I’ve been thinking and talking about evidence-based policy a
lot lately. Conversations at work with
Public Health colleagues; the conference of the New
Directions in the Study of Alcohol Group (NDSAG); various blogs and Twitter discussions.
After the NDSAG conference, I
flippantly reduced much of the content to be being the sentiments of this song:
But it’s actually more than being flippant. At the conference, which focused on the
nature of addiction and pathological behaviour from alcohol use through other
drugs to behavioural addictions such as gambling, many of the debates boiled
down to the old political and sociological chestnuts of structure/agency;
pleasure/harm; individual/society; freedom/safety.
As Jim
Orford powerfully argued, at root these come down to issues of power, but I
was reminded of my basic undergraduate paper on political sociology when the
likes of Steven Lukes were being
quoted. Really, power, like addiction,
is just another word or concept (and really a set of concepts) through which to
think about all these problems. In
itself, a conceptual lens doesn’t resolve a problem; it provides a way to think
about it. (With the exception, of
course, of the
concept of the carnivalesque, which resolves all our issues with alcohol
policy – of which more in a week or so.)
What thinking of these issues in terms of power reveals,
though, is the seriousness of Skunk Anansie’s point. (I don’t know if this is a better or worse
use of musical analogy than Billy
Joel.) Issues of power are
political, and when we talk about addiction, or indeed any form of substance
use, we are talking about power – in fact it’s revealed in the 12 step
programme very clearly, when AA
members are instructed to recognise their ‘powerlessness’ in the face of
alcohol, or when someone like Gerard
Hastings complains about the role international companies play in providing
choices for consumers.
This isn’t actually much of an insight, and it’s certainly
not original. At the NDSAG conference, James Nicholls made again the
point that comes across so powerfully in The Politics of Alcohol:
that alcohol is partly such an interesting topic for the sociologist or
historian because it illuminates wider debates about freedom, ideology and so
forth. If we’re defining ‘good’
drinking, we’re saying something about what we think a ‘good’ human being or
citizen looks like.
This marks a point that’s more fundamental than my immediate
response to Robin
Davidson’s presentation at the NDSAG conference about evidence-based
policy, or a colleague’s comments about the role of evidence in policymaking in
town halls and Whitehall. I’m not just
saying things are political in terms of competing priorities, or politicians
having to be popular. I’m saying issues
of addiction and substance use, in a sense, aren’t special at all. They’re about power, sure, but then so are all
questions, if you want them to be: ‘everything, political’.
Policymaking isn’t a case of making ‘good’ or ‘bad’, ‘right’
or ‘wrong’ decisions; it’s about values and principles. The sooner public health and addiction
professionals realise this, the sooner they’ll make an impact on
decision-making.
