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Since 1986 we have witnessed a succession of mass media campaigns that have aimed to provide information about HIV infection and AIDS. From the now notorious Department of Health and Social Security (DHSS) iceberg and tombstone motifs designed to imprint the word ‘AIDS’ on the ‘general public’ consciousness, to the Health Education Authority’s (HEA’s) attempts to address the ‘realities’ of heterosexual sexual behaviour, the campaigns have been widely criticised both for their reliance upon fear tactics and for not meeting their ostensible aims of changing behaviour. In this paper we will propose that not only is this due to inherent contradictions in the use of the advertising media for the purposes of health education, but also that the real impetus of the campaigns has not been educational at all.
Background:
In public health emergencies, evidence, intervention, decisions and translation proceed simultaneously, in greatly compressed timeframes, with knowledge and advice constantly in flux. Idealised approaches to evidence-based policy and practice are ill equipped to deal with the uncertainties arising in evolving situations of need.
Key points for discussion:
There is much to learn from rapid assessment and outbreak science approaches. These emphasise methodological pluralism, adaptive knowledge generation, intervention pragmatism, and an understanding of health and intervention as situated in their practices of implementation. The unprecedented challenges of novel viral outbreaks like COVID-19 do not simply require us to speed up existing evidence-based approaches, but necessitate new ways of thinking about how a more emergent and adaptive evidence-making might be done. The COVID-19 pandemic requires us to appraise critically what constitutes ‘evidence-enough’ for iterative rapid decisions in-the-now. There are important lessons for how evidence and intervention co-emerge in social practices, and for how evidence-making and intervening proceeds through dialogue incorporating multiple forms of evidence and expertise.
Conclusions and implications:
Rather than treating adaptive evidence-making and decision making as a break from the routine, we argue that this should be a defining feature of an ‘evidence-making intervention’ approach to health.
Central government grants finance over sixty per cent of local authority expenditure and one grant in particular, the Rate Support Grant, finances over fifty per cent. Hence the annual distribution of the Rate Support Grant attracts considerable attention on the part of local authorities. However, the trend in shares of grant since local government reorganization, which has increasingly favoured London and the Metropolitan areas at the expense of the shire counties, has provoked considerable controversy. This paper reviews past and present methods used to distribute the Rate Support Grant in the light of this trend and provides, in particular, a critique of the present method with proposals for remedial action. Whilst the statistical aberrations described could be easily remedied, the dispute over the equity of the resulting distribution of the Rate Support Grant will remain unresolved until politicians provide more explicit guidance on the principles upon which the expenditure needs of local authorities are to be assessed.
