorter, and only scratches the surface of analysis.

5 steps to policy analysis

  1. Define the problem.

Perhaps we can sum it up as: (a) the impact of this virus and illness will be a level of death and illness that could overwhelm the population and exceed the capacity of public services, so (b) we need to contain the virus enough to make sure it spreads in the right way at the right time, so (c) we need to encourage and make people change their behaviour (primarily via hygiene and social distancing). However, there are many ways to frame this problem to emphasise the importance of some populations over others, and some impacts over others.

  1. Identify technically and politically feasible solutions.

Solutions are not really solutions: they are policy instruments that address one aspect of the problem, including taxation and spending, delivering public services, funding research, giving advice to the population, and regulating or encouraging changes to social behaviour. Each new instrument contributes an existing mix, with unpredictable and unintended consequences. Some instruments seem technically feasible (they will work as intended if implemented), but will not be adopted unless politically feasible (enough people support their introduction). Or vice versa. This dual requirement rules out a lot of responses.

  1. Use values and goals to compare solutions.

Typical judgements combine: (a) broad descriptions of values such as efficiency, fairness, freedom, security, and human dignity, (b) instrumental goals, such as sustainable policymaking (can we do it, and for how long?), and political feasibility (will people agree to it, and will it make me more or less popular or trusted?), and (c) the process to make choices, such as the extent to which a policy process involves citizens or stakeholders (alongside experts) in deliberation. They combine to help policymakers come to high profile choices (such as the balance between individual freedom and state coercion), and low profile but profound choices (to influence the level of public service capacity, and level of state intervention, and therefore who and how many people will die).

  1. Predict the outcome of each feasible solution.

It is difficult to envisage a way for the UK Government to publicise all of the thinking behind its choices (Step 3) and predictions (Step 4) in a way that would encourage effective public deliberation. People often call for the UK Government to publicise its expert advice and operational logic, but I am not sure how they would separate it from their normative logic about who should live or die, or provide a frank account without unintended consequences for public trust or anxiety. If so, one aspect of government policy is to keep some choices implicit and avoid a lot of debate on trade-offs. Another is to make choices continuously without knowing what their impact will be (the most likely scenario right now).

  1. Make a choice, or recommendation to your client.

Your recommendation or choice would build on these four steps. Define the problem with one framing at the expense of the others. Romanticise some people and not others. Decide how to support some people, and coerce or punish others. Prioritise the lives of some people in the knowledge that others will suffer or die. Do it despite your lack of expertise and profoundly limited knowledge and information. Learn from experts, but don’t assume that only scientific experts have relevant knowledge (decolonise; coproduce). Recommend choices that, if damaging, could take decades to fix after you’ve gone. Consider if a policymaker is willing and able to act on your advice, and if your proposed action will work as intended. Consider if a government is willing and able to bear the economic and political costs. Protect your client’s popularity, and trust in your client, at the same time as protecting lives. Consider if your advice would change if the problem seemed to change. If you are writing your analysis, maybe keep it down to one sheet of paper (in other words, fewer words than in this post up to this point).

Policy analysis is not as simple as these steps suggest, and further analysis of the wider policymaking environment helps describe two profound limitations to simple analytical thought and action.

  1. Policymakers must ignore almost all evidence

The amount of policy relevant information is infinite, and capacity is finite. So, individuals and governments need ways to filter out almost all of it. Individuals combine cognition and emotion to help them make choices efficiently, and governments have equivalent rules to prioritise only some information. They include: define a problem and a feasible response, seek information that is available, understandable, and actionable, and identify credible sources of information and advice. In that context, the vague idea of trusting or not trusting experts is nonsense, and the larger post highlights the many flawed ways in which all people decide whose expertise counts.

  1. They do not control the policy process.

Policymakers engage in a messy and unpredictable world in which no single ‘centre’ has the power to turn a policy recommendation into an outcome.

  • There are many policymakers and influencers spread across a political system. For example, consider the extent to which each government department, devolved governments, and public and private organisations are making their own choices that help or hinder the UK government approach.
  • Most choices in government are made in ‘subsystems’, with their own rules and networks, over which ministers have limited knowledge and influence.
  • The social and economic context, and events, are largely out of their control.

The take home messages (if you accept this line of thinking)

  1. The coronavirus is an extreme example of a general situation: policymakers will always have very limited knowledge of policy problems and control over their policymaking environment. They make choices to frame problems narrowly enough to seem solvable, rule out most solutions as not feasible, make value judgements to try help some more than others, try to predict the results, and respond when the results do not match their hopes or expectations.
  2. This is not a message of doom and despair. Rather, it encourages us to think about how to influence government, and hold policymakers to account, in a thoughtful and systematic way that does not mislead the public or exacerbate the problem we are seeing. No one is helping their government solve the problem by saying stupid shit on the internet (OK, that last bit was a message of despair).

 

Further reading:

The longer report sets out these arguments in much more detail, with some links to further thoughts and developments.

This series of ‘750 words’ posts summarises key texts in policy analysis and tries to situate policy analysis in a wider political and policymaking context. Note the focus on whose knowledge counts, which is not yet a big feature of this crisis.

These series of 500 words and 1000 words posts (with podcasts) summarise concepts and theories in policy studies.

This page on evidence-based policymaking (EBPM) uses those insights to demonstrate why EBPM is  a political slogan rather than a realistic expectation.

These recorded talks relate those insights to common questions asked by researchers: why do policymakers seem to ignore my evidence, and what can I do about it? I’m happy to record more (such as on the topic you just read about) but not entirely sure who would want to hear what.

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Filed under 750 word policy analysis, agenda setting, Evidence Based Policymaking (EBPM), Policy learning and transfer, POLU9UK, Prevention policy, Psychology Based Policy Studies, Public health, public policy, Social change, UK politics and policy