For decades, UK governments have used the phrase ‘prevention is better than cure’ to describe a new direction in policy and policymaking. 

In this post, Paul Cairney and Emily St Denny reflect on the large gap between this statement of intent and actual outcomes, and the limited extent to which ‘evidence informed policymaking’ can help reduce it. The post trails Dr St Denny’s guest lecture on this topic at the University of Manchester on 12th February, and the publication of their book by Oxford University Press . 

UK governments have used variations of the phrase ‘prevention is better than cure’ to sum up reforms to policy and policymaking since 1950. However, there is always an unusually large gap between their stated intentions and actual outcomes. We are not describing the usual ‘implementation gap’ or the argument that governments deliberately renege on their promises. Rather, it is possible for ‘prevention’ policy to go nowhere, even when governments make a high profile and sincere commitment to its delivery. 

It is common to describe the need for 'evidence based' policy to close this gap between general intention and specific action. However, our explanations for the lack of policy progress should demonstrate why research alone could never solve the problem. 

1. It is difficult to know what policymakers mean when they make a commitment to prevention. When they make sense of prevention, they also reduce their commitment. 

‘Prevention’ describes a range of potential policies to intervene in people’s lives to ward off bad outcomes, from supporting pregnant mothers to preventing older people entering NHS care, and from population-wide initiatives to targeted programmes. For example, we focused on UK and Scottish government action to reduce socioeconomic inequalities, or the costs of public services, in areas such as employment, crime, health, educational, and families policies. 

Further, ‘preventive policymaking’ can be associated with different ways of making policy, each with their own buzzwords, such as to foster ‘localism’, ‘joined-up government’, the ‘co-production’ of policy with communities and service users, and ‘evidence-based policymaking’.

As such, the idea of prevention is vague enough to generate support in principle. However, it also masks the need to make political choices. When these choices arise, governments are less committed to reform. It is easy to propose preventive services but not to identify the ‘reactive’ public services that would need to be reduced. Think of prevention policy as one side of a coin (the tail), since governments are actually committed to preventive and reactive services simultaneously. Their default is to give more support to the latter. The coin usually turns up heads. 

2. They engage in a policy process that is too complex to understand or control. 

Our book suggests that policymakers engage in a complex policymaking system over which they have limited understanding and even less control. They can only pay attention to a tiny proportion of their responsibilities, and policy outcomes seem to ‘emerge’ locally in the absence of central government control. These insights help highlight problems associated with preventive policymaking, including:

• Policy problems associated with prevention seem to be intractable, at least to politicians juggling a commitment to reform with an image of electability and governing competence. 

• The scale of the task becomes overwhelming, and seems impossible during a 4-5 year term.

• The social benefits of reform are difficult to measure, but the political costs are clear. 

• UK government performance management systems are not conducive to policies with long-term social and economic benefits.

• Prevention is often about ‘early intervention’ in family life, or the regulation of personal behaviour, which raises problems regarding the role of the state in our lives.

• It is difficult to resolve tensions between centralised versus localist approaches, and between competing forms of evidence. 

3. ‘The evidence’ does not solve these problems, but public policy research can help. 

‘Evidence based policymaking’ is not the solution to the puzzle we describe, but there is a role for academic research. For example, we identify three lessons from research on the success story of tobacco policy:

First, make clear political choices. It is possible to reduce uncertainty with evidence. However, prevention is about ambiguity: only the exercise of power to make political choices can resolve the potential to define – and seek to solve – policy problems in many different ways. 

Second, foster a well-defined policymaking environment conducive to prevention policy. Options include setting up a dedicated unit to ‘own’ prevention, or a more collaborative arrangement in which many organisations have high ownership. 

Third, treat prevention policy as a series of choices, not a one-off event. Many governments seem to suggest that they adopted a radically new policy during a single ‘ window of opportunity’ and didn’t have to worry about the details. Rather, policy progress requires the adoption of many mutually-reinforcing policy instruments during many ‘windows’. 

These suggestions do not represent a ‘magic bullet’ solution, but they do show policymakers how to avoid underestimating their task and making the same mistakes as their predecessors.


Paul Cairney is Professor of Politics and Public Policy, University of Stirling, UK (@Cairneypaul). His research interests are in comparative public policy and policy theories (Understanding Public Policy), which he uses to explain the use of evidence in policy and policymaking, in one book (The Politics of Evidence-Based Policy Making), several articles, and many, many blog posts: https://paulcairney.wordpress.com/ebpm/

Emily St Denny is Lecturer in Politics, University of Stirling, UK (@EmilyStDenny). Her research interests include social and public health policy, gender equality, and policymaking in the devolved UK.