Public health program evaluation: we found X, so should do more of what we are doing

by Carl V Phillips

Some amusement making the rounds in UK social media is this report by the leading anti-tobacco QUANGO/sock puppet, ASH. It can be easily summarized with: “declines in smoking have stalled, therefore we need more money to do more.” Few observers have failed to notice that ASH is basically admitting that what they have been doing does not seem to be having much effect, and offering that as the reason they should be empowered to keep doing more of the same. Also notable is that they are blatantly using their resources (government money) to lobby for more resources (government money) — which is soon to be illegal but probably largely unenforceable.

What many observers may not realize is that this is SOP within “public health”, even when the authors are not blatantly asking to line their own pockets. Think about it: When was the last time you saw any program evaluation (analysis of the effectiveness of an intervention) in public health that reached the conclusion, “this is not working (or we predict it will not work), so it is time to give up on it”?

During my postdoc I attended an American Public Health Association (APHA) annual meeting (I hope the only time I will ever do so). It was quite the education to observe numerous (well over 100) talks and posters that were evaluating interventions. About half of them reported success, by whatever narrow measure they considered, and recommended doing more of the intervention. (It later became clear to me that many of these probably cooked the numbers in various ways to get those results, but I was not digging that deep at the time.) About half of them reported no apparent success from the intervention, and recommended doing the same intervention more intensively so that there would be success. There was exactly one presentation that I saw, which reported that the potential impact of public health intervention to prevent equestrian accidents was trivial, that recommended abandoning the effort. I assume that the author of that has had a far more productive career as a result of that research, having been kicked out of public health for offering that conclusion.

It makes no difference at all what fills in the X from the title of this post. No matter what the results — stunning success, absolute waste of money, or the creation of misery and harm — public health people will always conclude we should be doing more of whatever it is they are doing. And a bunch of other stuff that has never been evaluated also.

It is not about science. It is not really even about goals. It is about performing the tasks. Saying that they just want more money for themselves is the most charitable explanation for their behavior. At least that is rational selfish rent-seeking. Often the explanation seems to be rather more embarrassing (genuine cluelessness that not everything works; virtue signaling) or considerably more nefarious (wanting to impose what is functionally religious ritual, for its own sake).


5 responses to “Public health program evaluation: we found X, so should do more of what we are doing

  1. BTW, why aren’t there more lawsuits about using CDC money to buy laws from cities?

  2. Your opening observation is point on good sir. Basically the Antis have mastered taking ANY statistic about smoking increasing/decreasing/remaining-the-same and have prepared arguments as to why that particular condition PROVES that they should get more money. It’s really comical, and I’m amazed that they don’t simply get booted out of the legislative chambers with the door slammed on their backsides when then use these things.

    Your ending paragraph sums it up perfectly!


  3. It’s not totally obvious that smoking rates have stalled – at least since the rise of vaping – I’ve plotted the smoking prevalence data:

    • Carl V Phillips

      Yeah, but that doesn’t really matter, does it? The conclusion would be the same no matter the observation.

      In any case, that was what they (not I) claimed.

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