Evidence and narrative constructing policy problems

The use of evidence in policy has been heavily influenced by the 'Evidence-based policymaking’ (EBPM) approach. EBPM aims to counter the grounds for policymaking deemed to be arbitrary and uninformed, either following political motivations, or borne out of laziness and poor practice. According to Ian Sanderson, EBPM is derived from 'evidence-based medicine' (EBM) in seeking to use information and knowledge more effectively to justify intervention, particularly in the UK and US (2002, p. 1). A general critique of the evidence emphasis by policy analysts has been provided by Majone (1989) who argues that an image projected is one of "technical, nonpartisan problem solvers", while in fact they are more akin to lawyers than engineer or scientist, making policy arguments. Further, the pursuit of being objective and atheoretical can mean policy analysis becomes too abstract, which Gale has argued EBPM leads to a “to-ing and fro-ing between theory and data” (Gale, 2001, p. 380). Finally EBPM has also been scrutinized by those who object to “...the continuing influence of the ‘modernist’ faith in progress informed by reason” (Sanderson, 2002, p. 1). As Cairney describes, the roots of EBPM lies in:

"...the early post-war idea that the policymaking process will be improved when we make it more scientific and, therefore, better able to incorporate scientific evidence...This idea has given way to a more recent sense that policymaking will always be messy, and that an appeal to the primacy of science or ‘the evidence’ can go too far" (Cairney, 2015, p. ix).

Evidence can be used in different ways for political means with no guarantee of neutrality and objectivity. This acknowledgement of the uses of evidence is why some prefer the term ‘evidence-influenced’ or ‘evidence aware’ policy with the understanding of a hierarchy of knowledge being imposed (Nutley et al., in Marston & Watts, 2003). Alternatively, Gale urges us not to think of policy development over time, in terms of progress but rather as ‘temporary policy settlements’ acknowledging power flows and intentions (2001, p. 389).

Constructivists would go further than materialist acknowledgement of power flows and interests, questioning the existence of an objective scientific knowledge at all and limitations of cultural and historical contingencies in drawing policy implications (Sanderson 2002, p.6). Indeed constructivist theory has much to add in a focus on ideas, in exploring policy norms from institutions and epistemic communities, as well as the social construction of problems. Simmons, Dobbin, and Garrett (2007, p. 451) describe the social construction of policy as constructing both legitimate ends and appropriate means that varies, “...from one period to the next”.

There is also a spectrum of constructivism to note, from ‘hard’ to ‘soft’, making different claims and holding varying degrees of skepticism about scientific knowledge and the relation with social practices (Robbins, 2012). Hard constructivists will see social constructs as defining our world and science is one social method among many, meaning it cannot adjudicate for all claims about what is real in the world. Soft constructivists tend to believe there is a real and independent objective world but our concepts of reality are also real, reflecting, "...incomplete, incorrect, biased, and false understandings of an empirical reality" (ibid., p. 128).

It must also be kept in mind that “...interests, like everything else, can be constructed” (Latour, 2005, p. 145). Certainly interests can inform our understanding of actions and behaviour in a policy context but there is also a critique of the ‘interests approach’. STS scholars including Woolgar, Gilbert, Mulkay and Knorr Cetina see utility in uncovering the social processes for the production of knowledge but remind us that to be aware of our own constructions in putting forward another representation of the world (Webster, 1991, p. 21-2). Therefore, when considering underlying rationales for apparent interests, our own representation of interests must also be considered.

One challenge is that interests of actors and their core identity are assumed to go hand in hand. Ikeda recognizes the fusion of actors and core identities in the, “...public interest view of public policy, which in effect treats persons who have moved from the private sector to government employment as having been thereby transformed from self-interested profit-seeking actors into public-spirited and selfless public servants” (2002, p. 6). Even differing interests may be constrained by the possible options: “policy analysts can appear very similar to policy makers who seek to construct policy problems in ways that match the answers they already have available” (Gale, 2001, p. 384). Presumed (stereotypical) interests ascribed to actors will be important to keep in mind, especially later in this chapter when discussing public health actors. Evidence is one aspect of policy that prompts debate. Another is the need for policy to appear in the form of a narrative, which I will be sensitive to throughout the thesis. I will discuss problem narratives in the next section through the example of 'market failure' in relation to innovation policy problems, which I also argue is a central narrative story for NTDs.

I have discussed in the previous section how evidence has been an important part of producing policy problems and solutions, giving a technical appearance rather than relying on argumentation. Evidence is a route to achieve an appearance of technicality but also important is what form of evidence is presented and what story is told. Policy problems require an outwardly objective and justificational identification. In this sense identifying a problem for intervention is often characterized in terms of market failure, where market forces or private actors do not provide immediate solutions.

Market failure arises from a status quo (or equilibrium) where the market generally provides for societal needs and wants, but when this is not met (e.g. when it is difficult to derive profits or no one is responsible for delivery) government or other non-market actors must amend market conditions or offer provision. NTDs can be understood a result of a market failure for drug and other medical innovations. A typical argument might be: "...the pharmaceutical industry has little incentive to invest in research and development (R&D) for infectious diseases that predominantly plague poor nations, as medicines cannot be sold there at a price that would allow pharmaceutical firms to cover their high R&D costs" (Mueller-Langer, 2013, p. 185). WHO director Margaret Chan called for a public–private partnership (PPP) approach to tackling NTDs, in response to market failure of affordable medicines.37

I question why a market failure explanation is required and what might be missing in this characterization of the policy problem. Grounded in welfare economics, market failure is given as a starting point to summarize a policy and determine future action, providing economic legitimization. In critiquing this economic theory, public choice theorists (interested in economics applied to politics), challenge the assumption of a perfect government rather than focusing on market failure itself (Tullock et al 2002; Ikeda, 2002).

In essence my argument is that market failure provides a policy narrative: a starting point and signposting for policy problems but it also directs the potential solution, in providing a narrative for the problematization of a policy problem. Narrative is essential in this analysis and how it is delivered through an economicized language. The imagery is of a well-functioning machine that operates well but cannot cater for all social needs in their entirety, with an underlying assumption that the market provides more than it can and should. Regulation and government intervention must then step in to remedy a sometimes-malfunctioning market. Another way of challenging a malfunctioning market, or to that point a malfunctioning government is bottom up through publics and civil society. One vehicle is through social movements, discussed next.

3.2.3 Advocacy through social movements and scientist activism