Obesity is one of the most significant new challenges to have emerged for policymakers in the twenty-first century. Long considered a private matter, in recent times obesity has become associated with mounting concerns about costs to the health service and the wider economy. There is also a growing perception that societal factors, and not just individual failings, are responsible for this trend. And as a result obesity rose rapidly up the public agenda in the first decade of the century. What began as agitation within the health community (see WHO 2000) quickly spread to the political realm. By the mid- to late-2000s, it was an issue the authorities could not afford to ignore. In 2007, the much-hyped Foresight report highlighted the scale of the challenge facing the British government, and in particular sounded a dire warning about the consequences of inadequate action to address the obesity trend. A year later in Australia, the Preventative Health Task Force, similarly anticipated in public health circles, issued an equally stark assessment to the Commonwealth government. Obesity was, according to these experts and the political figures they mobilised, an ‘epidemic’, a ‘tsunami’, a ‘time bomb’. And in response to this looming threat, the ‘war on obesity’ was born.
Though obesity remains an issue of fitful attention for high politics, over half a decade later, it has, unmistakably, slipped down the public agenda. It no longer commands the same attention of Prime Ministers, health czars, celebrities, or editorial writers. Obesity is, in the choice words of one journalist interviewed for the project, ‘just not sexy anymore’. Yet the ‘war on obesity’ has hardly been won. Rates of obesity remain just as high as they were in 2007. The estimated public costs of obesity—direct to the health service and via the downstream economic effects—continue to climb, too. So how can we explain the apparent petering out of interest and attention?
In this book, I suggest that in order to understand this development, so pronounced in the case of obesity but familiar to scholars of policy more broadly, we need to take a closer look at the real ‘war on obesity’—the political battle to define obesity as a public problem in need of attention across sites of democratic debate and policymaking. The key weapon in this war is knowledge, in the form first and foremost of scientific evidence. Virtually everyone engaged in the debates across Australia and Britain couches their claims in terms of ‘the evidence’. From those who promote radical regulatory reform to those who deny the existence of any problem altogether, from scientific advisors to opinion columnists and patient group advocates, all actors claim to advocate for ‘evidence-based’ policy on obesity. There is, of course, a temptation to be cynical about this state of affairs: they would say that, wouldn’t they? But what I want to argue here is that this universal refrain to evidence has complex, ambivalent implications, certainly more so than instinctive scepticism in policy studies and dominant accounts in (critical) public health would suggest. In important respects, the shared commitment to evidence-based policymaking (EBPM) enables democratic contestation and promotes expert and stakeholder buy-in. But I also show how the emphasis on evidence contributes to the marginalisation of obese voices, and the omission or elision of the emotive edge to this issue. And I go on to argue that this blunting of emotion should be seen in the light of the way actors also moderate and mollify their claims as they move across venues of elite and expert discussion. The result, I conclude, is a fractured, confused stalemate that risks serving the interests of the most powerful actors involved. Though these are common trends across both countries, I suggest that it is the Australian case that exhibits these pathologies more acutely and problematically—Australia’s obesity debate is one that more severely excludes critical voices and that conditions actors to couch their claims in more narrowly feasible terms. This discrepancy between the cases in degree, in turn, can help to explain the factors underpinning the petering out of the ‘war on obesity’, and ultimately inform efforts to reignite political debate on this issue. What results is an account of obesity politics that has affinities with, and seeks to extend, some of the most exciting work on the knowledge politics of complex and contested policy issues.
To provide this more sensitive and resonant account, this book centres around two key questions: first, how do actors engaged in policy debate make sense of obesity as a problem?, and second, how and to what effect do they draw on and present these divergent interpretations across different venues of discussion? Drawing on a rich analysis of qualitative data, I identify the key narratives that actors adhere to and promote in order to make sense of this issue and underpin claims for solutions. I show how adherents to these different accounts draw on knowledge claims about the issue, revealing unique insights into how such claims conflict, cloud, and coalesce as they shift across sites of debate and over time.
I use this introductory chapter to set the scene for this analysis. I start by situating the project in the context of recent debates in policy studies about the role of expert knowledge in democratic policymaking, as well as in the context of the widening schism between mainstream and critical public health accounts of obesity politics. I do so with a view to foreshadowing the novelty of my claims, and their capacity to speak to (and challenge) these different perspectives in equal measure. I then devote a good deal of attention to outlining my approach, both because of its potential to contribute to narrative scholarship in policy studies more broadly and because of its importance in grounding the rich analysis that follows. I move on to spell out my core argument in brief, before running through the outlines of the chapters through which this argument develops. I conclude with a brief statement about what I hope and expect to achieve in making these claims.
The Politics of Policy Knowledge: From Positions to Practices
Understanding the knowledge on which political decisions are taken has long been perhaps the chief interest in policy scholarship (for the most classic statements, see Lasswell 1951; Weiss 1977; Schon 1983; Majone 1989). Discussion in the last decade or so has centred around the notion of ‘EBPM’, a legacy of the New Labour government’s much-publicised commitment to implementing ‘what works’. This was a commitment that met with sympathy and enthusiasm from some quarters in the policy studies community (see Davies et al. 2000). But it has equally encountered fierce criticism. Some prominent scholars have lauded the prospect of EBPM in an ideal world but remain cynical that it can amount to anything more than a fig leaf for preconceived policy in reality (see Pawson 2006). This reality, for them, is less EBPM and more ‘policy-based evidence-making’ (Marmot 2004). More vocal opposition still has come from policy scholars of a more critical orientation, for whom the call for EBPM represents a rallying cry for technocracy. Since evidence cannot be divorced from values, they say, the effort to reduce democratic decision-making to a dry, rational consideration of evidence must by its nature insidiously privilege the commitments and biases of the technocratic elite (Parsons 2002; Colebatch 2009). The controversy is largely simmering now, having erupted in response to ‘What works?’, with EBPM mollified to a much softer form of ‘evidence-informed’ policymaking for even its keenest proponents (e.g. Head 2010). But the debate should not be understood as settled. In fact, it represents a continuation of a long-standing dispute about the right place of expert knowledge in the policy process. This debate over whose knowledge ought to count, and over how and where such knowledge ought to be represented, is one with positions long staked out.
Yet in more recent years dedicated work on the politics of policy knowledge has, if not breached this impasse, skirted around it. This is work that is less concerned with ideological statements about the role of evidence in policymaking, and more grounded in rich and detailed study of policy practices and the manner in which they incorporate relevant forms of knowledge. This is not to say it is objective or value free—indeed, such work is for the most part interpretive or critical in nature, and thereby rejects or repudiates the very notion of objectivity (for this tradition, see especially Fischer and Forester 1993; Fischer 2000, 2003, 2009; Fischer and Gottweis 2012). But in its focus on practices, rather than polemicising, it opens up greater space for mutual engagement and interpretation about the politics of policy knowledge. This work often engages in the concepts and tools of science and technology studies (see Hoppe 1999, 2010), and its scholars therefore appreciate the nuanced, variegated relationship between the scientific and other sources and forms of knowledge and power in political affairs (e.g. Lahsen 2008; Dunlop 2014; Wesselink and Hoppe 2011). It moves past the reductive dichotomy between democracy and technocracy to examine the interaction between different sorts of experts and elites and the complex configurations of power through which technical expertise manifests, conflicts, and coalesces (e.g. Freeman and Sturdy 2014; Strassheim and Kettunen 2014). It goes ‘beyond EBPM’ to reveal the complex ways in which expert knowledge interacts with, and becomes mediated by, other claims to legitimate influence in policy work (e.g. Fischer 1995; Smith 2013). It is this exciting and growing branch of scholarship that I seek to build on in this book.
The politics of obesity represents an excellent case through which to make such a contribution, especially in relation to the two countries in my analysis. It is the rapid rise (and relative plateau or fall) of obesity on the agenda in Australia and the UK, and the hotly contested knowledge politics surrounding the issue in both countries underpinning these dynamics, that makes these contexts so interesting. Defined officially as a body mass index (BMI) of 30 or higher,1 obesity has emerged as an important issue in public health policymaking in these countries as elsewhere over the last three decades (see Wang et al. 2011; WHO 2000). But with this rise, there has been little prospect of consensus among experts, politicians, lobbyists, and non-governmental organisations (NGOs), among others, about its nature, its causes, and the appropriate public policy response. Obesity is, firstly, an issue of considerable contestation, on both ideological and material grounds (Dixon and Broom 2007). There are clashing philosophies about the role of the state; there are also a multitude of interests involved, including the powerful food and pharmaceutical industries, competing expert and professional groups, patient activists, and so on. Obesity is, secondly, an issue of great scientific uncertainty. Little is known about the relationship of obesity to health outcomes and even less known about the capacity of government to intervene (Botterill and Hindmoor 2012). And, finally, obesity is an issue of immense complexity (Foresight 2007). I...