Justice, Old Supreme Court, Singapore

Awkward Meeting: Policy, Evidence, and Public Values

Policy, evidence, and public values commonly meet in awkward circumstances, especially when the subject is obesity and health policy. On just about any day you can find controversy in the headlines about a policy designed to address obesity. On one side, you’ll find scientists offering evidence about the effect the proposal might or might not have, as well as the potential for unintended harm. On the other side, you’ll find advocates and policymakers guided by convictions, values, and sometimes a bias for action. A visible example is the fight over regulating sugar-sweetened beverages.

In the new issue of Virtual Mentor, Andrew Brown and David Allison propose a framework for reconciling public health needs with the evidence base and ethical values. Their specific focus is obesity policy. Roger Bernier addressed the same questions in a broader health policy context with a recent ethics grand rounds presentation at the University of Texas Southwestern Medical Center.

Allison and Brown bring sharp focus to the conflict between individual decision making and the need for public policy related to obesity. In doing so, they propose a set of considerations to steer policymakers clear of the unintended consequences seen too often in obesity:

  1. Evaluate whether the proposed policy addresses an exposure that can truly be considered a public health concern.
  2. Be honest about the quality and quantity of evidence about the policy.
  3. Generate sufficient, high-quality evidence before implementing the policy and have plans in place to generate quality evidence about the effectiveness of the policy once instated.
  4. Do not assume there is negligible or no harm from the policy.
  5. Do not assume that achieving a health benefit overrides respect for other values and ethical principles.
  6. Given a choice between two or more plausible policies, choose the policy that least compromises ethical values.

 

Bernier makes a case for public engagement to account for values that inevitably guide policy making as much or more than the evidence base does. He argues that durable public health policy requires public engagement because our culture has come to reject more paternalistic approaches.

For yet another perspective, it’s worth considering the process for implementing local health policy in the UK. A new study by Bridie Angela Evans finds a substantial gap between the evidence-based goals of national health policy and how it’s actually implemented at the local level.

Look at it from every angle and the only thing that’s clear is that it’s a messy business making health policy.

Click here to access the paper by Brown and Allison in Virtual Mentor, click here to access Bernier’s grand rounds presentation, and click here to read the study of bringing evidence into local UK health policy implementation.

Statue of Justice on the tympanum of the Old Supreme Court Building, Singapore, image © Kok Leng Yeo / Wikimedia

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