Is policy-making in the UK based on evidence? That is the question I address in my new book, Inside the Sausage Factory, in which I take four ‘public health’ policies from the 2010s and examine all the evidence that was cited for and against them in the media and in parliament.
You would hope that policies pertaining to the health of the public would be more evidence-based than most, but that is not necessarily so. While campaigners for each of the policies – plain packaging for tobacco, minimum pricing for alcohol, the sugary drinks tax and the de facto prohibition of fixed-odds betting terminals – had plenty of peer-reviewed studies and expert reviews to wave around, this ‘evidence’ suffered from serious flaws. When the policies were eventually introduced, there was little sign that they made the slightest improvement to any of the problems they were supposed to address.
Close examination of the campaigns which led to these four policies suggests that politicians did not make decisions based solely, or even mostly, on the evidence. It was claimed, for instance, that a Canadian province had seen the number of alcohol-related deaths fall by 32 per cent after a 10 per cent increase in the minimum price of alcohol. In fact, deaths rose significantly throughout the period in question. The modelling for the sugar tax, too, predicted a decline in obesity that never took place. The modelling of the relationship between alcohol-related deaths and minimum pricing in Scotland was wrong too. Instead of following facts, the government of the day bowed to political pressure whipped up by campaigners pushing policies had not existed until they came along. None of those policies had appeared in the manifestos of any of the main parties, with the exception of minimum pricing, which was mentioned by the Liberal Democrats in 2010 (and yet was never introduced in England).
A handful of MPs felt strongly about some of these policies, but they were low salience issues for the government as a whole. It was lobby groups such as Action on Sugar and the Campaign for Fairer Gambling that pushed them up the agenda, published press releases, got celebrity endorsements and garnered media coverage. This all had an effect on public opinion and forced the government to intervene. Politicians, wanting to get re-elected, gauged public opinion and asked themselves whether the political costs of doing nothing were greater than the costs of acting.
In the end, only 15 per cent of the public were opposed to plain packaging and only 6 per cent were opposed to clamping down on fixed-odds betting terminals. Resistance to the sugar tax was more substantial, at 33 per cent, but opponents were clearly in the minority and George Osborne needed to make an announcement at the Budget that would take the nation’s mind off the cuts he was making to disability benefits. Public opinion was evenly split on minimum pricing.
Once the ‘public health’ interest groups had put their policies on the agenda, the government could not put off a decision forever
It would be an exaggeration to call this government by opinion poll, but that would be a more accurate description than ‘evidence-based policy-making’. Evidence did serve a purpose. Modelling studies showed how the policy could work in theory. Evidence from other countries where similar policies were in place reassured politicians that the they were enforceable and would probably not create a public backlash. The regular publication of new research gave the pressure groups a way of keeping their issue in the news, but scientific evidence was only one part of the overall campaign and was never decisive. In the plain packaging campaign, there were far more references in the media to Lynton Crosby, a government adviser, and his alleged links to the tobacco industry, than there was to all the peer-reviewed evidence on plain packaging combined. Similarly, Jamie Oliver’s support for the sugar tax was mentioned in more articles than all the evidence for the policy combined. It was the general climate of opinion, not the careful scrutiny of academic research, that mattered.
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?
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