Policy nz

There's not much use in thinking of policy initiatives as analogous to clinical interventions, writes Tim Tenbensel.

Instead of simply asking, “Does this intervention work?”, realist evaluators ask: “What works, for whom, in what circumstances and why?” The research base for clinical effectiveness and safety has been underpinned by the ideal that it is possible to demonstrate that something is effective, independent of context. Please support us and the hard work of our journalists by So, a sugar tax might encourage food companies to reformulate their products, but this would depend on other features of the taxation system, and the history of relationships between food producers, retailers and government agencies. It is also potentially highly compatible with a Tiriti o Waitangi approach because it makes it possible to ask: “What works for Māori in what circumstances and why?” The approach is known as “realist evaluation”, and it has its own catchphrase or “catch question”. When University of Otago professor of general practice Tim Stokes and colleagues looked at how the HealthPathways approach that was developed in Canterbury was implemented in the southern district, they found that it played out very differently. Take two much-debated health-policy measures – pay-for-performance in healthcare, and introduction of a tax on sugar-sweetened beverages. But, for many reasons, it is inappropriate to treat policy initiatives as analogous to clinical interventions. And, as I have noted in a previous column, “evidence-based policy” is the most obvious modern example of medicine providing the basis of a powerful, but ultimately misleading, metaphor. Underlying each of these phrases is the assumption that policy initiatives are analogous to clinical interventions. Since the onset of the COVID-19 pandemic, rates of eating disorders, particularly anorexia nervosa, have dramatically increased both in New Zealand and overseas.