Bertrand Russell anticipates Social Policy Bonds

Bertrand Russell (1872-1970) wrote: 

There is one peculiarly pernicious application of the doctrine that human nature cannot be changed. This is the dogmatic assertion that there will always be wars, because we are so constituted that we feel a need of them. .... If political organization were such as to make war obviously unprofitable, there is nothing in human nature that would compel its occurrence, or make average people unhappy because of its not occurring. Exactly the same arguments that are now used about the impossibility of preventing war were formerly used in defence of duelling, yet few of us feel thwarted because we are not allowed to fight duels. An outline of intellectual rubbish, first published 1943,from 'The Basic Writings of Bertrand Russell', Routledge Classics 2009

Incentives are important and so too is belief that we can end war. Of course, nobody knows how to end even a single conflict, but much human progress has happened serendipitously, with no overall plan. I think we can do better than that, and issue Conflict Reduction Bonds, for instance, which supply incentives for people to find ways of ending conflict that we cannot know in advance. The causes of war are many, complex and volatile. No organization as currently structured can possibly anticipate and address them. We need new types of organization that have incentives to research, adapt, and address all likely causes of war. War and any form of violent political conflict are too important to be left to government or the generals.

Is global health overmedicalised?

Are we overmedicalising global health? is the title of a recent podcast by Dr Jocalyn Clark, who has also written an article (which I haven't read) on the subject. It's a great question, and one that needs answering. My suspicion is that, as in other policy areas, approaches are too much determined by existing institutions and their outlook and goals. These goals don't always coincide with those of society; sometimes they could even be in conflict with them. In global health, Dr Clark says, there is:

...a medicalisation of these global health problems which occurs when global health issues, which are so strongly linked to poverty and inequity, instead get defined and framed in medical terms and then the solutions developed for them are similarly medicalised.

As society becomes more complex, relationships between cause and effect in physical and mental health, and also in crime, environmental well-being, illiteracy and many other areas, become less easy to identify. But current approaches rely largely on government institutions to make a stab at identifying these relationships and then try to do something to influence them and so improve outcomes. For simple relationships, this can work well and, indeed, government might be the only organization that can deal with certain social and environmental problems. But for complex relationships, especially those that vary markedly over space and time, approaches that rely on government are going to be inefficient at best and in conflict with wider goals at worst. We need, instead, to subordinate institutional structures, outlook and goals to outcomes. And these outcomes must be broad, societal outcomes, rather than those articulated by  existing institutions.

'Health care is but one determinant of health', says Dr Clark, rightly. Targeting broad health outcomes would be a more reliable way of achieving health goals than, as is done now, framing health goals in terms of existing institutions and existing approaches. One solution might be to adopt the Social Policy Bond principle and issue Health Bonds, which would inject market incentives into the achievement of our health goals and reward whoever achieves these goals, whoever they might be, and however they might do so.

When government should step back: higher education

Marina Warner writes:

[T]here is a central contradiction in the [UK] government’s business model for higher education: you can’t inspire the citizenry, open their eyes and ears, achieve international standing, fill the intellectual granary of the country and replenish it, attract students from this country and beyond, keep up the reputation of the universities, expect your educators and scholars to be public citizens and serve on all kinds of bodies, if you pin them down to one-size-fits-all contracts, inflexible timetables, overflowing workloads, overcrowded classes. Diary, Marina Warner, 'London Review of Books' dated 11 September

Quite. There are some easily quantifiable benefits of education, such as universal literacy and numeracy, but not many. Government can and should target such goals and it could also usefully target attendance at approved educational establishments for children up to the age of 16 or 18. But when it comes to higher education, government should perhaps step back; it could still fund institutions if there's a public will for it, but there is a strong case for making its funding conditional only on certain minimum standards, rather try to apply the narrow, accountancy-based, short-term goals that are a feature of the business world. The demand for tertiary education is relatively informed; students relatively mobile. Government in this, and other policy areas, needs to exercise some humility. Diversity of funding sources, as between government and other sources, and within government, would also be helpful. I've done a short piece here on how an outcome-focused Social Policy Bond regime could approach education.

An update: released today (8 September) is a report done by the charity Save the Children, which says, referring to the UK: "The most comprehensive study of pre-school and primary school-aged children in a generation found disadvantaged children are the worst affected, with four in ten not reading well by the age of 11."