This article is written by Lisa Paterson, community development worker, BC Public Service, Canada

While working in youth services in the UK during the 1990s and 2000s, I witnessed the far-reaching positive impact that well-thought-out youth programmes can have on young people’s lives and their wider communities.

As my career progressed, I began to notice a pattern. Every five years, a new government would be elected, nearly always on the promise of new social policies. Strategies less than four or five years old were cancelled, re-hashed or re-branded. Campaigns using catchy slogans made bold bids for hearts and minds.

Whether or not any previous governments’ initiatives or policies were working was almost never a deciding factor in these decisions. The aim of a campaign wasn’t so much reform as restructuring and redesign. Community practitioners would routinely roll their eyes and say: “Here we go again.”

In the 1980s, public services became heavily politicised. Youth services were always a prime target, either in the battle for votes or in the crosshairs of austerity. Yet the impact of this tinkering by the uninitiated had far-reaching consequences beyond politics.

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The problems this causes are now indisputably part of history. What they show is that complex social issues require longer term solutions than a five-year election cycle can offer.

The 2011 London Riots

Research written about the 2011 riots in London UK stresses that there was no single cause of the event. Before the riots however, many youth projects across London's inner-city estates had been closed due to funding cuts. In the London borough of Haringey, for example, youth project funding was cut by 75% in 2011. Eight of the borough's 13 youth clubs were subsequently shut. These were decisions based on austerity policies rather than any evidence of the positive impact these projects had had on young people and their communities. That such factors barely feature in the analysis after the riots highlights the unintended consequences of political decisions made without evidence.

The ‘Communities that care’ strategic planning model in British Columbia, Canada demonstrates the importance of longitudinal research, evidence-based practice and the need for prevention-based work and planning. The model is refreshing to learn about because it uses evidence to shape long-term policies developed by communities themselves.

The Finnish baby box

Another example of a long-term intervention is what is called the “baby box”, which is given to all Finnish parents regardless of income and contains around 50 products needed for the first year of a baby’s life.

In the 1930s, Finland was a poor country with high infant mortality (65 out of every thousand babies died). Baby boxes were introduced in 1938 originally to families on low income. By 1949, they were offered to all expecting mothers and families.

Legislation required mothers to visit a doctor or municipal prenatal clinic before the fourth month of pregnancy to get a grant or maternity box. The box provided mothers with everything they needed to look after their baby and connected pregnant women to the doctors and nurses in Finland's developing welfare state.

Without decisions made for the long term based on evidence, we are in danger of living with decisions that serve political agendas, not people.

Over the decades that followed, infant survival rates rapidly improved. Several reasons are given for this. One is the maternity box and prenatal care for all women in the 1940s, followed in the 1960s by a national health insurance system and central hospital network. This is an example of a social policy, developed through the use of evidence and brought about through political changes, resulting in social wellbeing.

Public health now faces similar tensions between clear scientific evidence and political priorities.

Since the SARS outbreak of 2002 until 2003, there has been a new emphasis in the sector on rigorous scientific evidence and expertise. Currently, it is expected that politicians should be guided by public health experts when making policy decisions. We are now more aware than ever of the role that epidemiological research plays in our everyday lives.

China’s approach to road traffic accidents

In the 1980s, researchers in China began to conduct epidemiological studies on road traffic accidents. These studies were carried out as part of a cross-disciplinary effort in order to understand the cause of the accidents and look at how government policy could improve health outcomes.

Viewed through an epidemiological lens, road traffic accidents became seen as a public health problem, almost a non-communicable “disease”. Interpreting the evidence through this unorthodox displicine eventually led to China’s first road traffic safety law, which was adopted in 2003. With further new laws, traffic accidents and fatalities in China have since decreased dramatically. By 2019, the number of serious traffic accidents resulting in death or disability was reduced by 90%.

There is a growing awareness of the need for evidence-based policy planning. The question is: What is informing these decisions? Is it the practitioners, the politicians, or the evidence found in our communities?

Without decisions made for the long term based on evidence, we are in danger of living with decisions that serve political agendas, not people, and which therefore have to seek out evidence in order to prop themselves up. The human, societal and economic costs of this approach can be devastating. Public servants must champion an evidence-first approach. — Lisa Paterson

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