Wednesday, 15 December 2010

What is the role of government?

Reaction to the leaked US diplomatic cables reveals an uncomfortable truth in the attitude of those elected to represent us

The perceived roles of government are diverse and differ depending on to whom you speak.  For some the role of government is to provide jobs and a stable economy, for others it’s there to support the disadvantaged and vulnerable via the welfare state, for others its simply exists to provide a stable environment in which the economy can grow and private organisations can profit; by producing a growing consumer base, a suitably educated workforce or in extremis defending the realm.  For most, it’s probably a mixture of all of the above.
On a more fundamental level the role of government is much simpler, defined by a basic principle, upon which competing interpretations of its functions and priorities compete.  For those fortunate enough to live in a representative democracy (the overwhelming majority of Europe and the Americas) the primary function of government is to represent and serve those that have elected it.  The clue is in the name and it is ultimately answerable to the electorate.  For those executive functions and personnel that are not directly elected such as civil servants, their role is to serve the elected members who appoint them to assist in the service of the electorate.  This can be viewed as a linear relationship; at the top the electorate, below them the elected members (government ministers et al) that are elected to serve their interests and directly beneath the them at the bottom are the civil service that serve the government.  It’s a simplistic model, having no place for the private sphere, but it serves to illustrate the basic structure on which modern society is built.

The leaking of US diplomatic cables and Afghanistan files by Wikileaks during recent months have called into question the nature of the relationship between citizen and government.  Government officials, media and citizens from across the US, Europe, the Middle East and beyond have sought to criticise the leaks on two fronts; that they put lives in danger and that some information should not be shared with the public.  Diplomats and civil servants should, according to this analysis, be free to operate in secrecy above and beyond the knowledge and concerns of the citizens to whom they are ultimately answerable.  This represents a significant shift from the linear structure of the relationship between citizen, government and civil service described above to something considerably more ambiguous.  This new structure more clearly resembles an inverted pyramid; the electorate at the bottom and elected officials and the civil service above, side by side.  This structure illustrates that the  government and its unelected functions operate on an equal footing and in cooperation, neither directly responsible to each other or the electorate that serve them. 

To claim that this structure exists in reality rather than in the minds of those that have sought to criticise the leaks is actually a moot point.  More importantly the whole affair demonstrates that an attitude pervades both governments and media that free sharing of information is undesirable, that those in power should not have to adhere to principles of transparency nor be answerable to those that appointed them, to whom they are responsible.  This belief that ordinary citizens are incapable of understanding nor have the right to this information betrays an inherent arrogance and more than a whiff of authoritarianism.

This attitude has been further demonstrated in the pressure applied to private organisations that have provided support to Wikileaks.  The image of the internet as independent and beyond the power of governments has been utterly shattered as state pressure has been used to prohibit the actions of citizens, specifically from gaining knowledge of those appointed to serve them.  The United States has blocked access to the Wikileaks website, Mastercard and Visa have denied their customers across the globe the right to choose whether or not to spend their money supporting an independent organisation, knowledge of corrupt practices by Pfizer and Shell, which are undoubtedly in the public interest, are viewed as state secrets that should be hidden from the public.  That much of the information leaked is of little surprise or in many cases much tamer than expected, is inconsequential.  The image rendered is of insecure governments clinging desperately to as much control as possible as it slowly ebbs away.

Sadly the shift from in attitude from the linear to the inverted pyramid model described above may never have occurred.  It is perhaps more evident that the last century represents a shift toward a less authoritarian stance as education and knowledge continued to diffuse throughout societies and across national boundaries.  The post 9/11 authoritarian tendencies were a  reaction – that have since lost momentum - to external threats of a once in a generation magnitude  and the Freedom of Information act highlighted the desire for those in power to illustrate their transparency and good intentions (though Tony Blair’s confession that he now considers it a huge mistake is perhaps a hint of how power can breed arrogance).

That progress has been made toward the synchronization of what we are lead to believe and what actually occurs in reality is simply not enough; these insights into the machinations of power only serve to highlight that much more progress must be made.  If knowledge is power, then it is imperative that these leaked documents continue to pour into the public domain.  

Thursday, 9 December 2010

Evidence based policy takes another hit

Government proposal calls into question the role of science in drug policy making

It is self evidently logical that those best placed to advise government on a policy are experts working in that, or a closely related field; be they scientists, front-line staff or academics. This does not always happen in practice; thankfully drug policy is one area where it has for several decades, though it must be noted that it has not necessarily translated into evidence based policy. That presupposes that policy makers are predisposed to implement the recommendations of their advisors. This is best illustrated in the refusal by successive governments to move drug policy away from the criminal justice system to the realm of public health.

Worryingly, drug policy looks set to drift yet further away from the healthcare system.  It has been reported recently that legislation will be passed in the British Parliament that will remove the legal requirement for scientists to be appointed to the Advisory Council on the Misuse of Drugs (ACMD).  The ACMD is a body comprised of experts from several fields including vetinary, medicine, pharmaceuticals and chemistry.  Their remit is to conduct research and advise the Home Secretary on how to regulate and legislate controlled substances in the UK.

This apparent act of sabotage appears ideologically motivated and as such, represents a body blow for evidence based policy making. Removing the requirement for scientists creates the possibility that the panel could be repopulated with acquisecent individuals willing to support the governments approach, free from the constrains of evidence.  The Council provided a sustained challenge to New Labour and their pretensions of evidence based policy making; the coalition seems set to neutralise it before it creates the same problems for them.

There is evidence and support for policies that view problem drug usage as a public health, rather than a criminal justice issue.  Instead of putting drug addicts in prison - where drugs and boredom are both in plentiful supply - put them into care; rehabilitation and medical care is not only more humane but also delivers greater results.  A key step toward this is decriminalisation, a policy followed in other parts of Europe with success.  Decriminalisation paves the way for addicts to be channelled into healthcare rather than the criminal justice system thus removing problem users from the cycle of drug abuse and crime.  It should be noted that despite billions of pounds of investment prohibition of drugs has not only utterly failed, but continues to exacerbate the problem; their availability to end users continues to increase as their price continues to fall.
Unfortunately decriminalisation (a key step toward reform of drug policy into an issue of public health) has been unpalatable for British governments since the 1960s when the current classification system was introduced.  The punitive populism harnessed by Michael Howard in the 1990s (subsequently continued by New Labour) pushed drug policy further toward the criminal justice system and away from the control of health professionals.  The ACMD ran into trouble with a number of New Labour home secretaries for having the audacity to perform its primary role; advise the government on drug policy using scientifically researched evidence.  It represented a contradiction; an expert source of evidence based policy for a government whose primary concern was the consideration of public perception.

This contradiction was played out when it came to reclassifying Cannabis and other controlled substances.  A particularly interesting report in which the government had no interest was published in 2007 and sought to rank controlled substances by their harm (both physical and social).  The report suggested that under the current classification system Ecstasy should be a Class C drug, Alcohol Class A; this was summarily ignored.  The Advisory Council also opposed the reclassification of Cannabis from Class C to B in 2009, stating a lack of evidence on which to base the move.  Several public clashes involving the head of the ACMD professor David Nutt occurred; in a particularly controversial article he compared the death rates for equestrian sports and ecstasy usage conclusively concluding that the former was a significantly greater risk to public health.  This use of evidence to illustrate holes in government policy was not welcome and following a further clash over the classification of alcohol  professor Nutt was sacked.  Several other scientists resigned over the incident.

Removing the requirement for scientists to sit on the ACMD is still just a proposal, yet it serves to highlight two things.  First that support for evidence based policy making has diminished; secondly that explicitly ideologically motivated policy has very much returned.  Sadly, it also augurs badly for the treatment of problem drug usage becoming a public health issue, a development that might actually begin to tackle it.  Tackling problem drug usage and related crime as a criminal justice issue is 'treating the symptoms' at its best.  The causes of the symptoms are complex and diverse, some medical some social; it is no coincidence that the majority of problem drug use occurs amongst the poorest and least educated members of society and that thousands of educated, stable individuals indulge in recreational drug usage each weekend without harm to themselves or those around them.  But just because an issue is complex and difficult does not mean we should not take the hard road, take the difficult decisions and begin addressing it in a logical, evidence based way.

Monday, 6 December 2010

The spurious relationship

Role models play an essential role in everyday life.  When looking for new ideas, inspiration or best practice individuals and organisations often turn to others to guide them, or at the very least, provide a counter-point to their own approach.  But which to choose?  In any given situation there are a plethora of different role models from which to choose and it is this decision that is often more instructive than the behaviour or idea that is borrowed.  

It’s fair to say that if I chose to take as my role model an arrogant individual that believed in the universality of their opinions, that the principal of an eye for an eye was a legitimate practice in the 21st century, that poor people wouldn’t be so if they worked harder, that extreme wealth inequality is desirable, that providing healthcare to the most vulnerable is evil, that institutional racism and homophobia should be quietly ignored, most of my peers would be quite alarmed.  They would be especially concerned if the individual from whom I was seeking advice also had a higher than average likely hood of developing mental illness, was more likely to be obese and live a shorter life than the majority of people in the West, was more likely to commit a sexual offence or commit murder than everyone else around them .  If such a person did exist, they would be a truly terrible role model for us all.

Unfortunately in the United Kingdom this type of role model is viewed as the ideal candidate.  Successive governments and now the incumbent administration have turned to the United States for policy inspiration irrespective of the sad truth that for all its wealth the USA is ranked absolute or nearly bottom of every index of wellbeing, health and equality in the Western World.  That Scandinavia, France and Germany gravitate toward the top of all these indexes, that they sit on our doorstep as positive, functioning role models, is sadly inconsequential to the policy makers of the United Kingdom.  That the United States is a largely conservative nation in which its most progressive party sits to the right of centre, sadly failed to deter those on the mainstream of the British Left from imitating it as a legitimate route back to power.   

There are two truths in modern wealthy societies; the first that more equal societies (irrespective of overall wealth) rank much higher in terms of wellbeing (this includes mental health, stress, physical health, education rates, equality of opportunity) and are generally less consumed by major public health issues such as teenage pregnancy and alcoholism.

The second is that the law of diminishing returns applies to the growing wealth of Western economies such as the United States and the UK.  In fact, as overall wealth increases the benefits it delivers grow progressively smaller.  At the same time the number of major public health issues has continued to increase.  It does not take a genius to spot the problem; as the US and the UK have become wealthier the benefits have shrunk to the point that wealth is creating as many problems as it solves.  To exacerbate this problem further the UK and US have concentrated their growing wealth at the top of society, it has not ‘trickled down’ to the wider population.  The growth in inequality has sent both nations plunging to the bottom of almost every meaningful measure of a decent society available (most of this also applies to Australia, a fellow ‘Anglo-Saxon’ nation).
Three things to note; firstly there are two forces both working in tandem, both detrimental.  Secondly many of our European neighbours are wealthier and healthier than the UK, so the current situation is not an inevitable consequence of wealth.  Third; in the post war period the UK has followed where the US has led. 

There are a number of reasons why the UK and its policy makers have pursued this masochistic path, best summed up as the rather spurious ‘special relationship’.  This apparent bond is far greater than that which concerns foreign policy, it also encapsulates the feeling that the UK is a kindred spirit of the United States both culturally and socially.  There is the idea of the Protestant work ethic, a shared and fundamental element in the nature of both nations.  Then there is laughable propaganda that is the ‘American Dream’, the idea that in the US wealth, fame and a better life are just a bit of hard work away.  Why should we not seek to be more like the wonderful land of opportunity across the Atlantic?  Conspicuous consumption and better standards of living looked so much fun to those in austere 50s Britain; there was seemingly no time or desire to ask where it may take us.  That much of the American dream that we pursue, like Hollywood, is actually an empty illusion has been ignored.

The post-colonial hangover has also fuelled close ties with the US as those in power in Britain sought to keep up with their predecessors, no longer possessing their own strategic clout they simply hung onto the coat tails of the new world power regardless of where it took them.  This original ‘special relationship’ continues to direct foreign policy to this day as policy makers live out their West Wing fantasies of walking Washington’s corridors of power. 

The United States is a vast place full of neuroses and contradictory forces and to caricature it as an out and out basked case is a little glib.  It is in theory and reality fifty different states, not just one nation.  But the fundamental point remains; the United States provides a terrible role model.  

The central issue is that the very problems we attempt to tackle are the result of chasing the United States down the path of deindustrialisation, of retail and service led economic growth constructed on cheap consumer credit and vast, damaging, inequality.  To think that the solution is essentially more of the same is to ignore the root cause of the challenges we face; until the US is able to adopt a radically different approach to tackling its own problems the spurious relationship should be ignored at all costs.