Today sees the release of my new book Inside the Sausage Factory: The Illusion of Evidence-Based Policy-Making. The title is a reference to something Bismarck supposedly said about law-making. It can be a messy process, but it is supposed to be ‘evidence-based’ these days, especially in areas like public health.
The book looks at four campaigns for “public health” policies in Britain in the 2010s: plain packaging for tobacco, minimum pricing for alcohol, the sugary drinks tax and the de facto ban on fixed-odds betting terminals (FOBTs). I look at the evidence that was cited the most by politicians and the media, but the thing that stands out is that the decisions to introduce (or reject) each of the policies do not seem to have had much to do with evidence.
Instead, I argue that everybody involved in the policy-making process, from voters up to the Prime Minister, was acting in their own rational self-interest. Paradoxically, this led to irrational policies being introduced (none of them worked).
The evidence from Inside the Sausage Factory suggests that politicians will succumb to pressure on low-salience issues unless they believe that the policy will be widely unpopular or conspicuously backfire. Once the ‘public health’ interest groups had put their policies on the agenda, the government could not put off a decision forever. They became barnacles on the boat that needed to be scraped off. With the exception of minimum pricing in England, which had significant public and political opposition, the government in Westminster concluded that the reputational risks of inaction were greater than the political, economic and legal risks of acting. The squeaky wheel got the grease.
For those of us who are of a liberal disposition, this is not a happy conclusion to reach. It implies that politicians are hostages to small pressure groups manipulating public opinion and that the cycle will repeat itself again and again. Where will it end?
In the campaigns I write about in Inside the Sausage Factory, several studies were referenced again and again by politicians, journalists and activists. The policies didn’t work and the evidence wasn’t very good, but at least evidence was cited from time to time. The evidence for banning “junk food” adverts and social media for the under-16s is negligible and the evidence from the generational tobacco ban is non-existent. Scientific evidence was not a decisive factor in any of the campaigns I studied from the 2010s. Today, it seems to be entirely optional.
Inside the Sausage Factory is the last in a series of publications about policy-making in “public health”.
The Corporate Playbook examines the fatuous view of policy-making that is trendy in “public health” academia.
Bootlegging Baptists looks at the economic incentives of paternalistic pressure groups and reasons why consumers do not mobilise to defend themselves.
The People vs Paternalism proposes a way of overcoming the paradox of participation and building a grassroots consumer rights organisation.
Anti-Capitalism and Public Health does what it says on the tin and examines the economic agenda of the “public health” lobby.
Not Invented Here asks why certain pressure groups oppose practical solutions to the problems they supposedly care about.
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