A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

The missing risks of climate change.

The risks of climate change are enormous, threatening the lives and livelihoods of millions to billions of people. The economic consequences of many of the complex risks associated with climate change cannot, however, currently be quantified. Here we argue that these unquantified, poorly understood and often deeply uncertain risks can and should be included in economic evaluations and decision-making processes. We present an overview of these unquantified risks and an ontology of them founded on the reasons behind their lack of robust evaluation. These consist of risks missing owing to delays in sharing knowledge and expertise across disciplines, spatial and temporal variations of climate impacts, feedbacks and interactions between risks, deep uncertainty in our knowledge, and currently unidentified risks. We highlight collaboration needs within and between the natural and social science communities to address these gaps. We also provide an approach for integrating assessments or speculations of these risks in a way that accounts for interdependencies, avoids double counting and makes assumptions clear. Multiple paths exist for engaging with these missing risks, with both model-based quantification and non-model-based qualitative assessments playing crucial roles. A wide range of climate impacts are understudied or challenging to quantify, and are missing from current evaluations of the climate risks to lives and livelihoods. Strong interdisciplinary collaboration and deeper engagement with uncertainty is needed to properly inform policymakers and the public about climate risks.

Comprehensive evidence implies a higher social cost of CO2.

The social cost of carbon dioxide (SC-CO2) measures the monetized value of the damages to society caused by an incremental metric tonne of CO2 emissions and is a key metric informing climate policy. Used by governments and other decision-makers in benefit-cost analysis for over a decade, SC-CO2 estimates draw on climate science, economics, demography and other disciplines. However, a 2017 report by the US National Academies of Sciences, Engineering, and Medicine1 (NASEM) highlighted that current SC-CO2 estimates no longer reflect the latest research. The report provided a series of recommendations for improving the scientific basis, transparency and uncertainty characterization of SC-CO2 estimates. Here we show that improved probabilistic socioeconomic projections, climate models, damage functions, and discounting methods that collectively reflect theoretically consistent valuation of risk, substantially increase estimates of the SC-CO2. Our preferred mean SC-CO2 estimate is $185 per tonne of CO2 ($44-$413 per tCO2: 5%-95% range, 2020 US dollars) at a near-term risk-free discount rate of 2%, a value 3.6 times higher than the US government's current value of $51 per tCO2. Our estimates incorporate updated scientific understanding throughout all components of SC-CO2 estimation in the new open-source Greenhouse Gas Impact Value Estimator (GIVE) model, in a manner fully responsive to the near-term NASEM recommendations. Our higher SC-CO2 values, compared with estimates currently used in policy evaluation, substantially increase the estimated benefits of greenhouse gas mitigation and thereby increase the expected net benefits of more stringent climate policies.

Fair algorithms for selecting citizens' assemblies.

Globally, there has been a recent surge in 'citizens' assemblies'1, which are a form of civic participation in which a panel of randomly selected constituents contributes to questions of policy. The random process for selecting this panel should satisfy two properties. First, it must produce a panel that is representative of the population. Second, in the spirit of democratic equality, individuals would ideally be selected to serve on this panel with equal probability2,3. However, in practice these desiderata are in tension owing to differential participation rates across subpopulations4,5. Here we apply ideas from fair division to develop selection algorithms that satisfy the two desiderata simultaneously to the greatest possible extent: our selection algorithms choose representative panels while selecting individuals with probabilities as close to equal as mathematically possible, for many metrics of 'closeness to equality'. Our implementation of one such algorithm has already been used to select more than 40 citizens' assemblies around the world. As we demonstrate using data from ten citizens' assemblies, adopting our algorithm over a benchmark representing the previous state of the art leads to substantially fairer selection probabilities. By contributing a fairer, more principled and deployable algorithm, our work puts the practice of sortition on firmer foundations. Moreover, our work establishes citizens' assemblies as a domain in which insights from the field of fair division can lead to high-impact applications.

Democratizing social scientists' impact on federal policy: Using the evidence act to help government and ourselves.

It is common for social scientists to discuss the implications of our research for policy. However, what actions can we take to inform policy in more immediate and impactful ways, regardless of our existing institutional affiliations or personal connections? Focusing on federal policy, I suggest that the answer requires understanding a basic coordination problem. On the government side, the Foundations of Evidence-based Policymaking Act (2018) requires that large federal agencies pose, communicate, and answer research questions related to their effects on people and communities. This advancement has opened the black box of federal agency policy priorities, but it has not addressed capacity challenges: These agencies often do not have the financial resources or staff to answer the research questions they pose. On the higher education side, we have more than 150,000 academic social scientists who are knowledge producers and educators by training and vocation. However, especially among those in disciplinary departments, or those without existing institutional or personal connections to federal agencies, we often feel locked out of federal policymaking processes. In this article, I define the coordination problem and offer concrete actions that the academic and federal government communities can take to address it. I also offer leading examples of how academics and universities are making public policy impact possible in multiple governmental spheres. I conclude by arguing that both higher education institutions and all levels of government can do more to help academic social scientists put our knowledge to work in service of the public good.

Social dilemmas among unequals.

Direct reciprocity is a powerful mechanism for the evolution of cooperation on the basis of repeated interactions1-4. It requires that interacting individuals are sufficiently equal, such that everyone faces similar consequences when they cooperate or defect. Yet inequality is ubiquitous among humans5,6 and is generally considered to undermine cooperation and welfare7-10. Most previous models of reciprocity do not include inequality11-15. These models assume that individuals are the same in all relevant aspects. Here we introduce a general framework to study direct reciprocity among unequal individuals. Our model allows for multiple sources of inequality. Subjects can differ in their endowments, their productivities and in how much they benefit from public goods. We find that extreme inequality prevents cooperation. But if subjects differ in productivity, some endowment inequality can be necessary for cooperation to prevail. Our mathematical predictions are supported by a behavioural experiment in which we vary the endowments and productivities of the subjects. We observe that overall welfare is maximized when the two sources of heterogeneity are aligned, such that more productive individuals receive higher endowments. By contrast, when endowments and productivities are misaligned, cooperation quickly breaks down. Our findings have implications for policy-makers concerned with equity, efficiency and the provisioning of public goods.

Modeling the evolution of the US opioid crisis for national policy development.

The opioid crisis is a major public health challenge in the United States, killing about 70,000 people in 2020 alone. Long delays and feedbacks between policy actions and their effects on drug-use behavior create dynamic complexity, complicating policy decision-making. In 2017, the National Academies of Sciences, Engineering, and Medicine called for a quantitative systems model to help understand and address this complexity and guide policy decisions. Here, we present SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), a dynamic simulation model developed in response to that charge. SOURCE tracks the US population aged ≥12 y through the stages of prescription and illicit opioid (e.g., heroin, illicit fentanyl) misuse and use disorder, addiction treatment, remission, and overdose death. Using data spanning from 1999 to 2020, we highlight how risks of drug use initiation and overdose have evolved in response to essential endogenous feedback mechanisms, including: 1) social influence on drug use initiation and escalation among people who use opioids; 2) risk perception and response based on overdose mortality, influencing potential new initiates; and 3) capacity limits on treatment engagement; as well as other drivers, such as 4) supply-side changes in prescription opioid and heroin availability; and 5) the competing influences of illicit fentanyl and overdose death prevention efforts. Our estimates yield a more nuanced understanding of the historical trajectory of the crisis, providing a basis for projecting future scenarios and informing policy planning.

Virology under the Microscope-a Call for Rational Discourse.

Viruses have brought humanity many challenges: respiratory infection, cancer, neurological impairment and immunosuppression to name a few. Virology research over the last 60+ years has responded to reduce this disease burden with vaccines and antivirals. Despite this long history, the COVID-19 pandemic has brought unprecedented attention to the field of virology. Some of this attention is focused on concern about the safe conduct of research with human pathogens. A small but vocal group of individuals has seized upon these concerns - conflating legitimate questions about safely conducting virus-related research with uncertainties over the origins of SARS-CoV-2. The result has fueled public confusion and, in many instances, ill-informed condemnation of virology. With this article, we seek to promote a return to rational discourse. We explain the use of gain-of-function approaches in science, discuss the possible origins of SARS-CoV-2 and outline current regulatory structures that provide oversight for virological research in the United States. By offering our expertise, we - a broad group of working virologists - seek to aid policy makers in navigating these controversial issues. Balanced, evidence-based discourse is essential to addressing public concern while maintaining and expanding much-needed research in virology.

Centering marginalized voices in advocacy for equitable policy change in kidney disease.

PURPOSE OF REVIEW: Inequities in kidney disease are a result of differences in healthcare access and inequitable structural policies that lead to downstream social challenges. An individual with kidney disease sits at the intersection of a variety of governmental and institutional policies that directly affect their access to kidney healthcare and different care delivery models. However, their voice in policy change is often neglected by stakeholders with more structural power. Marginalized individuals with kidney disease are disproportionately affected by kidney disease and inequitable policies can further these health disparities. The review aims to describe how marginalized individuals can be centered in research and lead in advocacy efforts to promote equitable policy change. RECENT FINDINGS: The marginalized patient voice is critical in advocacy to promote equitable policy change. We discuss examples illustrating research and advocacy methods which center and partner with marginalized communities to catalyze effective policy interventions. SUMMARY: Centralizing the patient voice when engaging in advocacy can identify and contextualize the effects of inequitable public policy and improve advocacy efforts.

Implications of the Centers for Medicare and Medicaid Services decision to expand indications for carotid artery stenting.

OBJECTIVE: On October 11, 2023, the Centers for Medicare and Medicaid Services (CMS) expanded the indications for carotid artery stenting (CAS) to include patients with ≥50% symptomatic or ≥70% asymptomatic carotid stenosis. The aim of this article was to investigate the implications of this decision. METHODS: The reasons behind the increased coverage for CAS are analyzed and discussed, as well as the various Societies supporting or opposing the expansion of indications for CAS. RESULTS: The benefits associated with expanding CAS indications include providing an additional therapeutic option to patients and enabling individualization of treatment according to patient-specific characteristics. The drawbacks of expanding CAS indications include a possible bias in decision-making and an increase in inappropriate CAS procedures. CONCLUSIONS: The purpose of the CMS recommendation to expand indications for CAS is to improve the available therapeutic options for patients. Hopefully this decision will not be misinterpreted and will be used to improve patient options and patient outcomes.

Addressing tobacco industry influence in tobacco-growing countries.

Protecting policy-making from tobacco industry influence is central to effective tobacco control governance. The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence. This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance. Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers. Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity. In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobacco-growing countries. In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies. The range of companies that operate in these contexts is particular and so is their engagement within political institutions. For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries. Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts.

Éviter que l'élaboration de politiques soit influencée par l'industrie du tabac est essentiel pour assurer une gestion efficace de la lutte antitabac. L'inclusion d'acteurs de l'industrie comme parties prenantes des processus législatifs demeure l'un des principaux leviers employés par les sociétés. Cette influence est renforcée par l'idée que l'industrie du tabac constitue un partenaire légitime du gouvernement dans le domaine de la gouvernance réglementaire. Pour lutter contre l'ingérence du secteur, il faut se concentrer sur les institutions gouvernementales qui officialisent les relations entre l'industrie et les responsables politiques. L'implication de l'industrie dans les institutions publiques est surtout observée dans les pays producteurs de tabac, où certains niveaux de gouvernement soutiennent activement le tabac en tant que bien économique. Dans le présent document, nous abordons le fait qu'une lutte contre l'influence de l'industrie du tabac requiert une attention particulière dans les pays producteurs, où un large éventail d'entreprises encouragent la production de tabac: approvisionnement en semences, équipements et produits chimiques, mais aussi transport, achat des feuilles, transformation et fabrication. La variété des entreprises œuvrant dans de tels contextes est spécifique, tout comme leur engagement au sein des organes politiques. Pour les gouvernements qui souhaitent privilégier les alternatives à la production de tabac (selon l'article 17 de la Convention-cadre pour la lutte antitabac), nous montrons à quel point l'application de l'article 5.3, qui vise à protéger les politiques de lutte antitabac contre l'ingérence de l'industrie, est fondamentale dans ces pays. Intégrer l'article 5.3 dans l'article 17 permettra (i) de renforcer la cohérence des politiques en vigueur, afin que les politiques relatives à des activités de remplacement ne soient pas contrecarrées par l'industrie du tabac; (ii) de favoriser la collaboration entre les secteurs pour lutter contre l'influence de l'industrie tout en développant des moyens de subsistance; et enfin, (iii) d'accroître la responsabilisation et la transparence dans les efforts menés dans la lutte antitabac.

Proteger la formulación de políticas contra la influencia de la industria tabacalera es fundamental para una gobernanza eficaz del control del tabaco. La inclusión de los actores de la industria como partes interesadas en los procesos políticos sigue siendo una vía crucial para la influencia corporativa. Esta influencia se ve reforzada por la idea de que la industria tabacalera es un asociado legítimo del gobierno en la gobernanza reglamentaria. La lucha contra la influencia de la industria tabacalera exige centrarse en las instituciones gubernamentales que formalizan las relaciones entre la industria y los responsables de formular políticas. La participación de la industria en las instituciones gubernamentales es especialmente relevante en los países productores de tabaco, donde algunos sectores del gobierno apoyan activamente el tabaco como un bien económico. En este documento, se analiza cómo el control de la influencia de la industria tabacalera requiere una consideración especial en los países productores de tabaco. En estos países, existe una gran variedad de empresas que apoyan la producción de tabaco, incluidos los proveedores de semillas, equipos y productos químicos, así como las empresas de transporte, de compra de hojas y de procesamiento y fabricación. La variedad de empresas que operan en estos contextos es particular y también lo es su compromiso dentro de las instituciones políticas. Para los gobiernos que desean apoyar alternativas al cultivo de tabaco (es decir, el artículo 17 del Convenio Marco para el Control del Tabaco), se ilustra cómo la aplicación del artículo 5.3, destinado a proteger las políticas de control del tabaco de la interferencia del tabaco, es fundamental en estos países. La integración del artículo 5.3 con el artículo 17 (i) reforzará la coherencia política, asegurando que las políticas de medios de vida alternativos no se vean perjudicadas por la interferencia de la industria tabacalera; (ii) fomentará la colaboración intersectorial al abordar tanto la interferencia de la industria tabacalera como el desarrollo de los medios de vida; y (iii) mejorará la rendición de cuentas y la transparencia en los esfuerzos de control del tabaco.

Perspectives of California Legislators on Institutional Barriers and Facilitators to Non-Partisan Research Evidence Use in State Health Policymaking.

BACKGROUND: Bridging the translational gap between research evidence and health policy in state legislatures requires understanding the institutional barriers and facilitators to non-partisan research evidence use. Previous studies have identified individual-level barriers and facilitators to research evidence use, but limited perspectives exist on institutional factors within legislatures that influence non-partisan research evidence use in health policymaking. OBJECTIVE: We describe the perspectives of California state legislators and legislative staff on institutional barriers and facilitators of non-partisan research evidence use in health policymaking and explore potential solutions for enhancing use. DESIGN: Case study design involving qualitative interviews. PARTICIPANTS: We interviewed 24 California state legislators, legislative office staff, and legislative research staff. APPROACH: Semi-structured recorded interviews were conducted in person or by phone to identify opportunities for enhancing non-partisan research evidence use within state legislatures. We conducted thematic analyses of interview transcripts to identify (1) when research evidence is used during the policymaking process, (2) barriers and facilitators operating at the institutional level, and (3) potential solutions for enhancing evidence use. RESULTS: Institutional barriers to non-partisan research evidence use in health policymaking were grouped into three themes: institutional policies, practices, and priorities. Interviews also revealed institutional-level facilitators of research evidence use, including (1) access and capacity to engage with research evidence, and (2) perceived credibility of research evidence. The most widely supported institutional-level solution for enhancing evidence-based health policymaking in state legislatures involved establishing independent, impartial research entities to provide legislators with trusted evidence to inform decision-making. CONCLUSIONS: Potential institutional-level changes within state legislatures may enhance evidence use in health policymaking, leading to improved health outcomes and lower healthcare costs for states.

The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health.

Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.

Overcoming Common Anxieties in Knowledge Translation: Advice for Scholarly Issue Advocates.

Policy Points Faced with urgent threats to human health and well-being such as climate change, calls among the academic community are getting louder to contribute more effectively to the implementation of the evidence generated by our research into public policy. As interest in knowledge translation (KT) surges, so have a number of anxieties about the field's shortcomings. Our paper is motivated by a call in the literature to render useful advice for those beginning in KT on how to advance impact at a policy level. By integrating knowledge from fields such as political science, moral psychology, and marketing, we suggest that thinking and acting like marketers, lobbyists, movements, and political scientists would help us advance on the quest to bridge the chasm between evidence and policy.

Unveiling viewpoints on national food environment policies in the Dutch newspaper discourse: an interpretative media content analysis.

BACKGROUND: National food environment policies can contribute to the reduction of diet-related non-communicable diseases. Yet, their implementation in the Netherlands remains low. It has been hypothesized that the media can play a pivotal role in inducing spikes in policy attention, thereby shaping political action. The aim of this study was to examine the discourse on food policies in Dutch newspaper articles between 2000-2022, by analyzing arguments used by various actors. METHODS: A systematic search in Nexis Uni was used to identify newspaper articles that covered national-level Dutch food environment policies published in seven Dutch national newspapers between 2000-2022. Covered policies were classified into six domains including food composition, labeling, promotion, prices, provision and retail and into the four stages of the policy cycle; policy formulation, decision-making, implementation, and evaluation. A grey literature search was used to identify food policies implemented during 2000-2022. Descriptive statistics were used to summarize coverage of policies over time, policy type and policy stage. An interpretive content analysis was performed on a random subsample of the newspaper articles to determine the actors, viewpoints and arguments of the food policies. RESULTS: We identified 896 relevant newspaper articles. The coverage of food policies in newspapers was initially low but peaked in 2018/2021/2022. Through grey literature search we identified 6 food policies which were implemented or adjusted between 2000-2022. The majority of the newspaper articles reported on food pricing policies and were discussed in the policy formulation stage. Academics (mainly supportive) were the most and food industry (mostly opposing) the least cited actors. Supportive arguments highlighted health consequences, health inequalities and collective responsibility, whereas opposing arguments focused on unwanted governmental interference and ineffectiveness of policies. CONCLUSIONS: Dutch newspaper articles covering food policies represented a variety of actors and arguments, with individual versus collective responsibility for food choices playing a central role in the arguments. These insights may serve as a basis for further research into why certain arguments are used and their effect on policy attention and implementation.

A realist impact evaluation of a tool to strengthen equity in local government policy-making.

BACKGROUND: Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. METHODS: We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. RESULTS: Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. CONCLUSION: Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.