Abstract
BackgroundThe notion of ‘fact-free politics’ is debated in Europe and the United States of America and has particular relevance for the use of evidence to underpin health and healthcare policies. To better understand how evidence on health and healthcare is used in the national policy-making process in the Netherlands, we explore how different statistics are used in various policy debates on health and healthcare in the Dutch government and parliament.MethodsWe chose eight ongoing policy debates as case studies representing the subject categories of morbidity, lifestyle, healthcare expenditure and healthcare outcomes, including (1) breast cancer screening rates, prevalence and incidence, (2) dementia prevalence and incidence, (3) prevalence of alcohol use by pregnant women, (4) mobility and school sports participation in children, (5) costs of smoking, (6) Dutch national healthcare expenditure, (7) hospital mortality rates, and (8) bedsore prevalence. Using selected keywords for each policy debate case, we performed a document search to identify documentation of the debates (2014–2016) on the websites of the Dutch government and parliament. We retrieved 163 documents and examined the policy debate cases through a content analyses approach.ResultsSources of the statistics used in policy debates were primarily government funded. We identified two distinct functions, i.e. rhetorical and managerial use of statistics. The function of the debate is rhetorical when the specific statistic is used for agenda-setting or to convince the reader of the importance of a topic. The function of the debate is managerial when statistics determine planning, monitoring or evaluation of policy. When evaluating a specific policy, applied statistics were mostly the result of routine or standardised data collection. When policy-makers use statistics for a managerial function, the policy debate mirrors terms derived from scientific debates.ConclusionWhile statistics used for rhetorical functions do not seem to invite critical reflection, when the function of the debate is managerial, i.e. to plan, monitor or evaluate healthcare, their construction does receive attention. Considering the current role of statistics in rhetorical and managerial debates, there is a need to be cautious of too much leniency towards the technocratic process in exchange for the democratic debate.
Highlights
There is an ongoing debate about the dividing line between facts and opinions, and the role of scientific knowledge in policy-making [1]
Sampling Based on analysis of the literature and our knowledge of ongoing policy debates in health and healthcare in the Netherlands, we focused on four categories of statistics, namely (1) morbidity statistics, (2) lifestyle statistics, (3) healthcare expenditure data, and (4) statistics on healthcare outcomes
Characterisation of analysed debate and sources of statistics Dementia The policy debate on dementia focuses on the recent Deltaplan Dementia
Summary
There is an ongoing debate about the dividing line between facts and opinions, and the role of scientific knowledge in policy-making [1] Terms such as ‘fact-free politics’ [2], ‘science as an opinion’ [3] and, more recently, ‘alternative facts’ [4] reveal a concern for the position and credibility of facts in both politics and policy-making. Policy-making is not a cyclical process fluently flowing from evidence to application and to full implementation It is iterative and context bound, involving the consideration of many values of which evidence is one, along with ideology, practicability, the complexity of the subject, timeliness and the distribution of power in politics [16,17,18]. To better understand how evidence on health and healthcare is used in the national policy-making process in the Netherlands, we explore how different statistics are used in various policy debates on health and healthcare in the Dutch government and parliament
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