Why INSITE is a not a good case study of evidence-based decision making.

Calls for evidence-based policy are routine.  And in Canada, the saga of the Vancouver safe injection facility INSITE is cited as an example of where politicians tried to ignore the evidence.  Consider two recent examples.

Source: iPolitics

Source: iPolitics

On Tuesday my university hosted a panel discussion by leading politicians in federal politics with an overriding theme of why young people should engage in the electoral process and, if nothing else, vote.  A laudable effort to be sure.  As is common with this type of event there were the usual questions of the audience.  Interestingly enough, the first such question asked the assembled leaders to comment on the place of evidence-based policy making.  Needless to say, all were quick to endorse the idea, some with more nuance than others.  Of particular interest were the comments of the New Democratic Party leader Thomas Mulcair who went out of his way to point to the efforts by the current Conservative government to shut down INSITE as an example of ignoring evidence in policy making.

Consider as well a recent blog post by my University of Ottawa colleague Scott Findlay where he argues that the Supreme Court of Canada’s decision to overrule the Government and insist that INSITE must remain open was about the proper use of evidence.  In his words, “evidence was critical to the Court’s decision”.  (Note that Findlay’s larger argument is not so much for evidence-based policy making as it is for transparency and openness).

Does this mean that the story of INSITE is the story of how evidence can and should influence public policy?  I think not.

As I argued in a paper in the Journal of Urban Health a few years ago, that INSITE continues to operate is not the result of a straightforward application of evidence to a public health intervention. In that article I argued that, on the contrary, “INSITE is the result of coalition building, the mobilization of public opinion, lobbying, and political and ideational struggle.” Without a doubt the use of evidence by the Supreme Court of Canada was a critical part of the story.  But to focus on that is to miss the fact that INSITE exists as a result of a complex combination of factors of which scientific evidence is but one.

hb_coverWhat is more, for many policy problems, this is the predominant pattern.  Evidence does play a role in policy making but it is most influential, as Roger Pielke puts it in his book The Honest Broker: Making Sense of Science in Policy and Politics, “in circumstances where the scope of choice is fixed and the decision-maker has a clearly defined technical question”. So, it is not that scientific evidence is not important, it is that its role is variable.  In other words, while we may want evidence-based decision making, only some decisions can be, or for that matter should be based on evidence.



3 thoughts on “Why INSITE is a not a good case study of evidence-based decision making.

  1. Craig Jones, PhD

    Patrick wrote, “INSITE exists as a result of a complex combination of factors of which scientific evidence is but one.” Can you supply an example of where this is NOT true?

    I think the point of the INSITE experience is that no amount of evidence can satisfy its critics because — as Colin Maugham explained — INSITE is about an ideology that the Harper Conservatives oppose; harm reduction for injection drug users. Recently the government of Canada aligned with Iran, China and Russia in opposing harm reduction measures at the UN Commission on Narcotic Drugs in Vienna. Evidence is not on the table, as far as this government is concerned. Evidence is no part of their calculation.

    What I’m more interested in, Patrick, is examples of where evidence SHOULD not be part of the consideration. Can you supply a couple of examples of this?

    Craig Jones

    1. pfafard Post author

      Three quick points. First, in general scientific evidence is arguably an ingredient to all policy decisions, assuming it is available. But that is not always the case. Governments, in times of crisis for example, often are forced to make decisions on the basis of incomplete information. Second, a number of important policy decisions turn on questions of values and value conflicts rather than evidence. So, for example, whether we should legalize physician assisted suicide (a live issue in both Ottawa and Quebec City) can be informed by evidence but the final decision is likely to be more a matter of a normative set of arguments. Finally, the opposite of evidence-based policy is not simply chaos or ideology.

      Patrick Fafard

      1. Craig Jones, PhD

        Patrick says, “a number of important policy decisions turn on questions of values and value conflicts rather than evidence.” Well this is stating the obvious. Evidence is no part of the INSITE question where THIS government is concerned.

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