Tag Archives: Evidence-based medicine

A 5-step strategy to make evidence count

5 stepsLet’s imagine a heroic researcher, producing the best evidence and fearlessly ‘speaking truth to power’. Then, let’s place this person in four scenarios, each of which combines a discussion of evidence, policy, and politics in different ways.

  1. Imagine your hero presents to HM Treasury an evidence-based report concluding that a unitary UK state would be far more efficient than a union state guaranteeing Scottish devolution. The evidence is top quality and the reasoning is sound, but the research question is ridiculous. The result of political deliberation and electoral choice suggests that your hero is asking a research question that does not deserve to be funded in the current political climate. Your hero is a clown.
  2. Imagine your hero presents to the Department of Health a report based on the systematic review of multiple randomised control trials. It recommends that you roll out an almost-identical early years or public health intervention across the whole country. We need high ‘fidelity’ to the model to ensure the correct ‘dosage’ and to measure its effect scientifically. The evidence is of the highest quality, but the research question is not quite right. The government has decided to devolve this responsibility to local public bodies and/ or encourage the co-production of public service design by local public bodies, communities, and service users. So, to focus narrowly on fidelity would be to ignore political choices (perhaps backed by different evidence) about how best to govern. If you don’t know the politics involved, you will ask the wrong questions or provide evidence with unclear relevance. Your hero is either a fool, naïve to the dynamics of governance, or a villain willing to ignore governance principles.        
  3. Imagine two fundamentally different – but equally heroic – professions with their own ideas about evidence. One favours a hierarchy of evidence in which RCTs and their systematic review is at the top, and service user and practitioner feedback is near the bottom. The other rejects this hierarchy completely, identifying the unique, complex relationship between practitioner and service user which requires high discretion to make choices in situations that will differ each time. Trying to resolve a debate between them with reference to ‘the evidence’ makes no sense. This is about a conflict between two heroes with opposing beliefs and preferences that can only be resolved through compromise or political choice. This is, oh I don’t know, Batman v Superman, saved by Wonder Woman.
  4. Imagine you want the evidence on hydraulic fracturing for shale oil and gas. We know that ‘the evidence’ follows the question: how much can we extract? How much revenue will it produce? Is it safe, from an engineering point of view? Is it safe, from a public health point of view? What will be its impact on climate change? What proportion of the public supports it? What proportion of the electorate supports it? Who will win and lose from the decision? It would be naïve to think that there is some kind of neutral way to produce an evidence-based analysis of such issues. The commissioning and integration of evidence has to be political. To pretend otherwise is a political strategy. Your hero may be another person’s villain.

Now, let’s use these scenarios to produce a 5-step way to ‘make evidence count’.

Step 1. Respect the positive role of politics

A narrow focus on making the supply of evidence count, via ‘evidence-based policymaking’, will always be dispiriting because it ignores politics or treats political choice as an inconvenience. If we:

  • begin with a focus on why we need political systems to make authoritative choices between conflicting preferences, and take governance principles seriously, we can
  • identify the demand for evidence in that context, then be more strategic and pragmatic about making evidence count, and
  • be less dispirited about the outcome.

In other words, think about the positive and necessary role of democratic politics before bemoaning post-truth politics and policy-based-evidence-making.

Step 2. Reject simple models of evidence-based policymaking

Policy is not made in a cycle containing a linear series of separate stages and we won’t ‘make evidence count’ by using it to inform our practices.

cycle

You might not want to give up the cycle image because it presents a simple account of how you should make policy. It suggests that we elect policymakers then: identify their aims, identify policies to achieve those aims, select a policy measure, ensure that the selection is legitimised by the population or its legislature, identify the necessary resources, implement and then evaluate. Or, policymakers aided by expert policy analysts make and legitimise choices, skilful public servants carry them out, and, policy analysts assess the results using evidence.

One compromise is to keep the cycle then show how messy it is in practice:

However, there comes a point when there is too much mess, and the image no longer helps you explain (a) to the public what you are doing, or (b) to providers of evidence how they should engage in political systems. By this point, simple messages from more complicated policy theories may be more useful.

Or, we may no longer want a cycle to symbolise a single source of policymaking authority. In a multi-level system, with many ‘centres’ possessing their own sources of legitimate authority, a single and simple policy cycle seems too artificial to be useful.

Step 3. Tell a simple story about your evidence

People are ‘cognitive misers’ seeking ‘rational’ and ‘irrational’ shortcuts to gather information for action, so you won’t get far if you bombard them with too much evidence. Policymakers already have too much evidence and they seek ways to reduce their cognitive load, relying on: (a) trusted sources of concise evidence relevant to their aims, and (b) their own experience, gut instinct, beliefs, and emotions.

The implication of both shortcuts is that we need to tell simple and persuasive stories about the substance and implications of the evidence we present. To say that ‘the evidence does not speak for itself’ may seem trite, but I’ve met too many people who assume naively that it will somehow ‘win the day’. In contrast, civil servants know that the evidence-informed advice they give to ministers needs to relate to the story that government ministers tell to the public.

how-to-be-heard

Step 4.  Tailor your story to many audiences

In a complex or multi-level environment, one story to one audience (such as a minister) is not enough. If there are many key sources of policymaking authority – including public bodies with high autonomy, organisations and practitioners with the discretion to deliver services, and service users involved in designing services – there are many stories being told about what we should be doing and why. We may convince one audience and alienate (or fail to inspire) another with the same story.

Step 5. Clarify and address key dilemmas with political choice, not evidence

Let me give you one example of the dilemmas that must arise when you combine evidence and politics to produce policy: how do you produce a model of ‘evidence based best practice’ which combines evidence and governance principles in a consistent way? Here are 3 ideal-type models which answer the question in very different ways

Table 1 Three ideal types EBBP

The table helps us think through the tensions between models, built on very different principles of good evidence and governance.

In practice, you may want to combine different elements, perhaps while arguing that the loss of consistency is lower than the gain from flexibility. Or, the dynamics of political systems limit such choice or prompt ad hoc and inconsistent choices.

I built a lot of this analysis on the experiences of the Scottish Government, which juggles all three models, including a key focus on improvement method in its Early Years Collaborative.

However, Kathryn Oliver and I show that the UK government faces the same basic dilemma and addresses it in similar ways.

The example freshest in my mind is Sure Start. Its rationale was built on RCT evidence and systematic review. However, its roll-out was built more on local flexibility and service design than insistence on fidelity to a model. More recently, the Troubled Families programme initially set the policy agenda and criteria for inclusion, but increasingly invites local public bodies to select the most appropriate interventions, aided by the Early Intervention Foundation which reviews the evidence but does not insist on one-best-way. Emily St Denny and I explore these issues further in our forthcoming book on prevention policy, an exemplar case study of a field in which it is difficult to know how to ‘make evidence count’.

If you prefer a 3-step take home message:

  1. I think we use phrases like ‘impact’ and ‘make evidence count’ to reflect a vague and general worry about a decline in respect for evidence and experts. Certainly, when I go to large conferences of scientists, they usually tell a story about ‘post-truth’ politics.
  2. Usually, these stories do not acknowledge the difference between two different explanations for an evidence-policy gap: (a) pathological policymaking and corrupt politicians, versus (b) complex policymaking and politicians having to make choices despite uncertainty.
  3. To produce evidence with ‘impact’, and know how to ‘make evidence count’, we need to understand the policy process and the demand for evidence within it.

*Background. This is a post for my talk at the Government Economic Service and Government Social Research Service Annual Training Conference (15th September 2017). This year’s theme is ‘Impact and Future-Proofing: Making Evidence Count’. My brief is to discuss evidence use in the Scottish Government, but it faces the same basic question as the UK Government: how do you combine principles of evidence quality and governance principles? In other words, if you were in a position to design an (a) evidence-gathering system and (b) a political system, you’d soon find major points of tension between them. Resolving those tensions involves political choice, not more evidence. Of course, you are not in a position to design both systems, so the more complicated question is: how do you satisfy principles of evidence and governance in a complex policy process, often driven by policymaker psychology, over which you have little control?  Here are 7 different ‘answers’.

Powerpoint Paul Cairney @ GES GSRS 2017

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The Politics of Evidence

This is a draft of my review of Justin Parkhurst (2017) The Politics of Evidence (Routledge, Open Access)

Justin Parkhurst’s aim is to identify key principles to take forward the ‘good governance of evidence’. The good governance of scientific evidence in policy and policymaking requires us to address two fundamentally important ‘biases’:

  1. Technical bias. Some organisations produce bad evidence, some parts of government cherry-pick, manipulate, or ignore evidence, and some politicians misinterpret the implications of evidence when calculating risk. Sometimes, these things are done deliberately for political gain. Sometimes they are caused by cognitive biases which cause us to interpret evidence in problematic ways. For example, you can seek evidence that confirms your position, and/ or only believe the evidence that confirms it.
  2. Issue bias. Some evidence advocates use the mantra of ‘evidence based policy’ to depoliticise issues or downplay the need to resolve conflicts over values. They also focus on the problems most conducive to study via their most respected methods such as randomised control trials (RCTs). Methodological rigour trumps policy relevance and simple experiments trump the exploration of complex solutions. So, we lose sight of the unintended consequences of producing the ‘best’ evidence to address a small number of problems, and making choices about the allocation of research resources and attention. Again, this can be deliberate or caused by cognitive biases, such as to seek simpler and more answerable questions than complex questions with no obvious answer.

To address both problems, Parkhurst seeks pragmatic ways to identify principles to decide what counts as ‘good evidence to inform policy’ and ‘what constitutes the good use of evidence within a policy process’:

‘it is necessary to consider how to establish evidence advisory systems that promote the good governance of evidence – working to ensure that rigorous, sys­tematic and technically valid pieces of evidence are used within decision-making processes that are inclusive of, representative of and accountable to the multiple social interests of the population served’ (p8).

Parkhurst identifies some ways in which to bring evidence and policy closer together. First, to produce evidence more appropriate for, or relevant to, policymaking (‘good evidence for policy’):

  1. Relate evidence more closely to policy goals.
  2. Modify research approaches and methods to answer policy relevant questions.
  3. Ensure that the evidence relates to the local or relevant context.

Second, to produce the ‘good use of evidence’, combine three forms of ‘legitimacy’:

  1. Input, to ensure democratic representative bodies have the final say.
  2. Throughput, to ensure widespread deliberation.
  3. Output, to ensure proper consideration the use of the most systematic, unbiased and rigorously produced scientific evidence relevant to the problem.

In the final chapter, Parkhurst suggests that these aims can be pursued in many ways depending on how governments want to design evidence advisory systems, but that it’s worth drawing on the examples of good practice he identifies. Parkhurst also explores the role for Academies of science, or initiatives such as the Cochrane Collaboration, to provide independent advice. He then outlines the good governance of evidence built on key principles: appropriate evidence, accountability in evidence use, transparency, and contestability (to ensure sufficient debate).

The overall result is a book full of interesting discussion and very sensible, general advice for people new to the topic of evidence and policy. This is no mean feat: most readers will seek a clearly explained and articulate account of the subject, and they get it here.

For me, the most interesting thing about Parkhurst’s book is the untold story, or often-implicit reasoning behind the way in which it is framed. We can infer that it is not a study aimed primarily at a political science or social science audience, because most of that audience would take its starting point for granted: the use of evidence is political, and politics involves values. Yet, Parkhurst feels the need to remind the reader of this point, in specific (“it is worth noting that the US presidency is a decidedly political role”, p43) and general circumstances (‘the nature of policymaking is inherently political’, p65). Throughout, the audience appears to be academics who begin with a desire for ‘evidence based policy’ without fully thinking through the implications, either about the lack of a magic bullet of evidence to solve a policy problem, how we might maintain a political system conducive to democratic principles and good evidence use, how we might design a system to reduce key ‘barriers’ between the supply of evidence by scientists and its demand by policymakers, and why few such designs have taken off.

In other words, the book appeals primarily to scientists trained outside social science, some of whom think about politics in their spare time, or encounter it in dispiriting encounters with policymakers. It appeals to that audience with a statement on the crucial role of high quality evidence in policymaking, highlights barriers to its use, tells scientists that they might be part of the problem, but then provides them with the comforting assurance that we can design better systems to overcome at least some of those barriers. For people trained in policy studies, this concluding discussion seems like a tall order, and I think most would read it with great scepticism.

Policy scientists might also be sceptical about the extent to which scientists from other fields think this way about hierarchies of scientific evidence and the desire to depoliticise politics with a primary focus on ‘what works’. Yet, I too hear this language regularly in interdisciplinary workshops (often while standing next to Justin!), and it is usually accompanied by descriptions of the pathology of policymaking, the rise of post-truth politics and rejection of experts, and the need to focus on the role of objective facts in deciding what policy solutions work best. Indeed, I was impressed recently by the skilled way in which another colleague prepared this audience for some provocative remarks when he suggested that the production and use of evidence is about power, not objectivity. OMG: who knew that policymaking was political and about power?!

So, the insights from this book are useful to a large audience of scientists while, for a smaller audience of policy scientists, they remind us that there is an audience out there for many of the statements that many of us would take for granted. Some evidence advocates use the language of ‘evidence based policymaking’ strategically, to get what they want. Others appear to use it because they believe it can exist. Keep this in mind when you read the book.

Parkhurst

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Kathryn Oliver and I have just published an article on the relationship between evidence and policy

Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

“There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems”.

We use this table to describe how the policy process works, how effective actors respond, and the dilemmas that arise for advocates of scientific evidence: should they act this way too?

We summarise this argument in two posts for:

The Guardian If scientists want to influence policymaking, they need to understand it

Sax Institute The evidence policy gap: changing the research mindset is only the beginning

The article is part of a wider body of work in which one or both of us considers the relationship between evidence and policy in different ways, including:

Paul Cairney, Kathryn Oliver, and Adam Wellstead (2016) ‘To Bridge the Divide between Evidence and Policy: Reduce Ambiguity as Much as Uncertainty’, Public Administration Review PDF

Paul Cairney (2016) The Politics of Evidence-Based Policy Making (PDF)

Oliver, K., Innvar, S., Lorenc, T., Woodman, J. and Thomas, J. (2014a) ‘A systematic review of barriers to and facilitators of the use of evidence by policymakers’ BMC health services research, 14 (1), 2. http://www.biomedcentral.com/1472-6963/14/2

Oliver, K., Lorenc, T., & Innvær, S. (2014b) ‘New directions in evidence-based policy research: a critical analysis of the literature’, Health Research Policy and Systems, 12, 34 http://www.biomedcentral.com/content/pdf/1478-4505-12-34.pdf

Paul Cairney (2016) Evidence-based best practice is more political than it looks in Evidence and Policy

Many of my blog posts explore how people like scientists or researchers might understand and respond to the policy process:

The Science of Evidence-based Policymaking: How to Be Heard

When presenting evidence to policymakers, engage with the policy process that exists, not the process you wish existed

Policy Concepts in 1000 Words: ‘Evidence Based Policymaking’

‘Evidence-based Policymaking’ and the Study of Public Policy

How far should you go to secure academic ‘impact’ in policymaking?

Political science improves our understanding of evidence-based policymaking, but does it produce better advice?

Psychology Based Policy Studies: 5 heuristics to maximise the use of evidence in policymaking

What 10 questions should we put to evidence for policy experts?

Why doesn’t evidence win the day in policy and policymaking?

We all want ‘evidence based policy making’ but how do we do it?

How can political actors take into account the limitations of evidence-based policy-making? 5 key points

The Politics of Evidence Based Policymaking:3 messages

The politics of evidence-based best practice: 4 messages

The politics of implementing evidence-based policies

There are more posts like this on my EBPM page

I am also guest editing a series of articles for the Open Access journal Palgrave Communications on the ‘politics of evidence-based policymaking’ and we are inviting submissions throughout 2017.

There are more details on that series here.

And finally ..

… if you’d like to read about the policy theories underpinning these arguments, see Key policy theories and concepts in 1000 words and 500 words.

 

 

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How far should you go to secure academic ‘impact’ in policymaking? From ‘honest brokers’ to ‘research purists’ and Machiavellian manipulators

Long read for Political Studies Association annual conference 2017 panel Rethinking Impact: Narratives of Research-Policy Relations. There is a paper too, but I’ve hidden it in the text like an Easter Egg hunt.

I’ve watched a lot of film and TV dramas over the decades. Many have the same basic theme, characters, and moral:

  1. There is a villain getting away with something, such as cheating at sport or trying to evict people to make money on a property deal.
  2. There are some characters who complain that life is unfair and there’s nothing they can do about it.
  3. A hero emerges to inspire the other characters to act as a team/ fight the system and win the day. Think of a range from Wyldstyle to Michael Corleone.

For many scientists right now, the villains are people like Trump or Farage, Trump’s election and Brexit symbolise an unfairness on a grand scale, and there’s little they can do about it in a ‘post-truth’ era in which people have had enough of facts and experts. Or, when people try to mobilise, they are unsure about what to do or how far they are willing to go to win the day.

These issues are playing out in different ways, from the March for Science to the conferences informing debates on modern principles of government-science advice (see INGSA). Yet, the basic question is the same when scientists are trying to re-establish a particular role for science in the world: can you present science as (a) a universal principle and (b) unequivocal resource for good, producing (c) evidence so pure that it speaks for itself, regardless of (d) the context in which specific forms of scientific evidence are produced and used?

Of course not. Instead, we are trying to privilege the role of science and scientific evidence in politics and policymaking without always acknowledging that these activities are political acts:

(a) selling scientific values rather than self-evidence truths, and

(b) using particular values to cement the status of particular groups at the expense of others, either within the scientific profession (in which some disciplines and social groups win systematically) or within society (in which scientific experts generally enjoy privileged positions in policymaking arenas).

Politics is about exercising power to win disputes, from visible acts to win ‘key choices’, to less visible acts to keep issues off agendas and reinforce the attitudes and behaviours that systematically benefit some groups at the expense of others.

To deny this link between science, politics and power – in the name of ‘science’ – is (a) silly, and (b) not scientific, since there is a wealth of policy science out there which highlights this relationship.

Instead, academic and working scientists should make better use of their political-thinking-time to consider this basic dilemma regarding political engagement: how far are you willing to go to make an impact and get what you want?  Here are three examples.

  1. How energetically should you give science advice?

My impression is that most scientists feel most comfortable with the unfortunate idea of separating facts from values (rejected by Douglas), and living life as ‘honest brokers’ rather than ‘issue advocates’ (a pursuit described by Pielke and critiqued by Jasanoff). For me, this is generally a cop-out since it puts the responsibility on politicians to understand the implications of scientific evidence, as if they were self-evident, rather than on scientists to explain the significance in a language familiar to their audience.

On the other hand, the alternative is not really clear. ‘Getting your hands dirty’, to maximise the uptake of evidence in politics, is a great metaphor but a hopeless blueprint, especially when you, as part of a notional ‘scientific community’, face trade-offs between doing what you think is the right thing and getting what you want.

There are 101 examples of these individual choices that make up one big engagement dilemmas. One of my favourite examples from table 1 is as follows:

One argument stated frequently is that, to be effective in policy, you should put forward scientists with a particular background trusted by policymakers: white men in their 50s with international reputations and strong networks in their scientific field. This way, they resemble the profile of key policymakers who tend to trust people already familiar to them. Another is that we should widen out science and science advice, investing in a new and diverse generation of science-policy specialists, to address the charge that science is an elite endeavour contributing to inequalities.

  1. How far should you go to ensure that the ‘best’ scientific evidence underpins policy?

Kathryn Oliver and I identify the dilemmas that arise when principles of evidence-production meet (a) principles of governance and (b) real world policymaking. Should scientists learn how to be manipulative, to combine evidence and emotional appeals to win the day? Should they reject other forms of knowledge, and particular forms of governance if the think they get in the way of the use of the best evidence in policymaking?

Cairney Oliver 2017 table 1

  1. Is it OK to use psychological insights to manipulate policymakers?

Richard Kwiatkowski and I mostly discuss how to be manipulative if you make that leap. Or, to put it less dramatically, how to identify relevant insights from psychology, apply them to policymaking, and decide how best to respond. Here, we propose five heuristics for engagement:

  1. developing heuristics to respond positively to ‘irrational’ policymaking
  2. tailoring framing strategies to policymaker bias
  3. identifying the right time to influence individuals and processes
  4. adapting to real-world (dysfunctional) organisations rather than waiting for an orderly process to appear, and
  5. recognising that the biases we ascribe to policymakers are present in ourselves and our own groups

Then there is the impact agenda, which describes something very different

I say these things to link to our PSA panel, in which Christina Boswell and Katherine Smith sum up (in their abstract) the difference between the ways in which we are expected to demonstrate academic impact, and the practices that might actually produce real impact:

Political scientists are increasingly exhorted to ensure their research has policy ‘impact’, most notably in the form of REF impact case studies, and ‘pathways to impact’ plans in ESRC funding. Yet the assumptions underpinning these frameworks are frequently problematic. Notions of ‘impact’, ‘engagement’ and ‘knowledge exchange’ are typically premised on simplistic and linear models of the policy process, according to which policy-makers are keen to ‘utilise’ expertise to produce more effective policy interventions”.

I then sum up the same thing but with different words in my abstract:

“The impact agenda prompts strategies which reflect the science literature on ‘barriers’ between evidence and policy: produce more accessible reports, find the right time to engage, encourage academic-practitioner workshops, and hope that policymakers have the skills to understand and motive to respond to your evidence. Such strategies are built on the idea that scientists serve to reduce policymaker uncertainty, with a linear connection between evidence and policy. Yet, the literature informed by policy theory suggests that successful actors combine evidence and persuasion to reduce ambiguity, particularly when they know where the ‘action’ is within complex policymaking systems”.

The implications for the impact agenda are interesting, because there is a big difference between (a) the fairly banal ways in which we might make it easier for policymakers to see our work, and (b) the more exciting and sinister-looking ways in which we might make more persuasive cases. Yet, our incentive remains to produce the research and play it safe, producing examples of ‘impact’ that, on the whole, seem more reportable than remarkable.

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Why doesn’t evidence win the day in policy and policymaking?

cairney-southampton-evidence-win-the-dayPolitics has a profound influence on the use of evidence in policy, but we need to look ‘beyond the headlines’ for a sense of perspective on its impact.

It is tempting for scientists to identify the pathological effect of politics on policymaking, particularly after high profile events such as the ‘Brexit’ vote in the UK and the election of Donald Trump as US President. We have allegedly entered an era of ‘post-truth politics’ in which ideology and emotion trumps evidence and expertise (a story told many times at events like this), particularly when issues are salient.

Yet, most policy is processed out of this public spotlight, because the flip side of high attention to one issue is minimal attention to most others. Science has a crucial role in this more humdrum day-to-day business of policymaking which is far more important than visible. Indeed, this lack of public visibility can help many actors secure a privileged position in the policy process (and further exclude citizens).

In some cases, experts are consulted routinely. There is often a ‘logic’ of consultation with the ‘usual suspects’, including the actors most able to provide evidence-informed advice. In others, scientific evidence is often so taken for granted that it is part of the language in which policymakers identify problems and solutions.

In that context, we need better explanations of an ‘evidence-policy’ gap than the pathologies of politics and egregious biases of politicians.

To understand this process, and appearance of contradiction between excluded versus privileged experts, consider the role of evidence in politics and policymaking from three different perspectives.

The perspective of scientists involved primarily in the supply of evidence

Scientists produce high quality evidence only for politicians often ignore it or, even worse, distort its message to support their ideologically-driven policies. If they expect ‘evidence-based policymaking’ they soon become disenchanted and conclude that ‘policy-based evidence’ is more likely. This perspective has long been expressed in scientific journals and commentaries, but has taken on new significance following ‘Brexit’ and Trump.

The perspective of elected politicians

Elected politicians are involved primarily in managing government and maximising public and organisational support for policies. So, scientific evidence is one piece of a large puzzle. They may begin with a manifesto for government and, if elected, feel an obligation to carry it out. Evidence may play a part in that process but the search for evidence on policy solutions is not necessarily prompted by evidence of policy problems.

Further, ‘evidence based policy’ is one of many governance principles that politicians should feel the need to juggle. For example, in Westminster systems, ministers may try to delegate policymaking to foster ‘localism’ and/ or pragmatic policymaking, but also intervene to appear to be in control of policy, to foster a sense of accountability built on an electoral imperative. The likely mix of delegation and intervention seems almost impossible to predict, and this dynamic has a knock-on effect for evidence-informed policy. In some cases, central governments roll out the same basic policy intervention and limit local discretion; in others, it identifies broad outcomes and invites other bodies to gather evidence on how best to meet them. These differences in approach can have profound consequences on the models of evidence-informed policy available to us (see the example of Scottish policymaking).

Political science and policy studies provide a third perspective

Policy theories help us identify the relationship between evidence and policy by showing that a modern focus on ‘evidence-based policymaking’ (EBPM) is one of many versions of the same fairy tale – about ‘rational’ policymaking – that have developed in the post-war period. We talk about ‘bounded rationality’ to identify key ways in which policymakers or organisations could not achieve ‘comprehensive rationality’:

  1. They cannot separate values and facts.
  2. They have multiple, often unclear, objectives which are difficult to rank in any meaningful way.
  3. They have to use major shortcuts to gather a limited amount of information in a limited time.
  4. They can’t make policy from the ‘top down’ in a cycle of ordered and linear stages.

Limits to ‘rational’ policymaking: two shortcuts to make decisions

We can sum up the first three bullet points with one statement: policymakers have to try to evaluate and solve many problems without the ability to understand what they are, how they feel about them as a whole, and what effect their actions will have.

To do so, they use two shortcuts: ‘rational’, by pursuing clear goals and prioritizing certain kinds and sources of information, and ‘irrational’, by drawing on emotions, gut feelings, deeply held beliefs, habits, and the familiar to make decisions quickly.

Consequently, the focus of policy theories is on the links between evidence, persuasion, and framing issues to produce or reinforce a dominant way to define policy problems. Successful actors combine evidence and emotional appeals or simple stories to capture policymaker attention, and/ or help policymakers interpret information through the lens of their strongly-held beliefs.

Scientific evidence plays its part, but scientists often make the mistake of trying to bombard policymakers with evidence when they should be trying to (a) understand how policymakers understand problems, so that they can anticipate their demand for evidence, and (b) frame their evidence according to the cognitive biases of their audience.

Policymaking in ‘complex systems’ or multi-level policymaking environments

Policymaking takes place in less ordered, less hierarchical, and less predictable environment than suggested by the image of the policy cycle. Such environments are made up of:

  1. a wide range of actors (individuals and organisations) influencing policy at many levels of government
  2. a proliferation of rules and norms followed by different levels or types of government
  3. close relationships (‘networks’) between policymakers and powerful actors
  4. a tendency for certain beliefs or ‘paradigms’ to dominate discussion
  5. shifting policy conditions and events that can prompt policymaker attention to lurch at short notice.

These five properties – plus a ‘model of the individual’ built on a discussion of ‘bounded rationality’ – make up the building blocks of policy theories (many of which I summarise in 1000 Word posts). I say this partly to aid interdisciplinary conversation: of course, each theory has its own literature and jargon, and it is difficult to compare and combine their insights, but if you are trained in a different discipline it’s unfair to ask you devote years of your life to studying policy theory to end up at this point.

To show that policy theories have a lot to offer, I have been trying to distil their collective insights into a handy guide – using this same basic format – that you can apply to a variety of different situations, from explaining painfully slow policy change in some areas but dramatic change in others, to highlighting ways in which you can respond effectively.

We can use this approach to help answer many kinds of questions. With my Southampton gig in mind, let’s use some examples from public health and prevention.

Why doesn’t evidence win the day in tobacco policy?

My colleagues and I try to explain why it takes so long for the evidence on smoking and health to have a proportionate impact on policy. Usually, at the back of my mind, is a public health professional audience trying to work out why policymakers don’t act quickly or effectively enough when presented with unequivocal scientific evidence. More recently, they wonder why there is such uneven implementation of a global agreement – the WHO Framework Convention on Tobacco Control – that almost every country in the world has signed.

We identify three conditions under which evidence will ‘win the day’:

  1. Actors are able to use scientific evidence to persuade policymakers to pay attention to, and shift their understanding of, policy problems. In leading countries, it took decades to command attention to the health effects of smoking, reframe tobacco primarily as a public health epidemic (not an economic good), and generate support for the most effective evidence-based solutions.
  2. The policy environment becomes conducive to policy change. A new and dominant frame helps give health departments (often in multiple venues) a greater role; health departments foster networks with public health and medical groups at the expense of the tobacco industry; and, they emphasise the socioeconomic conditions – reductions in smoking prevalence, opposition to tobacco control, and economic benefits to tobacco – supportive of tobacco control.
  3. Actors exploit ‘windows of opportunity’ successfully. A supportive frame and policy environment maximises the chances of high attention to a public health epidemic and provides the motive and opportunity of policymakers to select relatively restrictive policy instruments.

So, scientific evidence is a necessary but insufficient condition for major policy change. Key actors do not simply respond to new evidence: they use it as a resource to further their aims, to frame policy problems in ways that will generate policymaker attention, and underpin technically and politically feasible solutions that policymakers will have the motive and opportunity to select. This remains true even when the evidence seems unequivocal and when countries have signed up to an international agreement which commits them to major policy change. Such commitments can only be fulfilled over the long term, when actors help change the policy environment in which these decisions are made and implemented. So far, this change has not occurred in most countries (or, in other aspects of public health in the UK, such as alcohol policy).

Why doesn’t evidence win the day in prevention and early intervention policy?

UK and devolved governments draw on health and economic evidence to make a strong and highly visible commitment to preventive policymaking, in which the aim is to intervene earlier in people’s lives to improve wellbeing and reduce socioeconomic inequalities and/ or public sector costs. This agenda has existed in one form or another for decades without the same signs of progress we now associate with areas like tobacco control. Indeed, the comparison is instructive, since prevention policy rarely meets the three conditions outlined above:

  1. Prevention is a highly ambiguous term and many actors make sense of it in many different ways. There is no equivalent to a major shift in problem definition for prevention policy as a whole, and little agreement on how to determine the most effective or cost-effective solutions.
  2. A supportive policy environment is far harder to identify. Prevention policy cross-cuts many policymaking venues at many levels of government, with little evidence of ‘ownership’ by key venues. Consequently, there are many overlapping rules on how and from whom to seek evidence. Networks are diffuse and hard to manage. There is no dominant way of thinking across government (although the Treasury’s ‘value for money’ focus is key currency across departments). There are many socioeconomic indicators of policy problems but little agreement on how to measure or which measures to privilege (particularly when predicting future outcomes).
  3. The ‘window of opportunity’ was to adopt a vague solution to an ambiguous policy problem, providing a limited sense of policy direction. There have been several ‘windows’ for more specific initiatives, but their links to an overarching policy agenda are unclear.

These limitations help explain slow progress in key areas. The absence of an unequivocal frame, backed strongly by key actors, leaves policy change vulnerable to successful opposition, especially in areas where early intervention has major implications for redistribution (taking from existing services to invest in others) and personal freedom (encouraging or obliging behavioural change). The vagueness and long term nature of policy aims – to solve problems that often seem intractable – makes them uncompetitive, and often undermined by more specific short term aims with a measurable pay-off (as when, for example, funding for public health loses out to funding to shore up hospital management). It is too easy to reframe existing policy solutions as preventive if the definition of prevention remains slippery, and too difficult to demonstrate the population-wide success of measures generally applied to high risk groups.

What happens when attitudes to two key principles – evidence based policy and localism – play out at the same time?

A lot of discussion of the politics of EBPM assumes that there is something akin to a scientific consensus on which policymakers do not act proportionately. Yet, in many areas – such as social policy and social work – there is great disagreement on how to generate and evaluate the best evidence. Broadly speaking, a hierarchy of evidence built on ‘evidence based medicine’ – which has randomised control trials and their systematic review at the top, and practitioner knowledge and service user feedback at the bottom – may be completely subverted by other academics and practitioners. This disagreement helps produce a spectrum of ways in which we might roll-out evidence based interventions, from an RCT-driven roll-out of the same basic intervention to a storytelling driven pursuit of tailored responses built primarily on governance principles (such as to co-produce policy with users).

At the same time, governments may be wrestling with their own governance principles, including EBPM but also regarding the most appropriate balance between centralism and localism.

If you put both concerns together, you have a variety of possible outcomes (and a temptation to ‘let a thousand flowers bloom’) and a set of competing options (outlined in table 1), all under the banner of ‘evidence based’ policymaking.

Table 1 Three ideal types EBBP

What happens when a small amount of evidence goes a very long way?

So, even if you imagine a perfectly sincere policymaker committed to EBPM, you’d still not be quite sure what they took it to mean in practice. If you assume this commitment is a bit less sincere, and you add in the need to act quickly to use the available evidence and satisfy your electoral audience, you get all sorts of responses based in some part on a reference to evidence.

One fascinating case is of the UK Government’s ‘troubled families’ programme which combined bits and pieces of evidence with ideology and a Westminster-style-accountability imperative, to produce:

  • The argument that the London riots were caused by family breakdown and bad parenting.
  • The use of proxy measures to identify the most troubled families
  • The use of superficial performance management to justify notionally extra expenditure for local authorities
  • The use of evidence in a problematic way, from exaggerating the success of existing ‘family intervention projects’ to sensationalising neuroscientific images related to brain development in deprived children …

normal brain

…but also

In other words, some governments feel the need to dress up their evidence-informed policies in a language appropriate to Westminster politics. Unless we understand this language, and the incentives for elected policymakers to use it, we will fail to understand how to act effectively to influence those policymakers.

What can you do to maximise the use of evidence?

When you ask the generic question you can generate a set of transferable strategies to engage in policymaking:

how-to-be-heard

ebpm-5-things-to-do

Yet, as these case studies of public health and social policy suggest, the question lacks sufficient meaning when applied to real world settings. Would you expect the advice that I give to (primarily) natural scientists (primarily in the US) to be identical to advice for social scientists in specific fields (in, say, the UK)?

No, you’d expect me to end with a call for more research! See for example this special issue in which many scholars from many disciplines suggest insights on how to maximise the use of evidence in policy.

Palgrave C special

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Filed under Evidence Based Policymaking (EBPM), Prevention policy, Public health, public policy, tobacco, tobacco policy

The Science of Evidence-based Policymaking: How to Be Heard

I was interviewed in Science, on the topic of evidence-based policymaking, and we discussed some top tips for people seeking to maximise the use of evidence in a complex policy process (or, perhaps, feel less dispirited about the lack of EBPM in many cases). If it sparks your interest, I have some other work on this topic:

I am editing a series of forthcoming articles on maximising the use of scientific evidence in policy, and the idea is that health and environmental scientists can learn from many other disciplines about how to, for example, anticipate policymaker psychology, find the right policymaking venue, understand its rules and ‘currency’ (the language people use, to reflect dominant ways of thinking about problems), and tell effective stories to the right people.

Palgrave C special

I have also completed a book, some journal articles (PAR, E&P), and some blog posts on the ‘politics of evidence-based policymaking’.

Pivot cover

Two posts appear in the Guardian political science blog (me, me and Kathryn Oliver).

One post, for practitioners, has ‘5 things you need to know’, and it links to presentations on the same theme to different audiences (Scotland, US, EU).

ebpm-5-things-to-do

In this post, I’m trying to think through in more detail what we do with such insights.

The insights I describe come from policy theory, and I have produced 25 posts which introduce each of them in 1000 words (or, if you are super busy, 500 words). For example, the Science interview mentions a spirograph of many cycles, which is a reference to the idea of a policy cycle. Also look out for the 1000-word posts on framing and narrative and think about how they relate to the use of storytelling in policy.

If you like what you see, and want to see more, have a look at my general list of offerings (home page) or list of books and articles with links to theirs PDFs (CV).

how-to-be-heard

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Filed under Evidence Based Policymaking (EBPM), public policy, Storytelling

We all want ‘evidence based policy making’ but how do we do it?

Here are some notes for my talk to the Scottish Government on Thursday as part of its ‘inaugural ‘evidence in policy week’. The advertised abstract is as follows:

A key aim in government is to produce ‘evidence based’ (or ‘informed’) policy and policymaking, but it is easier said than done. It involves two key choices about (1) what evidence counts and how you should gather it, and (2) the extent to which central governments should encourage subnational policymakers to act on that evidence. Ideally, the principles we use to decide on the best evidence should be consistent with the governance principles we adopt to use evidence to make policy, but what happens when they seem to collide? Cairney provides three main ways in which to combine evidence and governance-based principles to help clarify those choices.

I plan to use the same basic structure of the talks I gave to the OSF (New York) and EUI-EP (Florence) in which I argue that every aspect of ‘evidence based policy making’ is riddled with the necessity to make political choices (even when we define EBPM):

ebpm-5-things-to-do

I’ll then ‘zoom in’ on points 4 and 5 regarding the relationship between EBPM and governance principles. They are going to videotape the whole discussion to use for internal discussions, but I can post the initial talk here when it becomes available. Please don’t expect a TED talk (especially the E part of TED).

EBPM and good governance principles

The Scottish Government has a reputation for taking certain governance principles seriously, to promote high stakeholder ‘ownership’ and ‘localism’ on policy, and produce the image of a:

  1. Consensual consultation style in which it works closely with interest groups, public bodies, local government organisations, voluntary sector and professional bodies, and unions when making policy.
  2. Trust-based implementation style indicating a relative ability or willingness to devolve the delivery of policy to public bodies, including local authorities, in a meaningful way

Many aspects of this image were cultivated by former Permanent Secretaries: Sir John Elvidge described a ‘Scottish Model’ focused on joined-up government and outcomes-based approaches to policymaking and delivery, and Sir Peter Housden labelled the ‘Scottish Approach to Policymaking’ (SATP) as an alternative to the UK’s command-and-control model of government, focusing on the ‘co-production’ of policy with local communities and citizens.

The ‘Scottish Approach’ has implications for evidence based policy making

Note the major implication for our definition of EBPM. One possible definition, derived from ‘evidence based medicine’, refers to a hierarchy of evidence in which randomised control trials and their systematic review are at the top, while expertise, professional experience and service user feedback are close to the bottom. An uncompromising use of RCTs in policy requires that we maintain a uniform model, with the same basic intervention adopted and rolled out within many areas. The focus is on identifying an intervention’s ‘active ingredient’, applying the correct dosage, and evaluating its success continuously.

This approach seems to challenge the commitment to localism and ‘co-production’.

At the other end of the spectrum is a storytelling approach to the use of evidence in policy. In this case, we begin with key governance principles – such as valuing the ‘assets’ of individuals and communities – and inviting people to help make and deliver policy. Practitioners and service users share stories of their experiences and invite others to learn from them. There is no model of delivery and no ‘active ingredient’.

This approach seems to challenge the commitment to ‘evidence based policy’

The Goldilocks approach to evidence based policy making: the improvement method

We can understand the Scottish Government’s often-preferred method in that context. It has made a commitment to:

Service performance and improvement underpinned by data, evidence and the application of improvement methodologies

So, policymakers use many sources of evidence to identify promising, make broad recommendations to practitioners about the outcomes they seek, and they train practitioners in the improvement method (a form of continuous learning summed up by a ‘Plan-Do-Study-Act’ cycle).

Table 1 Three ideal types EBBP

This approach appears to offer the best of both worlds; just the right mix of central direction and local discretion, with the promise of combining well-established evidence from sources including RCTs with evidence from local experimentation and experience.

Four unresolved issues in decentralised evidence-based policy making

Not surprisingly, our story does not end there. I think there are four unresolved issues in this process:

  1. The Scottish Government often indicates a preference for improvement methods but actually supports all three of the methods I describe. This might reflect an explicit decision to ‘let a thousand flowers bloom’ or the inability to establish a favoured approach.
  2. There is not a single way of understanding ‘improvement methodology’. I describe something akin to a localist model here, but other people describe a far more research-led and centrally coordinated process.
  3. Anecdotally, I hear regularly that key stakeholders do not like the improvement method. One could interpret this as a temporary problem, before people really get it and it starts to work, or a fundamental difference between some people in government and many of the local stakeholders so important to the ‘Scottish approach’.

4. The spectre of democratic accountability and the politics of EBPM

The fourth unresolved issue is the biggest: it’s difficult to know how this approach connects with the most important reference in Scottish politics: the need to maintain Westminster-style democratic accountability, through periodic elections and more regular reports by ministers to the Scottish Parliament. This requires a strong sense of central government and ministerial control – if you know who is in charge, you know who to hold to account or reward or punish in the next election.

In principle, the ‘Scottish approach’ provides a way to bring together key aims into a single narrative. An open and accessible consultation style maximises the gathering of information and advice and fosters group ownership. A national strategic framework, with cross-cutting aims, reduces departmental silos and balances an image of democratic accountability with the pursuit of administrative devolution, through partnership agreements with local authorities, the formation of community planning partnerships, and the encouragement of community and user-driven design of public services. The formation of relationships with public bodies and other organisations delivering services, based on trust, fosters the production of common aims across the public sector, and reduces the need for top-down policymaking. An outcomes-focus provides space for evidence-based and continuous learning about what works.

In practice, a government often needs to appear to take quick and decisive action from the centre, demonstrate policy progress and its role in that progress, and intervene when things go wrong. So, alongside localism it maintains a legislative, financial, and performance management framework which limits localism.

How far do you go to ensure EBPM?

So, when I describe the ‘5 things to do’, usually the fifth element is about how far scientists may want to go, to insist on one model of EBPM when it has the potential to contradict important governance principles relating to consultation and localism. For a central government, the question is starker:

Do you have much choice about your model of EBPM when the democratic imperative is so striking?

I’ll leave it there on a cliff hanger, since these are largely questions to prompt discussion in specific workshops. If you can’t attend, there is further reading on the EBPM and EVIDENCE tabs on this blog, and specific papers on the Scottish dimension

The ‘Scottish Approach to Policy Making’: Implications for Public Service Delivery

Paul Cairney, Siabhainn Russell and Emily St Denny (2016) “The ‘Scottish approach’ to policy and policymaking: what issues are territorial and what are universal?” Policy and Politics, 44, 3, 333-50

The politics of evidence-based best practice: 4 messages

 

 

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Filed under ESRC Scottish Centre for Constitutional Change, Evidence Based Policymaking (EBPM), public policy, Scottish politics, Storytelling