PHP326 - How Policy-Makers Should Understand Qualitative Evidence Regarding Public Opinion

Abstract

I investigate the role of qualitative evidence of patient and public opinion in healthcare policy-making. When policy-makers seek input from patient representatives, Citizens Juries etc, on the traditional picture this is a quick or cheap alternative to quant: another way to understand public preferences and thus enhance democratic legitimacy. But this has various problems, eg the sample sizes don't justify any inferences regarding public opinion. A better account is inspired by observations of several real world cases in which qualitative evidence has influenced policy. In such cases, policy-makers end up sharing the opinions expressed by respondents. I argue that where qualitative research respondents find a certain consideration to be important, and policy-makers act on that finding, it's because they've seen the importance of that consideration for themselves; perhaps they see that a certain policy is morally obligatory, or a good idea. There is typically no need to generalise about what the public thinks. Thus I propose that the distinctive value of qualitative evidence is to provide direct insight into the substantive issues, eg to reveal reasons or normative considerations. In contrast, quantitative evidence will generally only reveal a factual claim about public opinion. Decision-makers then have to combine this factual claim with norms justified by other means before they can derive practical conclusions. Although the two kinds of research may address exactly the same policy question, they support completely different types of conclusion regarding that question. The new model explains why qual is useful despite lacking statistical significance; why deliberative forums are useful, despite being unrepresentative; and why even input from individual stakeholder representatives can be useful. I survey various implications for practice. For example, policy-makers using qual should not see themselves as neutral channels of public opinion; they should engage with the issues that respondents addressed.