This week the government told us that they weren’t going to introduce minimum alcohol pricing or plain, unbranded packets for cigarettes because there wasn’t enough ‘concrete evidence’ in the case of alcohol (http://www.bbc.co.uk/news/uk-politics-23346532) or, in the case of cigarettes, that it wanted to wait and see how things went in Australia (who are already doing this), first (http://www.bbc.co.uk/news/health-23288993). Now, if we put aside claims in the media that all of this is really about Conservative links to particular lobbyists it is using as strategists, or that is simply caving in to industry (http://www.guardian.co.uk/society/2013/jul/17/minimum-unit-price-alcohol-shelved?INTCMP=SRCH), then there is the beginning of sensible claim here – that we should be basing our health policy on evidence. Surely that would be a good thing, wouldn’t it?
Well, yes it would be a good thing if we based our health policy on evidence, but there are two problems here. First, if we wait for evidence, especially on public health issues, then we won’t ever do anything new. What we need to do is experiment to find out what interventions have the best chance of working, being aware of how different contexts affect results. If we are actually serious about trying to improve public health, how about we try things, carefully evaluate them, and then introduce them more widely if they work? There will be problems around borders and boundaries (if alcohol is cheaper in one area than another we might expect this), but the extent of this can be over-stated (Scotland is more than capable of doing things differently to England it would seem), and most people, most of the time, won’t be sufficiently motivated to make enough different to jeopardise an experiment. So let’s have a go – if we are serious about improving public health, let’s try out some new thinking and see what happens.
The second problem with the claim that the government are engaged in evidence-based policymaking in health is, of course, that they’ve spent billions of pounds reorganising the NHS at a time of austerity, but based on the very flimsiest of evidence that their plans have any chance of actually making things working. Even the research the government cited in their White Paper as supporting their research (the competition-based work from the LSE) seems to have been misunderstood by them. What we have an expensive, distracting reorganization at a time when the NHS needs to save money, and also at a time when what seems to be becoming clear from the devolution of health policy across the home nations is that what health systems need to improve is stability and continuity – not continual disruption and change. The WHO report on Scotland is particularly interesting in relation to this point (http://www.euro.who.int/en/who-we-are/partners/observatory/health-systems-in-transition-hit-series/countries-and-subregions/scotland-hit-2012).
So, if we are serious about making health policy evidence-based, that doesn’t mean we should sit on our hands and wait to see what happens when other countries experiment with public health measures (where things may be very different culturally and contextually anyway), and it certainly doesn’t mean we should be reorganizing the NHS. As those things are what the government are doing, it is easy to be cynical and suggest instead, that things are being driven instead by the alcohol and tobacco industry, and by simple ideology.