Yes, it's politely political

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.