Making Britain well: Closing the chasm between evidence and policy in behaviour change for health
Reported by Adisetu Joy Malih, CSaP Policy Intern (Jan-April 2023) and Patrick McAlary, CSaP Policy Research Assistant
A panel discussion chaired by Halima Khan from the Bennett Institute for Public Policy, called for government to invest in infrastructure that supports people in changing their health behaviour, allowing citizens to be more involved in the policy making process, and developing a better understanding of everyday lived experiences.
Importance of evidence in policy
The discussion focused on the gap between scientific evidence and policy making in public health, food safety, and the role of taxes and pricing in changing behaviours in public health.
Professor Dame Theresa Marteau, Department of Public Health and Primary Care, University of Cambridge made the simple point that the path towards making Britain well starts with addressing a neglect of evidence at all stages of policy-making. She highlighted the importance of having a range of interventions that change behaviour around key issues like smoking, alcohol consumption, diet, and exercise with an aim of reducing inequalities among the population. There is quite a lot of evidence for interventions to support behaviour change and this is paired with tangible policy ambitions, such as halving childhood obesity by 2030 and increasing healthy life expectancy by five years. However, government is not on track to achieve these lofty ambitions and part of this failure rests on a neglect of evidence.
This prompted an important question, why would a government ignore evidence (that it has often funded) to achieve its stated ambitions? Professor Marteau identified key factors including a neoliberal ideology within government, corporate interests and lobbying, and institutions that put a lower value on evidence. As an antidote, Professor Marteau prescribed a greater emphasis on citizens’ interests when it comes to policy prioritisation and design. Key to this is the role of deliberative democracy processes and inculcating evidence-friendly mechanisms within key institutions, such as real-time policy monitoring (including real-time evidence generation) and embedding evaluative processes.
As Professor Marteau emphasised: “If you can only do one thing, don’t ignore the evidence if you want to make Britain well”.
Prices matter in making Britain well
Dr Tim Leunig, Senior Policy Adviser to the Secretary of State, DHSC, opened his address with a direct solution for making conference delegates well by focusing on the provision of food at conferences. Decrying biscuits and cakes he declared: “We want an apple!” Following in the spirit of direct interventions for improving public health, Dr Leunig emphasised the importance of prices: peoples’ behaviours are influenced by how expensive things are. This point carried a note of caution that ran throughout his address, it is taxation, rather than subsidies or minimum pricing, that presents the most attractive and impactful path forward.
Citing the Soft Drink Industry Levy of 2018, Dr Leunig pointed to a reduction in portion sizes, from 2 litre to 1.75 litre bottles. This reduced average sugar consumption from these products without reformulating the product. Dr Leunig argued that a wider sugar tax would prompt reformulation in, for instance, ready meals and stir in sauces where there is scope for recalibration. Companies that market 99p ready meals have wafer thin profit margins and their target customers are price sensitive. As such, even minor taxes can impact the make-up of products and which products are (dis)continued.
Dr Leunig emphasised that taxation is a better policy than minimum pricing, as the latter simply gives a windfall profit to the company that is now obliged to sell their product at a higher rate. By contrast, raising taxes on sugar, cigarettes, or petrol can create space to cut other taxes. Reiterating the initial point that prices can shape behaviour, Dr Leunig pointed out that petrol prices impact the types of cars bought in the US. When petrol is expensive consumers opt for hybrid models, when petrol is cheap consumers are more willing to purchase less efficient models like pick-up trucks. The result of this is that cheaper petrol prices do not make it cheaper to travel: any gains are squandered in less efficient engines while raising petrol prices means more efficient cars and greater tax revenues to be used elsewhere.
Dr Leunig closed his address with a simple formula: offer politicians a tax, let them decide what to spend the money on, and then maybe, you will get buy in.
Deliberative policy-making processes
Dr Darren Bhattachary, CEO Basis Social, moved on to the key stakeholder in public health — people themselves. He was concerned with what can be learned about making Britain well by observing real people and engaging with them about their lives. In this he drew together threads from the previous addresses to consider the role of citizens in food policy. Citing the National Food Strategy and the People’s Plan for Nature, Dr Bhattachary argued that there was widespread appetite amongst the public for an overhaul of the food system. The point was that people do not want minimal protections with food policy being left to the market, rather, there is a strong public desire for positive policy interventions.
The goal is affordable food; this should not be confused with ‘cheap’ food. While the latter was understood as being concerned with improving company profit margins, the former was associated with ensuring that people have the necessary support and skills to eat well and to have a nutritious diet. ‘Affordable food’ is geared towards improved human health and animal welfare. People were open to whole systems interventions—including taxation—in pursuit of this goal, so long as revenue raised was funnelled into creating a more positive environment for change.
Dr Bhattachachary made the point that people want their values to guide through the production process and they want government to translate these values into policy decisions about the future of food and farming. Done well, this process of deliberation can help bridge the chasm between what citizens want and what those in power can deliver, ultimately creating a more legitimated policy-making process. He closed his address by pointing out that behaviour change is hard because real life is messy. As such, when policy-makers consider pulling big levers (i.e. taxation), they need to be mindful of lived experience.