Healthy Evidence
2,830 members317 posts

Who decides on government priorities?

Thinking about the potential effect of banning smoking in cars that contain children has led me to...

Does anyone brainstorm all potential interventions and then do a cost benefit analysis before deciding which one to pursue? IF we assume that the beneficiaries of this proposed law are the children, then could more benefits be achieved by educating people about passive smoking, or maybe education about diet, or by increasing the proportion of children who live in suitable accommodation, or ensuring that all households have sufficient income to feed their children properly, or even improved access to GPs or school nurses etc.?

There are many many things that could be done. Does anyone make an informed decision about which are pursued, or does it just depend on who shouts loudest?

3 Replies

There is no single answer to this because what government does is not always accurately reflected by a) what government SAYS it does and b) what the press decide to actually publish about what the government say they do.

So, with smoking for example, there is a mixed approached using education, local advertising, help to give up campaigns, work through GP practices and so on. All this is pretty much continuous but occasionally one bit or another will get a push, sometimes because it has lost momentum, but more often because some MP jumps on one particular bandwagon for a while.

The other thing that happens is that the government will release a white paper, perhaps, on one particular subject which will include a huge list of things that they are planning.

Somewhere in there will be something that appeals to a newspaper editor. It is not necessarily the most important thing in the list and possibly very low down on the priority scale, but the editor runs with it and does some huge splash.

From this point on it gets stupid. Every time the government want to talk about the subject in general, all they get asked about it this one little point. The fact that it is part of a bigger thing gets ignored. And the government do not help them selves either. They decide that since this has now become the focus of a campaign, they ought to make it the priority to make themselves look good, even though that is not the best way to go about things.

We have a similar problem with the flooding in Somerset at the moment. There is a huge growing campaign saying that this is all the Environment Agencies fault because they don't dredge enough - despite the fact that the floods have been caused by rain falling on land that is sometimes lower than the banked up rivers and that many of the rivers have not themselves been overwhelmed. (Note: the real solution is probably spend millions on lots of dykes and pumps like Holland - don't hold your breath for that). But because this campaign is so vociferous and a minister got yelled at, the government is promising dredging all over the place - whether that will actually help or not. The scientists at the environment agency and their expertise are, in consequence, fading into the distance.

So, yes things are brainstormed, things often start out well meaning and with a solid base, but they can get derailed for countless reasons, turned on their heads and end up being pretty hopeless and probably far too narrowly focused.

All because of presentation and communication.


"does anyone brainstorm..."

Surely that would imply...

1 like

Ben Goldacre has written about evidence-based policy:

The policy document he wrote with the Cabinet Office and Behavioural Insights Team is:

Test, Learn, Adapt: Developing Public Policy with Randomised Controlled Trials

That's the way it should be done, but not necessarily the way it is done!


You may also like...