Sunday, March 29, 2020

Paul Cairney & Emily St Denny's "Why Isn’t Government Policy More Preventive?"

Paul Cairney is Professor of Politics and Public Policy, University of Stirling. His publications include Understanding Public Policy (2019), Making Policy in a Complex World (with Tanya Heikkila and Matthew Wood 2019), The Politics of Evidence-based Policymaking (2016), and The Handbook on Complexity and Public Policy (2015).

Emily St Denny is a Lecturer in Public Policy at the University of Stirling. Her expertise lies in prevention policy, policymaking in the devolved UK, and public sector reform.

They applied the “Page 99 Test” to their new book, Why Isn't Government Policy More Preventive?, and reported the following:
Page 99 focuses on the UK Government’s public health policy and policymaking during a Labour government led by Tony Blair (1997-2007) and Gordon Brown (2007-2010). Labour’s election in 1997 had signalled a major shift in commitment to public health policies designed to reduce health inequalities. It saw smoking as the biggest cause of the health inequalities associated with ‘non-communicable diseases’ such as cancer and heart disease. It sought to boost the role of primary care in detecting illness more quickly, and to address the relationship between contributing factors such as obesity and ‘worklessness in deprived areas’. It sought to intervene early in the lives of children under three years old, to address likely inequalities in health, educational attainment, and ‘behavioural problems’. It also described new forms of policymaking, built on the idea of ‘evidence based policymaking’ and ‘joined up government’. The page ends by suggesting that key public health policymaking initiatives failed.

Page 99 is representative of one key time and place in the book. The Labour government era was sandwiched between (1) the Conservative governments of 1979-97, led by Margaret Thatcher and John Major, which had minimal interest in state action to reduce health inequalities, and (2) the Conservative-led governments from 2010, which inherited Labour’s commitment to reduce inequalities but also delivered an ‘austerity’ programme that exacerbated its cause (socio-economic inequalities). Labour’s election was clearly a turning point in policy, but its defeat in 2010 had a less clear effect. UK government policy from 2010 was marked by a focus on individual behaviour – smoking, drinking alcohol, eating high salt and sugar foods, and low exercise – rather than the ‘structural’ and environmental factors – income and wealth, housing, green space, pollution – associated with the ‘social determinants’ of health. Yet, Labour had also been moving in this direction, and its policies were closer to the government in 2010 than the one it replaced in 1997. The book also compares UK and Scottish government policy, showing that they faced similar problems in similar ways, with similar levels of success.

Page 99 ‘zooms in’ to the details of a recurrent problem in policy and policymaking. Governments in many countries seek to prevent the rise of (a) inequalities and (b) the costs of public services by intervening as early as possible in people’s lives. To do so, they describe an evidence-based and joined-up approach. However, governments do not keep up this commitment or solve the problems they describe.
Learn more about Why Isn't Government Policy More Preventive? at the Oxford University Press website.

--Marshal Zeringue