Zika and the political battle of rights

By Pia Riggirozzi, Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


 

In recent years there has been growing global awareness of the interplay between rights and social development. In 1997, in an attempt to mainstream human rights as a central feature of all UN programmes, the UN Secretary-General Kofi Annan, called for a reorientation of the UN’s mission to reflect the realisation of human rights as the ultimate goal of the UN (UNDP 2005). Within this approach, the UNDP declared that human rights should not be regarded as the outcome of development but should rather be seen as the critical means to achieving it. With the signature of the Millennium Declaration and more recently the Sustainable Development Goals (SDG) there has been a renewed focus on the links between global poverty and human rights in development. As a consequence, protecting and promoting rights, and creating opportunities for individuals and groups to access, enjoy and reproduce those rights have increasingly been furthered in transnational campaigns promoting broader civil liberties, the ‘right to development’ (Grugel and Piper 2009) and ‘human right to health’ (Oslo Declaration).

However, as Easterly (2009) argues ‘which rights are realised is a political battle’ contingent on a political and economic reality often determined by what is considered (national and internationally) visible and urgent. The response to the outbreak of the Zika in South and Central America is manifestation of that battle.

Zika and systemic injustices

In February 2016, South America became, for the first time, the epicentre of a Public Health Emergency of International Importance when the World Health Organisation (WHO) declared that the Zika virus and its link to neurological disorders deserved global attention. After nine months Zika dropped from the international radar as the WHO declared it was no longer an international emergency. But the crisis is not over. The Zika outbreak that began in 2015 and has now spread across much of Central and South America has implications over the medium and long term on equity, health, education, gender and community relations. The challenges of managing the medium/long-term impact of outbreaks, as previously seen in the case of Ebola, are still poorly understood, and so are the prospects of safeguarding the right to health and the right to development in policies advanced by international and national health agencies addressing those amongst the most vulnerable.

The Zika virus, as with other insect-borne diseases such as Dengue and Chikungunya, is part and parcel of troubling inequities, amongst which health inequality is key, based on deprived living conditions. What raised international alarm in 2015 was the number of cases of microcephaly detected in countries affected by the Zika virus, particularly in Brazil. Microcephaly is a condition where babies are born with unusually small skulls. It is a developmental defect and is usually also associated with serious nervous system disorders – including deficiencies in mental functions and muscular weaknesses of varying degrees (WHO 2016). More than 1.5 million people in Brazil have been stricken with the mosquito-borne Zika virus, and since the outbreak began in 2015, the country has logged around 4,000 confirmed and suspected cases of microcephaly. This is alarming, particularly compared to 2014 when there were 147 cases.

Economically disadvantaged segments of the population are at higher risk of exposure to Zika, of being infected, and of their children of being born with microcephaly or other genetic conditions that require special care in the long term. The Zika crisis has also reinforced the socio-cultural expectations about the role of child-raising/caring that disproportionately fall on women, limiting even more opportunities to engage in education programmes or seek/obtain formal employment. Finally, promiscuity, lack of education and the simple fact that poor women might spend more time at home and thus are more exposed to dirty water, sewage, and mosquito breeding grounds than men, also means that women bear the burden of the prospect of infection. This drama typically unfolds in conditions where infrastructural deficiencies and lack of quality medical care and social services are the norm.

Consequently, poor women and their families are likely to be stigmatised as poor, as women, as sexually irresponsible, as families marked by disability. The Zika crisis is, in effect, a window that exposes systemic injustices related to poverty and marginalisation of poor women and children. It also a constitutive dimension of the ‘structural violence’ as global, regional and national responses to the Zika outbreak have disproportionately concentrated on prevention of infection and transmission which although necessary and urgent do not change the structural and related socio-cultural conditions that perpetuate injustice and inequality in these societies.

Which rights are right? 

The Zika crisis is not gender neutral and a focus on women is needed. Take Brazil, where there is a large proportion of single parent families, the majority of which are headed by women. These households are more likely to experience perpetual cycles of poverty as a result of the economic shock of disease. In addition, where children are born with potentially disabling impairments, they are often further isolated by limited support or social protection. The significant increase in the number of infants with microcephaly in the Northeast of Brazil which triggered of the WHO declaration of international emergency, highlights the centrality of the social determinants of health in the transmission chain, as well as issues such as the social division of care and debates on sexual and reproductive health.

During 2016, a roll out of official declarations put women at the centre: the High Commissioner for Human Rights and the WHO reinforced the importance of women’s human rights being central in the response to the Zika outbreak in many states (Gostin and Phelan 2016), while the US Center for Disease Control and Prevention advised pregnant women to refrain from travelling to countries affected by the Zika virus. Most dramatically, health officials in El Salvador urged women not to get pregnant until 2018; Colombia called on women to delay pregnancy for six to eight months.

This particular response focusing on behaviour is problematic for at least three reasons. First, implementing vector control programmes in the poorest areas is particularly challenged by more structural issues of lacking infrastructure, running water and access to healthcare. And even if such operations are conducted, mosquitoes have previously shown their capacity to quickly resurface whenever there is inadequate funding or surveillance. Second, shifting responsibility to women’s behaviour delinks the disease from its social determinants and their rights; not least because most pregnancies amongst poor and vulnerable women in the region are unplanned. As Davies and Bennett (2016: 1046) note, responses tend to focus on the ‘immediate’ health-care problem, while the status of gendered inequality that underpins the prevailing unhealthy conditions is considered ‘beyond’ the capacity of public health interventions. Add to this prevailing high rates of sexual violence, elusive contraception, teen pregnancies and the lack of sexual education prevalent in Zika-affected countries. According to a study published by the Guttmacher Institute in 2014, as many as 56 per cent of pregnancies in Latin American and the Caribbean are unintended, either because of lack of access to contraceptives or because of associated forms of gender violence.

Third, reducing the problem in this way to a few modifiable behaviours ignores factors of social determinants of health and poverty. Responses to communicable diseases such as Zika, and before Ebola, have so far tended to focus overwhelmingly on short-term-vector control and surveillance (Gostin and Hodge 2016; Davies and Bennet 2016). Such responses may be effective in terms of disease containment, effectively masking the precarious social conditions in which they live, in which many rights remain merely notional.

A final issue raised by the Zika crisis is that of reproductive rights. In a region where birth control is limited and sexual violence is widespread, the debate on legalising abortion has gained prominence. Last February, the Obama administration put under Congressional consideration $1.8 billion in emergency funding to help prepare for and respond to the threat posed by the Zika virus. But abortion politics sterilised these discussions as Republican lawmakers leading a congressional hearing on the Zika outbreak made funding conditional on anti-abortion policies in recipient countries. And while Pope Francis hinted at softening the rigid stance of the Catholic Church on contraception because of the threat posed by the Zika virus, it is the region’s restrictive abortion laws that remain a critical problem. In most Latin American countries affected by Zika, abortion is illegal or can only take place in exceptional situations. In El Salvador, for instance, where more than 7,000 cases of Zika were reported between December 2015 and January 2016, abortions are illegal under any circumstances and miscarriages could even lead to homicide convictions if proven to be self-induced.

Advocacy groups in Brazil are increasingly presenting legal cases to the Supreme Court to legalise abortion and secure reproductive rights for women under the principles of the 1988 National Constitution that guarantees the right to health. But the challenges ahead are many, not least in what a human rights-based approach to health may mean in addressing the long-term consequences of Zika (and other such health crises).

To be clear, vector control actions are imperative, but policies and recommendations based on behaviour, control and prevention are not only not enough to address women’s marginalisation in society and the effect this has on their health, they may further exacerbate this problem in addressing the immediate health risk. More academic and policy debate is needed on the scale and nature of future needs (health, social, economic, educational, welfare) of vulnerable communities particularly women and children, and how to calculate them. Government awareness of this issue is still low in Central/South America and although regional, global and expert/practitioner networks might be able to provide support in the future (Riggirozzi 2015; Riggirozzi and Yeates 2015) both in defining the scale of need and in providing support to governments in developing policies to address them, their roles over the medium/long term require greater definition.

Governments in South and Central America are in urgent need of a multi-policy approach – and funding- if they are to put in place effective responses to mitigate long-term effects and not derail progress in terms of meeting the SDGs targets on gender, childhood, disability and inclusive growth. Vector control and compliance could be seen as first step. The right to health needs to be delivered with a view that development in general and the delivery of health in particular should be anchored in an understanding of the inequalities, discriminations and power relations that prevent many people having access to good healthcare systems, care provisions and education and a view that states have legal and ethical obligations under international law to ensure the best possible provision of services for all.

 

Pia is currently involved in a funded project on regional organisations and access to medicines in South America.

 

Doctoring Welfare: Why ATOS must adhere to the Hippocratic Oath

By Megan Sherman. Megan is an MSc Global Politics student and student liaison officer for Momentum Southampton. As a student journalist she has written for local and national media.


 

A Stanford Sociologist recently divulged the findings of his research on how to make effective political arguments. He found the most persuasive, successful arguments reframed the argument in terms of opponents’ moral values. This approach is less polarizing, and more consensual. It finds a common ground where both parties can agree. This way, progress might be made on policy where there is usually stalemate and stagnation.

It is this consensual approach to persuasion which I am trying to emulate by asking the Government to consider making ATOS adhere to the Hippocratic Oath. The Tory Party is hardly going to be convinced to reject the logic of austerity by an appeal to their compassion. But what they can’t do is reject this motion and still lay claim to being a party that respects moral values and ancient civic traditions. So this way we may make them tacitly accept a motion that would improve the lives of people for whom the benefits assessments reforms have brought untold misery.

The idea behind my petition was simple. People who make decisions that affect the lives of the ill are usually expected to adhere to an ethical code. Although technically the Hippocratic Oath is not a requirement for UK doctors, they are nonetheless expected to abide by the principle ‘Do No Harm.’ Arguably this ought to be a requirement for all organs of state. ATOS processes directly affect the health and wellbeing of the people who are the objects of their assessment, and it is the corporate approach of reducing people to an objectified, dehumanized thing that is causing the trouble with ATOS, so the need for a more humanistic approach that respects the rights and dignity of patients has never been more acute.

Smart people will notice and say that ATOS already has a code of ethics. But ATOS writing their own code of conduct is like the accountants and banks being seconded to write tax evasions law. Corporations cannot be entrusted to uphold ethical codes by themselves. They must be subscribed to a legal code which punishes a failure to abide by strict ethical regulations. ATOS can’t audit its own ethics for the same reason NGOs can’t audit their transparency structures themselves.

It is no exaggeration to say that welfare reforms have been a death penalty for some. The campaigns of disability activist groups shine a light on the troublesome correlation between DWP assessments and suicide. Films like I, Daniel Blake make an emblem of the struggles of genuinely unwell people against a suspicious, hyper-vigilant system that fails to treat the objects of its processes with compassion and respect. Political commentators with affinity for the struggles of the disabled try to bring their concerns to the attention of mainstream opinion.

I think the time is now for Parliament to debate bringing in a code of ethics for companies who deal with our sick citizens. If a doctor mistreats a patient, she is held accountable at tribunal. If an MP damages the interests of somebody in their constituency, she is held accountable at the ballot box. Perhaps, now, it is time for ATOS to be at a tribunal, being heard for its own deficiencies, instead of punishing those it perceives in others.

Please follow this link to the petition.

Health for All on Human Rights Day: A Pro-Poor Approach

By Pia Riggirozzi and Erica Penfold. Pia Riggirozzi is Senior Lecturer in Global Politics at University of Southampton (@PRiggirozziAcademia.edu) and Erica Penfold is Research Officer at the South African Institute of International Affairs. Both are partners at the ESRC-DFID funded project ‘Poverty Reduction and Regional Integration: SADC and Unasur Health Policies’ (@PRARIRepir). You can find more posts by Pia here.


In recent years there has been growing global awareness of the interplay between rights and the development process and a generalised recognition of social determinants of health connecting poverty, equality and health. Yet, for millions of people throughout the world, the full enjoyment of the right to health still remains a distant goal. Poverty remains one of the driving forces behind ill health, a lack of access to healthcare and medicines and consistent underdevelopment. The World Bank shows that 700 million fewer people live in conditions of extreme poverty in 2010 than in 1990 across developing regions. However, the Global South is still struggling, everyday thousands of children, women and men die silently from preventable diseases associated with poverty.

The United Nations acknowledges these issues as it continues to produce a stream of further guidance in the form of General Comments, such as the General Comment 14, while sponsoring global Declarations and Commissions on Social Determinants of Health. Human Rights Day observed by the international community on 10th December since 1950 acts as a reminder of the importance of recognition and advancement of rights and the human right to health. But the current high-level focus on health by the international community while recognising the strong relationship between poverty and health, in practice, has been quite conservative in turning the rhetoric into practice. Translating normative principles into politics of compliance and practices for policy implementation remains uneven across the wide spectrum of human rights issues, acknowledging and affecting bearers of rights in different ways. For William Easterly this is clear, ‘which rights to health are realised is a political battle’ contingent on a political and economic reality that profits on the margins of (poor) health. He is right, we can’t downplay politics. Think of a funder – whether the Gates Foundation, Welcome Trust, private charity or government programme – their agenda may well spend a great deal of resources (financial and human) on dealing with one disease. Or programmes advanced by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, or the Gates Foundation; despite having the best intentions, they may be guided by their own views, agendas and objectives. Undoubtedly, diseases like HIV, malaria and tuberculosis account for over 90 per cent of the global disease burden, yet the millions of dollars poured into programmes to tackle these diseases have done little to tackle weak healthcare systems which are in many cases unreachable or distrusted by the people they are designed to help. Equally critical, other peoples’ rights could be neglacted if diseases like dengue, leishmaniasis, Chagas and Chikungunya that also add to the increasing toll of human life and to the poverty-disease burden receive little attention. The risk is that what is visible and urgent leads over what is marginal and that actions targeted to the poor, yet ignoring the social factors that cause poverty and exclusion, discriminate positively, normalising and even reproducing inequities. The Ebola outbreak in West Africa is another reminder of these risks.

The realisation of people’s rights, entitlements, and obligations, is largely determined by the nature of the state and its capacity to respond to internal public demands, interests, and pressures. Philanthropists in rich countries and the global aid community more generally can mainstream and support national strategies. But we believe there is a role to pay by the neglected partners in development: regional organisations. Regional organisations can be key engines in the development of progressive social policies and advocacy of rights. For example, the Economic Community of West African States (ECOWAS) has established a regional court of justice adjudicating on national labour rights, while the Union of South American Nations (UNASUR) is now driving initiatives to expand entitlements to health care and social security within member states and it is shaping policies around disability all over the world, negotiating with one voice at the World Health Organisation. This makes sense because some social harms and epidemics are inherently cross-border, and are exacerbated or facilitated by regional developments.

Regional organisations that were built for other reasons are now becoming much more important for health and will be particularly important if we look at the Post-2015 Agenda. Organisations such as UNASUR and ECOWAS can provide donors and partners with a single point of contact for discussions and implementation of poverty reduction programmes in member countries. They are close to their populations and can develop technical cooperation, building infrastructure and strengthening capacity between the member states, rescaling practices to reduce socio-economic disparities.

Renewed focus on health, as a basic human right, is a poverty issue. It demands thinking about the deep determinants of (under)development and social exclusion and national, regional and global commitments to enhance access to health care, to medicines, to opportunities. Neglecting this will be a tragedy of aid assistance and possibly of the Sustainable Development Goals.

 

Enhancing Rights and Equity in Health: What Difference Can South American Regional Diplomacy Make?

By Pia Riggirozzi, Senior Lecturer in Global Politics at University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


The United Nations Day for South-South Cooperation last Friday must be taken as an opportunity to reflect about the place and opportunities for regional organisations in the South to provide leadership and direction in support of the right to health, equity and alternative practices of global (health) governance.

Back in 2005, during the Fourth Summit of the Americas in Mar del Plata, Buenos Aires, left-leaning Heads of State and anti-globalisation movements expressed their rejection to the US-led Free Trade Agreement of the Americas and brought to a close its negotiations. At the same time, South American leaders sealed a new deal towards alternatives modalities of regional governance. The birth of the Union of South American Nations (UNASUR) should be seen in this light. UNASUR crystallised as an ambitious integration project with renewed commitments on democratic principles, inclusion and human rights. Health in this context became a ‘locus for integration’ and a new framework to advance the right to health and legal paradigms linking citizenship and health.[1] To varying extents, UNASUR institutionalised regional theme-specific networks and country-based working groups to implement health projects, enabled spaces for knowledge exchange and regional strategies for medicine production and commercialisation, and helped coordinating common positions acting as a global player in the advocacy of health equity.

Nearly a decade after that meeting in Mar del Plata, has UNASUR diplomacy enhanced the right to health? Last June, at a speech for the 35th biannual conference for the Economic Commission for Latin America and the Caribbean (ECLAC), General Secretary, Alicia Bárcena stated, “cooperation in Latin America and the Caribbean is at a turning point, as the region still needs aid, but is also able to provide aid.”[2] Indeed, better-resourced and more confident Latin American governments are not only recipients and providers of aid but also carving out new spaces in global health diplomacy. 

Regional health diplomacy: UNASUR as norm-entrepreneur?

Tackling germs, negotiating norms, and securing access to medicines are persistent challenges that disproportionally affect developing countries’ participation in global health governance. Furthermore, over the last two decades, the excessive focus on global pandemics and security in global health diplomacy, rendered peripheral diseases that usually strike the poor and vulnerable, creating situations of marginalisation and inequality across societies. In other words, what is ‘visible’ and ‘urgent’ – what defines risks and ‘high politics’ in health to use the language of International Relations – leads over what is ‘marginal’. Furthermore, who frames what and why depends on how actors, including government officials, non-governmental organisations (e.g. Medicins Sans Frontieres, Oxfam, the Gates Foundations), institutions (e.g. World Health Organisation, World Bank, UNICEF, UNAIDS), public-private partnerships (e.g. GAVI), position and negotiate interests in global health governance.

Since 2010, UNASUR took up this glove acting as a corrective to the side-lining of rights on account of risk/security concerns in international health politics. One of the first positions taken by UNASUR at the WHO was concerning the impact intellectual property rights on access to medicines and the monopolist position of pharmaceutical companies on price setting and generics. Led by Ecuador and Argentina, UNASUR successfully advanced discussions on the role of the WHO in combating counterfeit medical products in partnership with the International Medical Products Anti-Counterfeiting Taskforce (IMPACT), an agency led by Big Pharma and the International Criminal Police Organisation (Interpol) and funded by developed countries engaged in intellectual property rights enforcement. Controversies focused on the legitimacy of IMPACT and its actions seen as led by technical rather than sanitary interests, unfairly restricting the marketing of generic products in the developing world. At the 63rd World Health Assembly in 2010, UNASUR successfully proposed that an intergovernmental group replaced IMPACT to act on, and prevent, counterfeiting of medical products. This resolution was approved at the 65th World Health Assembly in May 2012. In the course of this meeting, UNASUR also lobbied for opening negotiations for a binding agreement on financial support and research enhancing to meet the needs of developing countries.

More recently, led by the Ecuadorian delegation, UNASUR presented to discussion at the WHO an action plan which aims to improve the health and wellbeing of people with disabilities. This action plan was successfully taken up at the 67th session of the World Health Assembly in Geneva, in May 2014, when the WHO’s 2014-2021 Disability Action Plan was approved.[3] This plan focuses on assisting regional WHO member countries with less-advanced disability and rehabilitation programs and will be carried out by the WHO in conjunction with regional organisations such as: Caribbean Community (CARICOM), Central American Integration System (SICA), Southern Common Market (MERCOSUR) and UNASUR. This is not a minor issue as in countries that bear a ‘double burden’ of epidemic communicable diseases and chronic non-transmissible diseases. Supporting these developments, the South American Institute of Health Governance, UNASUR’s health think-tank, provides policy-oriented research, fostering debate and capacity building for policy-makers and negotiators in light of the post-2015 Development Agenda.

The limits of a broker

The presence of UNASUR in this type of health diplomacy, and its coordinated efforts to redefine rules of participation and representation in the governing of global health, are indicative of a new rationale in regional integration and regional policy-making in Latin America. These actions create new spaces for policy coordination and collective action where regional institutions become an opportunity for practitioners, academics and policy makers to collaborate and network in support of better access to healthcare, services and policy-making. For negotiators, UNASUR structures practices to enhance leverage in international negotiations for better access to medicines and research and development funding, as well as better representation of developing countries in international health governance. For advocacy actors, UNASUR represents a new normative platform for claiming and advancing the right to health within the region while at the same time attempting to establish itself as a broker between national needs and global norms, a political pathway that differs from the position held by Latin America in the past.

The experience of UNASUR opens an unprecedented opportunity to evaluate the ways regional organisations address rights-based concerns affecting ordinary people. It also teaches some important lessons while it highlights a troubling paradox. First, region should be seen as a space where politics and policy happens within a geographical space as much as trans-border actor with a unique capacity to rework and contest norms. Second, scholars interested in agenda setting in global politics, who often place attention to the dominance of powerful Northern-based actors, should address new corridors of diffusion and the agency of Southern regional arrangements as norm entrepreneurs advancing (human) rights. Researchers and practitioners interested in rights-based governance and development can’t afford to ignore Southern regional formation ambitions and their attempts rework global norms. Finally, innovative diplomatic intervention and South-South cooperation promoting rights, and the normative agency of regional organisation while must not be romanticised should neither be trivialised.

There however is a paradox at the heart of regional defense of equity. Normative claims about the morality of rights as an overarching approach to governance must not down-play politics. While UNASUR advocates health rights globally, regional frameworks pushing for reforms towards universal health systems are significantly filtered by quite conservative practices at the national level of politics. Translating normative principles into state action in support of better access to health care and medicines across Latin America remains uneven, affecting the bearers of (human) rights in different ways. This is reinforced by the absence of binding institutional mechanisms supporting fluent corridors of regional-national policy making.

Just as in Mar del Plata when the people (pueblos) buried the US-led FTAA ambitions, it is time to rethink not only whether a regional organisation such as UNASUR can itself become an entrepreneur advancing rights to health globally, but also how it can broker the right to, and universalisation of, health addressing the needs of economically and socially vulnerable populations through state action and reforms within the boundaries of member states.

[1] UNASUR Constitutional Treaty, at http://www.comunidadandina.org/unasur/tratado_constitutivo.htm, (3/3/2014)

[2] See http://periododesesiones.cepal.org/en/news/alicia-barcena-cooperation-region-turning-point (11/9/14)

[3] See http://upsidedownworld.org/main/ecuador-archives-49/4875-ecuador-pushes-for-greater-south-south-cooperation-and-stronger-public-disability-assistance-policies (8/9/2014)

Channel 4, Fat and the Facts

By Dr John Boswell, Politics & International Relations

Watching Supersize vs Superskinny, Channel 4’s latest venture into the ever-popular fat voyeur genre, I was struck by one thing in particular. Unlike the casual viewer, it wasn’t the enormous quantities of food that participants consumed (or actually in this case were forced to watch their ‘superskinny’ counterpart struggle down), nor the gratuitous footage of even bigger Americans in undignified situations, nor even the perma-tan and blonde highlights of the creepy Dr. Christian. Instead, having spent much of the last 4 years analysing the way political actors make sense of and argue about obesity, what stood out for me was the constant stream of facts and figures that viewers were bombarded with. From Perspex containers filled with kilograms of sugar and fat (a ‘shock’ technique filched from Jamie Oliver) to the sober clinical assessments delivered by the good doctor,  the show seemed to be jam packed with references to scientific claims on obesity and its impact on health.

This observation aligned neatly with what I had found in my research—a seemingly universal fetish for ‘the evidence’ whenever the issue of obesity comes up. Indeed, every policy actor I have come into contact with in both the UK and Australia, whether in public or private, seems to share this obsession. The evidence of my own gathered over this time shows that these actors typically litter their comments on the subject with facts and statistics, make extensive and deferential reference to ‘the evidence’ in general, and speak of the need for (or at least of the faint hope for) policymaking around this issue to be ‘evidence-based’. Now, to be clear, these actors disagree vehemently about the nature of obesity as a problem and about how public policymakers ought to react: for some, the obese are lazy oafs sponging off the NHS; for others, they are helpless victims of an ‘obesogenic’ environment poisoned by the wicked food industry; and for others still, they are objects of a moral panic inflamed by special research and pharmaceutical interests. Yet all share an obsession for the evidence, such that these conflicting accounts are all avowedly ‘evidence-based’. So how does that work?

An elegant explanation is that evidence is just a discursive resource that actors can draw on; that the fierce debate over the ‘obesity epidemic’ and its implications for public policy are just another case of science falling victim to politicisation. What I argue in this article (or view for free here), recently published as part of a special issue for Policy Sciences on ‘Evidence and Meaning’, is not that this is explanation is entirely wrong – I absolutely concur that ‘the evidence’ is not some innocent, neutral object beyond the dirty reality of politics and policymaking—but that it is overly simplistic. The debate over obesity is not a case of fixed coalitions drawing on scientific evidence solely for the purpose of reinforcing their preconceptions. It is a complex, dynamic one in which apparent ‘allies’ frequently and often openly contradict each other with respect to ‘the evidence’.

In light of this rather more optimistic stance, I ponder what this might mean in democratic terms. I acknowledge, of course, that the primacy of ‘the evidence’ has some drawbacks in this regard. While all the actors engaged in this debate (including and perhaps especially public health experts) also draw extensively on alternative forms of knowledge—common sense, professional experience, personal anecdote, etc—these claims are always enfolded within or made subordinate to claims about the evidence. This has pretty obvious exclusionary implications. But, on the other hand, the common refrain to the evidence has two key benefits. The first is that the currency given to evidence keeps all actors on board, even when they do not feel they are getting their way. They have faith that ‘the truth will out’; that the evidence proving their case will mount and become so compelling that policymakers will have no choice but to pursue their preferred course of action. The second benefit is that by committing to justifying their claims with reference to ‘the evidence’, all actors across this debate are submitting their accounts to a common standard of assessment. By demanding so publicly and vociferously that policymaking on obesity be ‘evidence-based’, they run the risk of being ‘hoisted with their own petard’ if their own use and interpretation of the facts is not seen to add up.

Which leads me back to the sums being done at Channel 4. If the show’s researchers are so concerned about facts and figures, then perhaps I should point them to the growing evidence that Dr. Christian’s methods of shock and humiliation do appalling damage to self-esteem and (as a result) are almost always counter-productive for weight loss and health in the long term. But something tells me the channel may be about as committed to improving public health in Supersize vs Superskinny as it is to advancing social welfare through Benefits Street.