The intervening state

Embracing complexity means greater accountability

The main ethical aim of governments is uncontroversial and longstanding: to pursue the common good. But best practice in how to specify, measure and seek the common good has changed significantly in recent years. One salient feature has been that greater attention is being paid to the idea that adequately pursuing the common good is helped by using direct measurements of citizens’ wellbeing to drive public decision-making, particularly by incorporating subjective measures such as life satisfaction scores. Attention to subjective wellbeing has made apparent how deep the effects of circumstances, such as unemployment, and mental health issues, such as depression, are on overall wellbeing and given strong reasons to think that these were previously taken less seriously than they should have been.

However, the relationship between subjective wellbeing and the main end goal of government policy needs to be interrogated. If taken as the only goal it will tend to curtail and impoverish our understanding of the kinds of public values that governments concerned with promoting the common good should be interested in. For example, it is important – yet unsurprising – to note that being the victim of a violent assault reduces subjective wellbeing. More important, however, is to notice that the reduction in subjective wellbeing is a response to and an interpretation of a sense of personal violation. So responding to these concerns is not just one of a number of ways in which government can increase wellbeing in the aggregate: it is something that individuals have a right to require of governments. Pursuit of the common good means governments must respond to the normative structure of situations, rather than just attempting to shift the subjective experiences of individuals. It is problematic if a government responds to a crisis in public trust – such as threatened the UK’s recently delayed GP Data for Planning and Research policy – by treating it purely as a communications challenge, rather than a signal that it is the trustworthiness of the policy that needs to be ensured. Rising to the challenge of demonstrating trustworthiness requires articulation and reconciliation of shared values.

Societal stigmatisation

This is true not just in extreme situations, such as interpersonal violence, but also in a range of cases related to health and wellbeing. For example, many long-term health conditions are subject to stigmatisation. Stigma requires picking out some human differences as significant, and labelling them. A distinguishing feature will become stigmatising only if it is associated (or comes to be associated) with existing negative attributes. A sense of shame or being stigmatised will affect individuals’ willingness to engage with healthcare, to disclose their conditions to others, or to continue to maintain an outgoing focus, as Russell T Davies’s It’s a Sin powerfully dramatised in the case of HIV/AIDS.

Many long-term illnesses are subject to stigma, and being stigmatised significantly worsens the experience of having a long-term condition. As sociologists Bruce Link and Jo Phelan argue, the relationship between stigma and status loss is bidirectional: stigma itself causes status loss, but low or diminished social status can itself be a cause of further stigma or discrimination. Power inequalities easily lead to stigmas being created where they previously did not exist; and lack of social power is one of the things that is often stigmatised. Stigmatisation is bad in itself for subjective wellbeing, and also tends to lead to further negative effects.

Because of all these factors, it is short-sighted to think, for example, of mental health stigma as just a matter of subjective experience. Stigma is by its nature a kind of othering of less powerful groups by more powerful groups. We need to think of it as a structural cause of unfair inequalities in health and wellbeing, and policy responses to it need to take this into account. As stigmatisation arises from systematic differences in power, and further magnifies these power differentials, attempting to remove stigmatisation without changing the underlying power structures is difficult, and can easily backfire.

Better awareness of these challenges explains why, despite the very welcome improvement in the volume and quality of data available to decision-makers, the task of government has become, if anything, more, rather than less, challenging. There are now many more ways in which a government can fail. Especially where, as in the case of stigma reduction or tackling structural racism, the problem that governments need to solve requires change of deep-seated social attitudes. Success is fragile and cannot be secured through legislation alone. Persuading rather than coercing is crucial. To make matters worse, the greater availability of data makes it more obvious when public policy fails to achieve its objectives.

Complex systems

Responding to these challenges, the RSA, among many other thoughtful commentators, has been arguing for a deep reorientation of public policy away from new public management approaches that focus on efficiency through setting targets and key performance indicators, to complex systems approaches. There is a range of approaches to public policymaking that draw on complexity science, but all are united in arguing that top-down or command-and-control systems in policy will often suffer from, among other faults, a failure to anticipate their systemic effects. This tends to lead to policies either not achieving their intended results or having unintended additional effects – what the American systems theorist and ecologist Donella Meadows called “policy resistance”.

Taking a long view, it is striking not just how intellectually strong the case is for the shift to complex systems approaches, but also that similar arguments have been made with relatively little effect for over 40 years. While complexity science has often recommended a much greater reflexivity in the approach to interventions, it has not always reflected sufficiently on the reasons why it has itself struggled for acceptance in public policy. Doing so will allow us to make progress on how governments should go about attempting to promote citizen wellbeing, and in particular the relationship between citizen wellbeing and the public good.

The paradox at the heart of systems thinking is that it is both familiar and deeply counterintuitive at the same time. It is hard to work in a large organisation, or to attempt to interact with government services such as social care, without becoming vividly aware of the ubiquity of unintended consequences and the myriad ways in which something that clearly seemed like a good idea in theory ends up being highly problematic in practice. For example, the Northern Ireland renewable heat incentive policy aimed to encourage businesses to shift from fossil fuels to renewables by subsidising the burning of wood pellets in boilers. However, the subsidy per kilowatt of energy produced ended up being higher than the cost of the fuel, meaning that it became profitable to run the boilers to heat empty sheds, leading to the ‘Cash for Ash’ scandal. While such experiences are universal, they will be interpreted differently, depending on the presuppositions we bring.

The mental model of causation that politicians and citizens alike tend to start from is akin to something like a billiards table: everything is static until a force is applied from the cue to the cue ball, which then strikes another ball and causes it to sink into the pocket. In such a world, causes are easy to identify, and responsibility is easy to parcel out. In reality, social systems, institutions and biological systems behave very differently. Where they exhibit stability, it tends to be a dynamic stability. Things do not stay the same because nothing is changing, but rather because they are kept within boundaries by dynamic interactions within a system. This is most obvious in the case of the processes of homeostasis in living organisms, where the maintenance of a fairly constant internal environment requires continual dynamic adjustments. The composition of a neighbourhood or rates of violent crime can be seen to also be affected by a process akin to homeostasis; stability and change should be understood in terms of the interaction of mechanisms, rather than presupposed as a constant.

The problems of complexity

Thinking in terms of complexity increases the range and density of interrelations that need to be taken into account in policymaking, and leaves policymakers better equipped to avoid certain obvious problems of policy resistance. However, better understanding systemic interrelations does not by itself reduce the difficulty of the ethical problems policymakers face in determining, measuring and pursuing the common good. Complex systems approaches are premised on a shift of our understanding of what causes what, and the implications this has for our planning: they do not by themselves tell us what our goals or aims should be. This is one reason for the otherwise surprising bedfellows that complexity brings together, cutting across political divides, from ecologists such as Donella Meadows, to market enthusiasts such as Hayek, and urbanites such as Jane Jacobs.

Complexity does not, however, leave everything the same when it comes to government policy. It has more radical implications too, as it compels a deeper reflection on the kinds of contingent reasons why policies can fail, and how to avoid this. Feedback loops and sensitivity to initial starting conditions can lead to unpredictable results even within deterministic systems. Where human beings are involved, as they always are in public policy, the ways in which citizens incorporate expectations of each other’s behaviour into their own actions is crucial. How the human beings who partially compose a system interpret elements of the system, and how easy or difficult the expectations of others make it for them to get what they want, will alter the behaviour of that system.

I call this performativity. The basic idea is simple, but mind-bending in its implications. As philosopher and psychologist William James remarked in his classic essay ‘The Will to Believe’, if you assume that someone is hostile to you, and then act on that basis, they may respond to your apparent distrust. If you then take their response as evidence of their hostility, things can easily escalate into a full-blown enmity in which it is true that the other person is hostile to you, even though this is true only because of your initial assumption. Start with the assumption that the other is trustworthy and likeable and act on this basis, and the cascade of behaviour may go the other way; the other returns the openness and compliments, which are interpreted as signs of friendliness and as the cause for further friendly moves. How many friendships and enmities have their basis in the contingent workings of performativity?

We are not spectators or detached scientific investigators of social reality, but the actors who are creating the show. As pithily summed up by the British economist Charles Goodhart, in what has come to be known as Goodhart’s law: “Any observed statistical regularity will tend to collapse once pressure is placed upon it for control purposes.”

One implication of performativity is that many of the problems that need to be tackled by governments will not be solved more easily by stronger or more directive government action. To take just one example, the dynamics of vaccine hesitancy are significantly shaped by judgements about trust in state authorities, and so replacing a model that previously encouraged vaccination on a voluntary and solidaristic basis with a mandatory one is liable to reduce public confidence in the programme. If the coercion is perceived to be heavy-handed or unmerited, it may increase vaccine refusals, and fail to increase overall vaccination rates, achieving the exact opposite of its aim.

This is a message that has been appreciated by those on the political right who emphasise market solutions, but generally resisted by the left and centre-left. However, this debate needs to be reconfigured. The theoretical reasons that economists advance for thinking that the deliverances of a market will be optimal for wellbeing hold only under assumptions such as perfect information and zero transaction costs, which never in fact obtain in real-world circumstances. Looked at from the perspective of a rigorous complexity approach, competition in an economy is no more likely to lead to results that are optimal for wellbeing than is the process of natural selection. Without firm government intervention, the interrelated systems that make up society will often act to exacerbate existing inequalities and increase the risks to those who are most vulnerable. In such circumstances, government inaction is neither neutral nor a way of maximising wellbeing, but amounts to allowing the vulnerable to come to harm.

However, nor is the idea that ambitious governmental intervention must fail supported by complexity approaches. While there are many instances in which public policy breaks down because systemic interactions have not been adequately attended to, it is simply mistaken to draw the conclusion that complexity approaches provide blanket support for government inaction. One obvious reason is that there is a range of cases in which the mechanisms that lead to disease and ill health, or conversely to health and wellbeing, are well understood, and there are many interventions that can be scaled cost-effectively to the level of a society without undermining their effects, or where wider take-up in fact enhances their effects (such as philanthropist Melinda French Gates argues is the case for women’s empowerment).

The main lesson that performativity should teach us is a greater flexibility in the way we think about value conflicts. There will be different ways of sustainably ‘solving’ a problem posed by conflicts of value such as population protection and liberty in the Covid-19 recovery period. What matters ultimately for policy is establishing effective control of the disease as the economy returns to normal, and doing so in a way that both maintains public confidence and leads to norms that encourage the behaviours required by the policy becoming more firmly embedded over time. What combination of social norms, restrictions and technologies will best succeed depends on the different perspectives, values and strategies that other citizens in fact have. It is something that policymakers need to develop in dialogue with publics rather than seek to impose upon them.

Whose responsibility?

Simple models of causation – because they discount the role of systems – tend to conflate causation and responsibility. Their first instinct is that if someone comes to harm then someone must be to blame; their second is that if no one can be found to blame, then the result is unfortunate but not unfair. Both instincts are mistaken.

Complex systems approaches require that policymakers not only see more interconnections, but also take ownership of more of them; it is no longer plausible to disclaim responsibility for unanticipated side effects of policy. As systems scientist John D Sterman put it, “there are no side effects – only effects”. As he explained, “‘Side effects’ are not a feature of reality, but a sign that the boundaries of our mental models are too narrow, our time horizons too short.” Complex systems accounts require us to acknowledge that it will often be the case that systemic harms and injustices occur without it needing to be the case that anyone intends to create harm or act unfairly.

The idea that people are set up to fail or are victims of systemic injustice creates a more complex set of questions about whom to hold responsible and how to do so. In my forthcoming book I describe what we need to overcome as the “Neglectful State”. This is a state that fails to attend to systemic risks to health and wellbeing, and as a result allows significant numbers to come to avoidable harm or death. Neglectful states often also attempt to deflect attention from their failings by redescribing systemic harms as failures of personal responsibility.

Moving on from a neglectful state to a nurturing one will not be easy in the current circumstances. The wider the range of effects that governments admit are relevant and that they can be held accountable for, the larger the target they create for opponents. This is one reason why, despite the preponderance of thoughtful voices over decades advocating for complex systems approaches to public policy, take-up of complex systems by governments is often resisted in practice.

Another reason is that complexity frameworks require us to think more creatively about the goals of public policy, what success looks like, and how to measure it. As we have seen, performativity implies that the ends at which policy should aim are not fixed and straightforward, and that we should not expect that the effects of interventions will be predictable. What is the best way to specify the common good in such circumstances? I argue that the idea of public value can help: public value is created, or captured, to the extent that public sector institutions further their democratically established goals. Such a perspective helps to articulate what is at stake in a policy decision such as whether to extend the scale of commercial use of NHS data, but importantly does not prejudge whether doing so will create (or destroy) public value. What matters is the extent to which doing so would enable the NHS better to pursue its goals as set out in the NHS Constitution, including the need to maintain trust in a confidential health system.

In order for governments to genuinely adopt complexity policy frameworks, they must not only have a real commitment to deep change, but also the confidence that there is a common understanding that shifting the dial on systemic problems is hard. Tackling a problem such as structural racism is much less like applying a force to get a cart moving down a well-maintained road, and more like rolling a stone up a steep hill. Even this image somewhat underestimates the difficulty of the task. The slopes and difficult terrain that challenge governmental attempts to dismantle systemic inequalities were not created by slow geological processes that predate human beings; they are created by us, and in certain respects they are us.

James Wilson is a professor of philosophy at UCL. His latest book, Philosophy for Public Health and Public Policy: Beyond the Neglectful State, will be published in September

This article first appeared in the RSA Journal Issue 3 2021