Why Policies Fail: An approach from social medicine

While the world is becoming increasingly globalized, some countries seem to be continuing to engage in various sorts of pre-modern policies such as:

1. Intuition-based policy: This refers to a type of policy measure that is conceived and implemented off the top of someone's head and cannot be brought to an end. It is not based on any scientific grounds.
2. Experience-based policy: This refers to a type of policy measure pursued simply because it has always been there through the ages. Once implemented, it cannot be brought to an end even after social conditions have changed. It is not based on any scientific grounds.
3. Cowardice-based policy: This refers to a type of policy scheme drawn up by government officials for the purpose of giving the appearance of addressing a matter at issue so as not to be grilled by legislators during a Diet session or on other occasions. As such, it is also known as an "alibi policy." Such schemes are drafted because of the lack of courage on the part of senior bureaucrats to confront politicians and in such a manner that no one would be able to butt in even when it has no substance. It is not based on any scientific grounds.

These three types of policy measures are collectively called "KKD policies" in Japan with KKD representing kan (intuition), keiken (experience), and dokyo (courage)—or dokyo-no-nasa (lack of courage) to be more precise. This certainly should not be expected in Japan, a country priding itself as one of the leading advanced economies in the world.

4. Conducive-to-something policy: This refers to a type of policy measure that is devised under the pretext of contributing to something but is unable to provide an answer to the following question: "Spending that amount of money in that area would certainly improve the situation there, but what impact would it have on all of those problems as a whole, or which of those problems would be solved and to what extent and by when?" Policy measures falling under this type may appear to have scientific grounds but rather are just stopgap measures that provide only ad hoc solutions, failing to capture the entire scope of problems. They are also referred to as a "missing-the-forest-for-the-trees policy."

Reportedly, you can find this type of policy measure in Japan once in a long while.

Most social problems—such as unemployment, crimes, elderly care, and bullying—are a complexity problem or a problem concerning interactions among factors. We often encounter a situation where saving someone's face would disgrace someone else. Everyone has his or her own say. A well-intentioned policy designed to help certain segments of society often turns out to be detrimental elsewhere. Indeed, subsidies and import restrictions, intended to protect domestic agriculture, have demotivated farmers and kept domestic rice prices high, thereby extinguishing the possibility of developing new uses of rice.

It is no easy task to predict and control various phenomena in this world of complexities, such as a market collapse and an outbreak of war. However, it is not totally impossible under the light of science. For instance, the development of modern medicine has made it possible to cure much of the illnesses threatening the human body, an object of immense complexity. Tuberculosis (TB), which used to be considered incurable and had long afflicted humankind, is now curable thanks to the discovery of antibiotics such as streptomycin. In 1980, smallpox, a deadly disease once referred to as the "devil's disease," was declared to have been eradicated by a World Health Organization (WHO) team led by Isao Arita. Curing mental illness has long been considered to be difficult, but various methods—i.e., serotonin medication, cognitive therapy, and the control of external factors such as promoting adequate rest—are beginning to be proven effective.

If the immense complexity of the human body and mind, which has yet to be understood fully, can be controlled at least to an extent, we should be able to control the illnesses affecting society, another object of complexity, by taking the same approach. Of course, this requires highly advanced knowledge and skills just as medical doctors are needed to control the complexity of the human body. Then, specifically, how can we acquire the required knowledge and skills to cure the illnesses affecting society?

Here again, a good reference can be found in a curriculum in medicine, a field of science that is going a step ahead. Medicine is broadly divided into two branches, namely, basic medical science (knowledge) and clinical medicine (applications and practice). The former seeks to understand and identify the structure and physiology of the human body, pathologies, and etiologies, whereas the latter deals with diagnosis, treatment, rehabilitation, and so forth. The fields of medicine also include preventive medicine, health science, medicine as a social science, medical ethics, and medical education.

In order to control the illnesses affecting the human body, it is necessary to understand the structure of the human body (anatomy) and the function of each organ and type of tissue (physiology), and we need to learn what is illness and why we fall ill (pathology), how we can remove the cause of illnesses or etiologies (pharmacology), and so forth. Likewise, in order to control the illnesses affecting society or social problems, we need to learn social medicine, i.e., how to cure the illnesses of society, which include understanding the structure of society (social anatomy) and its function (social physiology), and learning what is social illness (social pathology), what measures are possible and what effects can be expected from each (social pharmacology), and what is the problem-solving capacity of society (social immunology). Law, economics, public administration, sociology, psychology, and social system science are components of social medicine.

In addition to acquiring knowledge, it is also necessary to undergo practical training to learn practical skills to cure actual problems (clinical social medicine). Here, you would learn the basic theory of problem solving, i.e., discovering the problem, defining the problem, taking measures, and evaluating the outcome. At the same time, you would undertake case studies and learn how to solve actual problems, i.e., contacting individuals concerned and providing them with problem-solving capacity or empowering counterparts. Failure to solve social problems is mostly attributable to failure to define the problem properly in the second step of the problem-solving process, that is, taking measures without defining what problem exists and to whom (stakeholders analysis) and what needs to be achieved and by when in order to be considered a successful solution (overall goals). For instance, what constitutes a solution to the problem of bullying? How can we measure the degree of achievement? Is it enough to monitor the progress in solving the problem only at schools? What do we mean by an innovation-oriented country? Does it mean an increase in the number of patents registered, an expansion of Japanese companies' share in the global market in growth industries, or a rise in the business startup rate? A goal cannot be achieved unless it is clearly defined quantitatively. And if the goal is not set right (i.e., unless we use an appropriate measure and set the goal at an appropriate level), the implementation of measures intended to be a solution may cause distortions to society and the markets, generating a new host of problems. The determination of overall goals (what to achieve by when) is crucially important, and once consensus on the overall goals is reached among stakeholders, the remaining task is to define project goals (who should address which aspect of the problem within each project) and tackle them separately, paying careful attention to the interactions of complexity. Here, the project cycle management (PCM) and evaluation methods, which are applied to official development assistance (ODA) projects, would be effective.

Every year, the Japanese government spends an enormous amount of money in its budget for solving social problems. Nevertheless, no systematic curriculum for problem-solving has been put in place. In order to promulgate scientifically robust policies, the establishment of a practical educational curriculum—one that may be dubbed as a "school of social medicine"—is urgently needed.