The dynamic and principles of the scientific environment are starkly at odds with the dynamic of the political environment in which policies are made or broken. While a scientific approach is rational, evidence-based and formed through consensus of experts, the political environment is emotional, driven by communications and adversarial. Although decision-makers aspire to evidence-based policy-making, in contested areas the side with the most effective communications often seems to 'win'. The recent economic crisis in the UK and across mainland Europe has necessitated drastic cuts in public spending, impressing on officials the need to make savings and squeeze more value out of public resources. In the UK, the government marked out the health budget as one of only two areas of public spending to be shielded from the cuts. Still, relatively flat health spending has been outstripped by rising demand for services, and so any new policies requiring additional resources remain in theory unaffordable. Where new health policies have been introduced, such as the Cancer Drugs Fund (CDF), they have been driven not by scientific developments so much as by public opinion and political decision-making. Similarly, attempted policy change driven by or expressed in terms of economic or rational imperatives (such as attempts to reconfigure health services, or attempts to change statutory regulation of dispensing medicines), have failed in the face of patient and professional campaigns. To conclude that those who shout loudest will always win, is to over-simplify. Besides, in some policy debates, patient and professional advocacy groups are divided. Even if policies are pushed through by noisy campaigns, they can be reversed or stalled by the public officials who 'outlive' their political masters and realise they are in practice unworkable or inefficient. The answer? Begin with the science, but recognise that the communication of science is just as critical.

Does science or communications have greater influence in formulating policy? A UK perspective

248th National Meeting (2014)

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