Money up in smoke

From a godforsaken corner of the BBC website comes an interesting news story. A review for Public Health Wales has concluded that £1.5m of public money was spent in the past year on 10 projects that were unlikely to bring any health benefits at all. 

A smoking helpline, a scheme to raise awareness about skin cancer and a cooking bus to promote healthy eating all bombed.

How can this come about? Very easily. Projects to improve public health are bound to be useless unless they are grounded in an understanding of why people behave the way they do. Most are not. Our understanding of health behaviour is poor, mainly because there’s so little research happening in these areas.

A month ago I interviewed David Cameron – no, not that one: Professor David Cameron, Director of Cancer Services for NHS Lothian and the man in charge of moulding the new national cancer research networks between 2006 and 2010. He’s infuriated at how little hard facts informs what happens in health services.

He told me about the number of political initiatives to try and improve health in the UK where evaluation wasn’t even part of the process. “The attitude is: ‘Come up with a better way of doing things, and we’ll give you the money.’ But if you respond that you need to have the data to show you the best way, the answer is: ‘No, sorry, you have to know the answer or you don’t get the money.’”

The idea for a project all too often comes before the reason for doing it.

Why do particular groupings of men smoke, drink too much, eat unhealthily and indulge in risky behaviours? We have very little evidence. Until we do, and until we know whom to target with what help, many projects urging them to conform are doomed to failure.