I just read in the NY Times that a bill is creeping its way through Congress that would prohibit needle exchanges from being within 1,000 feet of anywhere that children might gather. Of course, if it passes it will means that the only place where an American needle exchange program will be allowed is in Canada. Such policies are, for lack of a better word, silly. If needles aren’t exchanged, they end up on the street, in the parks, and in many other places where children might gather. Safe needle injection sites make sure that injection drug users don’t acquire HIV, Hepatitis or other blood-borne diseases. They also provide counselling and the support and resources needed for those who wish to quit. And this is I expect the response that will be heard throughout the media.
But of course, politics is never about good policy, which is what makes political theory so interesting to me. At issue here is rather the question of tacit support for what is to some a morally questionable activity. How can someone be morally consistent if they fund safe injection sites while holding the belief that drugs are evil? Or buy condoms for teenagers while believing that sex before marriage is wrong?
I think there are at least two important things going on. The first is the assumption that ought actually is. If x is bad, and person y does x, then clearly y is a bad person. This is, of course, patently false, but that doesn’t prevent it from being relevant.
The second is that there is an assumption that the desired objective of public policy is universal. Policy wonks, parents and politicians all want the piece of policy to do different things – and they’re not always compatible. A politician will never support a piece of ineffective legislation, but we’re naive if we believe that ‘effective’ means ‘does what it is meant to.’
The first assumption makes problems easy to ignore. The second makes them difficult to address effectively if they do get the right amount of attention. The point of politics is to figure out how to overcome these hurdles.
So yes, my two cents for what it’s worth. Whenever issues like this hit the news, the response is overwhelmingly to cry foul over the fact that lawmakers are stifling good policies that work. Yes. Knowing what to do and how to do it is almost never the problem. Knowing how to motivate and frame and get around the intrinsic barriers, that’s the interesting and complicated part.
As way of example, take a look at PEPFAR. The United States government could have cared less about the Global AIDS epidemic until George W. Bush heard a piece of information that changed everything: it wasn’t just homosexuals and drug addicts getting infected in Africa, in fact most of the people were innocent wives and children. I stress ‘the innocent’ for my own amusement, as if it makes any sense to accuse men who have sex with men or injection drug users as ‘guilty’. But it worked. Negligence of the ‘bad people’ turned swiftly into compassion for the ‘innocent.’ It’s just a question of framing.
In the case of PEPFAR, Bush was in a unique position to turn his compassion into action. Of course, the tenets of PEPFAR (i.e. that 30% of the money must be spent on abstinence only programming, and that programs could not approve of prostitution) were laden with restrictions that made the policies ‘ineffective’ by the standards of most AIDS activists. The truth is though, that Bush’s objective was to protect who he deemed the innocent and PEPFAR does that quite well. It helps most those who are not engaged in what Bush finds morally reprehensible. Very effective, just not necessarily at the population level.
Getting policy to work is a creative process, it’s less about what works, and more about understanding structure, influence, personal desires and the prejudices of the populace. It’s about framing the issue in such a way that your objective meshes with everyone else’s. It’s a process of building what Rawls would call an overlapping consensus, an agreement about the objective without necessarily an agreement for reasons for wanting it.
I think that’s neat. And it explains why responding to “bad policy decisions” with facts and statistics is often ineffective. Better would be to stress the fact that some injection drug users want to quit, but don’t have the support. That not all injection drug users become ‘junkies,’ some experiment a few times and go back to a normal life. And of course, that each person who uses these clinics, and each person who doesn’t, is somebody’s child.
It’s always easier to rally to support the innocent, and it’s definitely more politically difficult to object to.
