HHH column: Why history doesn’t matter for policy making by Robert Vonk
The HHH column is a blog in which History, Health & Healing members share their thoughts: on research, current affairs, and anything to do with medical history. Each author will invite a new author to participate in the conversation. Last time, Trude Dijkstra, visiting postdoctoral fellow at the Warburg Institute in London, passed the pen on to Robert Vonk, senior advisor at the Council for Public Health and Society (Raad voor Volksgezondheid & Samenleving, RVS) and medical historian. An extended special edition of the HHH column on occasion of its first anniversary!
I have a confession to make. As much as I’d like to like the concept of applied history, I just can’t seem to warm to it. At least not to the strand of applied history that has gained traction after the outbreak of the COVID-19 pandemic, which claims that historians – and especially historians of medicine – have knowledge that is essential to ‘tackle’ wicked problems like fighting a pandemic while minimizing the social fall-out of the containment measures. This might be an unfashionable statement, but I don’t see why policy making would be intrinsically better when grounded in that ‘citizens resource’ called history, as the 2020 manifesto Aan de slag! calls it. Why? In my view, it overestimates the value of historical knowledge for policy making, while it grossly underestimates the worth of historical skills.
I realize that this criticism is a bit strange, coming from me. After all, I am both a historian and a policy advisor (the worst possible combination, according to Ido de Haan). In 2013, I defended my PhD thesis on the history of private health insurance in the Netherlands, and over the past eight years, I’ve worked for the National Institute for Public Health and the Environment (RIVM), the Social and Economic Council (SER), the World Health Organization (WHO) and the Council of Health & Society (Raad voor Volksgezondheid & Samenleving), contributing for example to Public Health Foresight Studies, Cost-of-illness-studies, and the impact of COVID-19 on population health in Europe. With the risk of sounding vain, I think I know something about history of medicine and policy advising in public health and health care.
That brings me to my first point: those who promote the value of historical knowledge for policy making, in my view, overestimate the power of that historical knowledge. As a policy advisor, I’ve rarely found direct use for historical knowledge – even when it concerned both my current and historical specialty, health care financing. History, after all, yields little actionable knowledge. If you want to influence policy makers, you must be able to say what they have to do, when, why and how. As historians we tend to gloss over the fact that policy makers are facing real time dilemma’s which need action now, not tomorrow. Decisions have to be made without knowing all the facts and under a great deal of uncertainty and pressure.
This is especially true during a crisis like the current pandemic. It’s a bit gratuitous to scoff, as the manifesto and related papers tend to do, the fact that policy makers rely on mathematical modelling, or on vaccines. But these things simply have more to offer to policy making than historical knowledge. We historians tend to come up with analogies: something has occurred in the past, and the success or failure of policies to deal with it therefore tells us something useful for the present. Drawing lessons from historical analogies, however, is a tricky thing to do. That’s where the authors of the manifesto and I agree. After all, historical analogies are so abundant it’s easy to cherry pick the one you like best, and the choice is usually not based on a scientific method, but on a moral position. We often choose historical analogies and lessons to draw from them because the analogy fits with what we already think should be done, not the other way around.
But even highlighting ‘historical patterns’, as the authors of the manifesto propose, is not always useful – especially when policy makers have to act in the heat of the moment. Historical patterns often boil down to truisms, but those usually don’t offer a concrete way forward. You don’t need history to know that health and disease are unequally distributed among populations, nor that there are social and political determinants and social inequalities that explain these disparities. That is all widely known and studied extensively by economists, sociologists, epidemiologists and others. So highlighting the fall-out of the 19th century cholera or small-pox epidemics is not going to add much to this already vast knowledge base, nor does it really inform what policy makers should do now.
Don’t get me wrong. I do think history is useful for policy makers, just not in the sense that history yields specific answers to acute problems. It provides context and in that way it helps policy makers understand the milieu of policy legacies and policy feedback loops in which they operate. The past shapes and limits what policy makers can or cannot do. For example, knowing something about the historical evolution of how health care is organized in the Netherlands helps you understand and appreciate that the Ministry of Health is anything but in control of the health care sector, as former Secretary-General Erik Gerritsen recently pointed out in De Correspondent. Private entrepreneurship (the non-profit kind) and decentralized organisations of health services have been the bedrock of health care in the Netherlands from the beginning of the 20th century, way before anyone had ever heard of ‘managed competition’. And – as virtually every minister for Health has experienced during the 20th century – it is hard to ‘govern’ a system in which every professional group or health institution has carved out its own relatively autonomous kingdom. The more you try to control, the more resistance you get. This is especially the case during health crises. True, this is not a ‘sexy’ kind of knowledge. Still, it’s especially this kind of ‘institutional memory’ that is rapidly fading in the halls of government as a result of the constant transferring of civil servants from one ministry to the other.
What has puzzled me most, is the emphasis on knowledge instead of skills – and the profound myopia on academic historians. It is, for example, a bit odd to complain about the lack of historians in any of the advisory bodies of government. Whether it is in the Netherlands Scientific Council for Government Policy (WRR), the Netherlands Institute for Social Research (SCP), the Social and Economic Council (SER), or the Council for Public Administration (ROB) – everywhere I meet historians who work as advisors or researchers. Historians are already deeply embedded in the world of policy advising, albeit outside of the limelight: not as council members (whose influence is limited anyway), but as full time advisors to those council members. In addition, many interns in the various layers of government are history students and after graduation many of them – not only the current Prime Minister – end up working for the public cause. Maybe it’s time to acknowledge that the bulk of historians in fact work outside academia?
Presuming that we – the academic historical elite – have sufficiently trained those students, we can safely assume that there is a lot of tacit historical knowledge present in various layers of government. So if you want to influence policy making, maybe you should involve them. They are your natural audience. Use them.
That requires some effort. You have to be both informed and visible. You need to invest in relationships when life is dull. But that’s easier than you think! Read up on current policy issues (all documents are public), consider how your research could inform policy makers, and send an e-mail or make a telephone call. If you keep track of where your (fellow) students end up, it shouldn’t be too difficult to find a willing ear. Speaking from my own experience, however, this rarely happens. Prior to 2020, I only received one such e-mail, resulting in a very informative seminar on local communities, inequalities and health, and on how being part of a tightly knit local community sometimes improves, but sometimes negatively impacts individual health.
It’s not surprising that many historians end up working in an advisory role. In my experience, contrary to what Ido de Haan claims, good historians are outstanding policy advisors, but not because they know history. It’s their training – and I cannot stress this enough – that is their prime asset. Historians are trained to quickly digest an abundance of information, contextualize it and write a coherent narrative based on contextualized information. This is, as I have experienced, an invaluable skill for policy advisors. You don’t have to be an expert on the topic you have to advise on, just as long as you’re able to quickly get a grip on the matter at hand, know how to discern what’s important and what isn’t and how it ties in with other issues in the body politic and society. We, as historians, tend to grossly underestimate that skill-set, and therefore our worth. We should acknowledge and treasure that set of skills, before we dash off to ‘apply’ our historical knowledge.