Works In Theory But Not In Practice? The Role Of The Precautionary Principle In Public Health Policy
| DOI | http://doi.org/10.1111/1467-9299.00252 |
| Date | 01 March 2001 |
| Author | Kenneth Calman,Denis Smith |
| Published date | 01 March 2001 |
PUBLIC MANAGEMENT
WORKS IN THEORY BUT NOT IN PRACTICE?
THE ROLE OF THE PRECAUTIONARY
PRINCIPLE IN PUBLIC HEALTH POLICY
KENNETH CALMAN AND DENIS SMITH
INTRODUCTION
What they’re short of is imagination. Officialdom can never cope with
something really catastrophic.
Albert Camus 1948, The Plague, p. 105.
Camus’s novel about a town’s response to plague reminds us, through the
medium of fiction, of the apparent fragility of modern living. This fragility
exists despite our technological and scientific advances. What emerges
though the narrative of The Plague is the organizational and human
response to disease and the limitations of management fully to concep-
tualize the extent of the problems that they face. In more recent years, such
notions of risk and probability have become dominant constructs within
many of our discussions about modern living (Beck 1992; Erikson 1994;
Giddens 1990) and yet they still often prove to be both elusive and emotive
issues for policy makers to deal with (Smith and Toft 1998). Given the sheer
complexity of these hazard issues and the extent of the uncertainty sur-
rounding them, we should not be surprised at the high level of concern
that people seem to have over the range and nature of the hazards that
they face. Risk is not a recent concern, however, and humans have shown
Professor Sir Kenneth Calman is the Vice Chancellor of the University of Durham. Until September
1998 he was Chief Medical Officer for England and Wales. Denis Smith is Professor of Management
and Head of the Centre for Risk and Crisis Management at the University of Sheffield.
Public Administration Vol. 79 No. 1, 2001 (185–204)
Blackwell Publishers Ltd. 2001, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street,
Malden, MA 02148, USA.
186 KENNETH CALMAN AND DENIS SMITH
a remarkable ability to devise defences against many of the problems that
arise out of our technological development. Consequently, subsequent gen-
erations have expressed similar concerns about hazard, albeit in different
contexts and set against different standards of acceptability. For example,
current debates about the risks associated with BSE and genetically modi-
fied foods can be seen to provide an echo of earlier debates on both pestic-
ide use (Carsen 1962) and cancer risks (Steingraber 1998). The literature on
risk provides us with constant warnings of such hazards as: global warm-
ing, toxic waste, nuclear radiation, genetically modified organisms, growth
hormones, treatment resistant viruses and pesticides. What prompts some
dire warnings to go unheeded, when concern is high around other issues,
remains a central component of risk debates (Smith and McCloskey 1998).
The origins of this paradox lie in a number of factors including: the volun-
tary – involuntary nature of the risk, the sense of helplessness felt by poten-
tial victims of the hazards, delayed versus immediate effects of any
exposure and the manner in which the hazard (and the uncertainty sur-
rounding it) is communicated to those affected.
It is clear from the range and ferocity of hazard debates that the various
protagonists will often take fundamentally different stances regarding the
nature of the problems under consideration and the potential solutions that
exist to mitigate the hazard. Indeed, some have argued that it is difficult
to find a mutually accepted solution to a problem when it is clear that the
various actors in the debates define the problem in quite different ways
(Weick 1988, 1993, 1995; Weick and Roberts 1993). What invariably frus-
trates policy makers is the manner in which groups can express concern
over one set of hazards whilst, at the same time, exposing themselves to
potentially greater hazard through other activities. The history of policy
initiatives for risk management is littered with attempts to ‘educate’ the
public (often termed the deficit model) or, more recently, to ‘communicate’
the risks more clearly to them in the hope that they will modify their behav-
iour accordingly. However, this approach might be seen to create a setting
in which the views of experts are given greater weight than those of the
groups who are exposed to the hazard. More recent research sees the deter-
mination of hazard (and, by implication its acceptability) as a negotiated
process between protagonists in the debates, with a recognition that risk is
a social construct (Irwin 1995; Irwin and Wynne 1996; Reddy 1996). This is
particularly the case in those situations for which there is little or no a priori
evidence for both the probability and consequences associated with the haz-
ard (Sheldon and Smith 1992). Inevitably, conditions will arise when it is
not possible to find a compromise position between the protagonists, and
the state (operating within its regulatory function) will need to intervene
in order to prevent a particular activity from taking place. Such an inter-
vention, and the use of a ‘precautionary principle’, raises a number of key
managerial and research issues. For example, to what extent should the
state curtail the use of certain products or prevent certain activities when
Blackwell Publishers Ltd. 2001
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