Whither evidence-based policy-making? Practices in the art of government




van Mossel, Catherine

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The term “evidence-based” is ubiquitous in practice and policy-making settings around the world; it is de rigueur to claim this approach. This dissertation is an inquiry into the work of evidence-based policy-making with a particular focus on the social practices of policy work/ers involved with developing policies relating to chronic disease at the Ministry of Health in British Columbia (B.C.), Canada. I begin with an examination of tensions in the policy-making literature germane to the relationship between knowledge, its production, and policy-making: the environment into which evidence-based policy-making emerged in the 1990s. Drawing on the theorising of knowledge, discourse, and power – particularly from Foucault’s work – for the analytic approach, I present the commitment to claims of “evidence-based” practices found in key government policy framework documents and policy workers’ accounts of their practices, gathered through interviews. I then show the unravelling of this commitment in those accounts. This research reveals how the policy frameworks construct chronic disease as a financial burden on the health care system and direct policy workers to develop policies with this construction in mind. The discourses associated with evidence-based policy-making narrow how policy workers can think about evidence and its production to positivist, scientific methods and numerical measures that will provide proof of cost cutting. Proponents of evidence-based policy-making laud it as keeping politics and ideology out of the policy-making process. However, the policy workers I interviewed reveal the power relations organising their deeply political work environment. Furthermore, the minutiae constituting policy-making practices produce a “managerialist approach to governance” (Edwards, Gillies, and Horsley, 2015, p. 1) in which people with chronic disease are noticeable by their near-absence. When they do appear, they are responsibilised to decrease the burden on the health/care system and the economy. I argue that as a governing project with an appearance of failure, given the many cracks in the commitment to the claim and the practices of being evidence-based, the discourse of evidence-based policy-making is actually quite successful. It has continuous effects: people are separated (so-called apolitical policy workers into imagined neutral space and decision-makers into political space), knowledge is divided, costs and responsibilities are downloaded to individuals, and evidence-based discourses appear in countless settings. The governing works.



policy-making, evidence, evidence-based policy-making, Foucault, chronic disease, critical inquiry, governmentality, policy workers, poststructuralism