A tale of two controversies: Standards of proof in health policy
Professor Ted Schrecker
29th January 2014, 4-5pm
Pennington Room, Grey College
This Durham CELLS seminar will be given by Ted Schrecker who is Professor of Global Health Policy, Durham University. Professor Schrecker is also an adjunct professor of Epidemiology and Community Medicine at the University of Ottawa.
Abstract The importance of social and environmental determinants of health is increasingly being recognized in health policy, at least at the level of rhetoric. Critical choices involve what is called at least in common law countries a standard of proof: how much evidence is considered to justify action. A substantial environmental policy literature dating back to the 1970s demonstrates (a) that there is no ‘right’ standard of proof; (b) that the choice is inescapably value-driven, and is one with respect to which scientists qua scientists have no special competence; and (c) that the choice cannot be avoided, since deferring action pending the availability of conclusive scientific evidence is itself a choice to value some risks, benefits and interests more highly than others.
I examine the treatment of standards of proof in two health policy debates: (a) policy toward endocrine-disrupting agents in the environment, primarily but not exclusively in the European Union, where the precautionary principle is entrenched in law and these agents have been addressed in a formal policy development process; (b) how public policy should address the ways I which the built environment, stress associated with economic insecurity, and the marketing activities of major food and beverage corporations contribute to rapid increases in overweight/obesity. The first case was selected because of potential health impact, current political salience and the fact that it replicates earlier contests in cancer policy, related to the need for evidence of human health impact and to the (non)existence of thresholds or no-effect levels of exposure. The second was selected because of potential health impact and perceived urgency within the public health community, and because it exemplifies the challenges of developing evidence-based policy to address multiple causal pathways that link social determinants of health to health outcomes.
In each case, misunderstandings about standards of proof offer powerful interests an opportunity to camouflage choices about the appropriate distribution of harms and benefits as scientific rather than normative/value driven. Whether such misunderstandings have been actively and strategically cultivated or passively capitalized upon is a matter for further research.
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