Policy process and practice Professor Roger Brownsword Director of TELOS, King’s College London

Factors in public health policy Evidence Risk Precaution and proportionality

1) Evidence Evidence about: causes of ill health and the efficacy of interventions Should be based on peer-reviewed research Usually incomplete and contested Conclusion: accuracy and fairness in presenting evidence is of crucial importance

2) Risk Assessing risk: Statistical view – considers probability and severity Social construct view – considers value judgements Conclusion: the assessment of risk in the development of policy should be based on the ‘statistical view’

3) Precaution and proportionality Prefer the term ‘precautionary approach’ Application involves weighing costs and benefits on case-by-case basis, and judgement The seriousness and urgency of the problem should also be considered Any intervention should be proportionate and the least intrusive

The intervention ladder Eliminate choice Restrict choice Guide choice by disincentives Guide choice by incentives Guide choice by changing the default policy Enable choice Provide information Do nothing

Reducing health inequalities Targeting strategies: Targeting disadvantaged or at-risk groups Concerns e.g. stigmatisation Universal strategies: Relies on people taking up opportunities Favours better educated people Conclusion: monitoring of strategies of crucial importance