EXPERTS AND ADVOCATES: MOBILISING EVIDENCE TO INFLUENCE THE DEVELOPMENT OF POLICY INTERNATIONALLY
Susanne MacGregor
London School of Hygiene and Tropical Medicine
THIRD ISSDP CONFERENCE: VIENNA
March 2009
WORK IN PROGRESS
This paper derives from ongoing research on the Politics of Illicit Drugs Policy, supported by the Leverhulme Trust. I should like to thank Marcus Whiting and Rachel Herring for research assistance. I should also like to thank those individuals who agreed to be interviewed by me. In this paper, some quotations from interviews are used and these are shown in italics. To preserve confidentiality and anonymity no attributions are given and identifying features have been removed.
EXPERTS AND ADVOCATES: MOBILISING EVIDENCE TO INFLUENCE THE DEVELOPMENT OF POLICY INTERNATIONALLY
INTRODUCTION
In an entertaining review of ‘the AIDS industry’ with sharp observations from her ten years working as an epidemiologist, Elisabeth Pisani discusses why it is that the accumulated evidence from scientific investigations seems to have so little influence on the direction of policy. She blames scientists partly for their failure to follow through and communicate their findings. You have to not just ‘do good science’ you have also to ‘sell good science’, she argues (Pisani 2008: 7). Ideology and politics are important barriers. ‘Science does not exist in a vacuum. It exists in a world of money and votes, a world of media enquiry and lobbyists, of pharmaceutical, manufacturing and environmental activism and religions and political ideologies and all the other complexities of human life’ (op cit: 5). Sometimes however, she says, it is the evidence itself which is faulty with inadequate attention to qualitative detail or even rank distortion of data – statistics will tell you anything if you torture them long enough (op cit: 299). But especially it is because ‘the gulf between those who have the information and those who make the decisions gapes wide’ (op cit:123).
Pisani compares the view from ‘Planet Epidemiology’ inhabited by scientists with that of ‘Planet Politics’, each with a different world view and set of interests. She ends with a plea for politics and epidemiology to get off their separate planets and stand shoulder to shoulder in the war against disease - then we would have a better Planet Earth.
There is a familiar critique of researchers for pursuing questions which are of interest only to them and not focusing sufficiently on real world issues or bothering to make their findings accessible. The drugs world has some people like this but my observation is that those who specialise in ‘drugs’ often do get out from the corridors of academia and get involved in one way or another. I will in this paper describe some of the forms that this involvement takes. But first an overview of the context in which research and policy interact contemporarily.
THE IMPORTANCE OF NETWORKS IN THE INFORMATION AGE
Today, ‘information is the key ingredient of our social organisation’, (Castells 1996: 477). We live in an era in which the scientist, the researcher and the information analyst have become major players in social and political life: no policy or practice can appear as legitimate without having a base in evidence. ‘We now have more data-driven policy.’ This is the context in which policy debates in the drugs field take place: but the field remains also one of contested politics.
Information networks become critical. Manuel Castells was one of the first to identify the rise of the network society where ‘dominant functions and processes in the information age are increasingly organised around networks. Networks constitute the new social morphology of our societies’ (op cit: 469). The huge expansion of ICT has played a key part in this, shaping the forms and speed of interaction and defining membership, access and influence. Being present in key networks is now critical to the exercise of power and the potential for change: being absent rules one out from influence. In this new phase, Castells argues, ‘politics becomes increasingly played out in the space of the media’ and ‘image-making is power-making’ (op cit: 476).
NEW SOCIAL MOVEMENTS
In contemporary politics, the rise of new social movements is also a notable development. New social movements seek the affirmation of excluded identities. From the civil rights movements in the US in the 1960s, demanding human rights and citizen status for African American people, to the women’s movement and gay liberation, the call has been for these identities to be seen as publicly good and politically salient. These demands have spread to include recognition of other groups as fully human and as full citizens. For our purposes, important groups here are those of people who are HIV+ and illegal drug users, especially injecting drug users but also some recreational drug users who experience stigma and disproportionate punishments for their behaviours. These forms of identity communities have borrowed techniques from other new social movements and formed alliances with them.
International alliances have played a key role in the spreading of ideas and practices, which originate within western liberal democracies, to other countries around the world. This trend developed and grew as new spaces opened up with the end of the Cold War and the collapse of the Soviet Union, providing opportunities for intervention by both bureaucracies and social movements. As well as such opening up of geographical space, the demise of the welfare state and emergent new forms of governance (stressing partnership and the involvement of civil society) provided further new opportunities for new players to enter the policy-making arena. This involvement was at times actively encouraged by bureaucracies. For example, the European Commission encouraged the involvement of so-called civil society (NGOs and the social platform): similarly service user involvement was promoted by governments within various human services. In the drugs field, it seems to some observers that ‘the bulk of the very well funded civil societies are for drugs – so today there are more challenges’ in upholding the legislation – ‘this has developed over the last ten or fifteen years’.
GLOBALISATION
A further feature of the context in which this new form of debate and action around drugs is taking place is that of globalisation. The thirty years 1979-2009 was the era of neo-liberalism (which may now be coming to an end). The dominant ideology was one which celebrated risk and the freedom of the market and involved in particular the liberalisation of international financial and commodity markets. At the same time as social problems grew, certain groups in society experienced increased regulation and surveillance as states attempted to control a situation which appeared to be getting out of control. Some of this took the form of the new public sector management and the emergence of ‘managerialism’ with a consequent downgrading of the influence of professionals, and research seemed to become skewed towards monitoring and information-collection rather than basic scientific analysis.
Although globalisation began as an economic policy, its development impacted on other policies, including social policies. There were calls for convergence in these areas too, especially as supra-national regional bodies like the European Union came into existence. Some nation-states felt that their cultures were threatened by these trends. In Sweden for example, where drugs were concerned, more and more people seemed to be coming into contact with and being influenced by a more liberal attitude, challenging national identity and established forms of social protection. As global integration intensified, more attention was paid to the global arena of policy-making. The result was a ‘cacophony of inputs in the political system’ (Buse et al 2005: 153).
Also in this period of neo-liberalism, there was a huge growth of social problems worldwide, including use of alcohol and illegal drugs. The construction of the European Union (EU), which led to freedom of movement of goods and people (Schengen agreement 1985) and abolition of border controls increased the threat that drugs posed. Following the collapse of the Soviet Union, there was an exponential growth in organised crime. ‘All the major criminal groups in the former Soviet Union had built up extensive business interests in the manufacture of amphetamines and Ecstasy, in the importation of cocaine into Europe and above all in the distribution and sale of heroin from Central Asia into Eastern and Western Europe and the USA’ (Glenny 2008: 86). Shadow economies grew and now account for between 15 and 20 per cent of global turnover.
THE BATTLE OF IDEAS
Politics and policy are forms of symbolic communication not merely the outcome of a series of ‘rational choices’. Nowhere is this symbolic character of policy more evident than in the battle of ideas around international drugs policy.[1]
Within drugs policy networks, bureaucracies and social movements play out an intricate dance on the international stage. In these exchanges, certain words emerge as shared ‘codes’ within their mutual language. Key terms - seemingly innocuous to an outside observer - indicate deep meanings and express values known and understood by the participants.
Pisani observes that ‘some governments look at the evidence around harm reduction and act with pragmatism and compassion. Others hide from the science behind a wall of ideology. Funnily enough, it is often those that are secure in their popular majority (such as Thatcher in 1986) or those that don’t have to worry too much about voters (such as Iran and China) that can afford to be compassionate. Those that look skittishly over their shoulders at every opinion poll (Washington, Jakarta) are more likely to allow dogma to overcome reason. That suggests that it is voters, rather than governments, who lack compassion’ (Pisani 2008: 254).
This quotation includes many of the key codes in the debate about drugs policy - pragmatism, compassion, science, ideology, dogma and reason. People at different positions in the policy arena apply these terms to themselves and to their opponents. ‘Every profession is the same’ commented a wise ambassador Pisani met in East Timor, ‘they think they have the knowledge and everyone else just has ideology’ (op cit: 282).
Opponents of the existing array of legislation maintain that drug control strategies are no longer simply counter-productive; they are doing more harm than good. In an important contribution, Julia Buxton argues that international drug control policies have been intertwined with US foreign policy goals since the launch of the control system nearly a century ago and that the US controls the international drug policy institutions (Buxton 2006). Furthermore she claims ‘the evolution of a comprehensive framework and legislative basis for prohibition ran parallel with the institutionalization of US control of the international control bodies’ (op cit: 51).
In 1998, it appeared that the UN was aiming for a ‘drug free world’ by 2008. But ‘the dynamics of cultivation and distribution had become infinitely more complex, raising serious questions as to the capacity of the control system to effect any significant reduction in supply in the long term. The target of zero cultivation set by the UN for 2008 looks wildly optimistic and hopelessly out of touch with trends in the illicit drug trade’ (Buxton 2006: 99).
Pisani distinguishes between the Drug Warriors and the Harm Reductionists, who battle especially over needle exchange and methadone. She points out that they agree on some things: drugs are harmful; because they are illegal and often expensive, they can lead to an increase in crime; injecting drugs can also infect you with viruses like hepatitis and HIV. Both support what they call ‘demand reduction’. After that their views diverge. The Harm Reductionists also ‘recognise that drugs can be a lot of fun. That’s why there will always be a market for drugs’ (op cit: 228). ‘The Drug Warriors see the whole edifice of harm reduction as a sham built to cover up the true agenda: legalisation of drugs’ - and needle distribution is the ‘toxic core of the edifice’ (ibid).
Others however, involved at high levels internationally, do not see harm reduction as the same as legalisation. Some uses of the term harm reduction are quite appropriate, they think: ‘amputating a diseased leg to save the body’ could be seen as a form of harm reduction. Also ‘the pro-drug lobby - it is not a unified church. You have the groups who generally believe that you have to reduce the harm related to use of drugs’ who do not argue straightforwardly for legalisation. These harm reductionists, within this ‘church’, stress using treatment rather than punishment as the way to deal with those ‘who get into a mess’ by using drugs. This is the treatment lobby, who draw on ideas familiar in the so-called old British system of prescribing to treat the disease of addiction. There can be some value in this, it is thought– here the orthodox medical treatment approach is accepted. But some aspects of the harm reduction approach are thought to cause more harm than they prevent: for example, by advising on how to reduce risk they encourage the very behaviour which causes harm. These are more likely to be non-medical practitioners and educationalists – social scientists perhaps, who are seen as well meaning but misguided. In addition and more dangerously, there is ‘another group who believe that the conventions and national laws are prohibitionist’ – these people within that camp are characterised by ‘dogma and ideology’ who ‘believe the fight against drugs has failed’ and they want deregulation. Many of these are now seen as very active on the international stage, linking in to politicians and opening public debate.