Rewriting the Policy Imaginary
In the public service, for the past dozen years or so, it was in vogue to borrow methods from other sectors and disciplines, seeking insights more precise, more actionable, or more defensible, than the anecdata Ministers heard from their constituents, less calcified than the policy research programs we cut in the 2010s. We called it policy innovation*, whether the innovation was a collection or interpretation method, a collaboration tool, a funding mechanism, or a congratulatory back-slap for the output itself. A play on the traditional “policy integration” function, a term indicative of departmental silos needing thread sewn between their layers, an integrated story told from a disparate chorus of data and documentation.
It wasn’t enough to use the flood of administrative or operational data every government program drowns in, the national statistics we so meticulously collect. It had to be Big Data, realer then real, data so complex the human eye, and traditional statistics, could not parse it. It wasn’t enough to gather insights from the public, we needed the semi-structured research methods of anthropology or user experience to bolster or slice a small N.
We thought we needed new terms to advocate for interdisciplinary work in institutions that do not easily allow for cross-functional reporting or collaboration; new names for the everyday practice of idea generation and vetting; new methods of funding to stoke interest in seemingly intractable problems unsolvable in a single political mandate or Budget line item. And because the policy function in the public service still requires demonstrating an economics, social science, or statistics background, it necessitated a shift in hiring and on-the-job training, a slight broadening of who could belong in the bureaucratic community. Calling it “innovation” was a believed to be a shortcut to senior management attention, approval, and funding; an indication that you had done your homework better than a consultant could; a promise of more sellable, sexier outputs, media coverage, and better outcomes.
When I used to lecture on this, in government and to public policy students, I defined the ideal of policy innovation as follows:
Methods that are new to government, newly championed, or newly technocraticized, that help ask and answer policy questions.
An approach and end result that are as innovative as they need to be, to be effective at solving the problems you think you have, and identify those you did not know existed.
It arose in a historic arc best captured by Patrick Dunleavy, Helen Margretts, Simon Bastow, and Jane Tinkler, from the New Public Management of the 80s and 90s, which prized private sector efficiency and performance measurement, disaggregating functions, encouraging competition, and incentivizing outcomes, through to the Digital Era Governance of the early 2000s, itself a response to a more networked and digitized public and bureaucracy, and a return to centralized government services. Policy innovation kept DEG’s focus on digital and centralized functions, but came with renewed interest in performance measurement, an opened government that shared intentions and data as a tactic to invite in external contributions, and a habit of borrowing loan words from other fields, like a summer exchange student showing off.
But the problem, then and now, was almost never a lack of information or insight or skill. The problem was a lack of policy imagination, or an uncreative policy imaginary, a failure to think beyond the bounds of what we, in the public service, were told were the rules, the priority issues, or the possible options.
An imaginary, writes Bob Jessop, is a “semiotic ensemble (without tightly defined boundaries) that frames individual subjects’ lived experience of an inordinately complex world and/or guides collective calculation about that world.” Lucy Mablin describes it as “packages of beliefs, ideas, material circumstances and processes which together form a perspective on a current situation.”
Hannah McGregor and Marcelle Kosman, on the podcast Witch Please, explain Bennedict Anderson’s use of the term “imagined communities” in the context of nation states as follows: “the way we identify the place, the boundaries we attach to it, the significance we attach to it, is not real….the nation is imagined as a community, because regardless of the actual inequality and exploitation that may and indeed does prevail within each, the nation is imagined in terms of fraternity, kinship, horizontal comradeship, very rose-colored glasses.”
The work of bureaucracy lives within this imaginary community of the nation state, in an imaginary community of bureaucrats organized into imaginary departments, functional classifications, and mandates; notoriously poorly equipped to handle problems that are less neatly categorized. As employees of the nation state, we collectively enact it through every bureaucratic act, every word of every briefing note that describes and reshapes the world, and it tells us what the bounds of those actions are. Author Max Gladstone, writes in the voice of a fictional, magical bureaucrat: “The world’s a complicated place and it changes, that’s all. People interpret the universe and their interpretation alters it".
I was once an advisor on an expert committee for a jurisdiction that will remain nameless, focused on clinical pathways for Long COVID. The doctors in the virtual room checked the box of consulting patients: we were present, standing in as end users of the services most of us still hadn’t been able to access, framed in identical zoom squares next to our professional counterparts, our title-less names signing the final report because when you become a patient, all other credentials evaporate. There are policy innovation terms for projects that live in the “consultation” rung of Sherry Arnstein’s Ladder of Participation, perceived as holier than other forms of public input, because we were in the room during development and not polled in absentia, conjured through personas, or represented by experts on our existence. But, in this case, our input was irrelevant because the questions asked were unimaginative.
Rather than identifying the discriminatory blocks in clinical assessment that shunt some patients into psychiatry instead of cardiology, the fields where we should have trained more specialists a decade ago to handle rising patient caseloads, the committee was tasked with the problem of triage and efficiencies. With limited resources, and no new funding, how should a doctor, or a health care system, decide which patients get treatment and which are shuffled onto waitlists for online patient education programs on lifestyle and adapting to illness?
“It can be a similar model to back pain clinics,” said one member, speaking about a complex neuro-immunological illness known to impair nearly every system in the body for an unknown amount of years, to patients too sick to sit upright and turn on their cameras. The preferred answer was a four-tiered taxonomy in which most patients, without even a basic diagnostic work-up, could safely be categorized as high functioning and low needs, whose care could be self or community-managed because the symptoms did not impact productivity.
“I believe they are simplifying something to the point of untruth,” writes Casey Plett in her book On Community, on the use of the term in the media as a politically-acceptable shorthand (e.g., “trans community” or “patient community”). “Among the many problems with abstracting ‘community’ are the vastly divergent material realities across communities! Some communities have fewer resources than others, and saying, ‘We have to take care of ourselves,’ well, that assumes the care in question is a resource available to be given no?....Community is an action; actions have limits.” So too, does the imagination, if the imaginer isn’t given the right tools or invited to use it in ways that break existing frameworks.
Today, the umbrella term of policy innovation has mostly died off, though some of the methods remain, encoded in formal training for public policy students and public servants and written into meta-policy requirements for how bureaucracy, and bureaucrats, should operate. The pandemic shifted what was considered innovative, returning to the private sector expertise and methodologies perceived to be needed to handle emergency supply chains; the more trusted traditional data analysis of epidemiology and public health.
In 2024, basic data collection and public health communication on the pandemic is nearly shuttered, many surveys and long covid clinics have closed, and patients are mostly routed back into a mainstream health system ill-made for what policy innovation would call “complex problems” and medicine would call “chronic multi-system illness”. My own anecdata belies this data gap and lack of curiousity: patient forums as active as ever, a steady stream of friend referrals and strangers asking questions in my DMs, reality TV show contestants who have visible brain fog on camera, singers canceling tours due to a new autoimmune diagnosis. All of whom have stepped into what Meghan O’Rourke calls “Invisible Kingdom” of illness and whose existence is downplayed, because, as Porochista Khakpour says, it “is evidence of death”.
I write openly about Long COVID, here and on social media, in talks and traditional news outlets, in professional bios and at work, in part because neither the policy innovation tools of my early bureaucratic career or the traditional methods of public health, are sufficient to fuel the policy imaginary at this stage of the pandemic. People are dying still, of acute infection and post-COVID complications, and of despair and suicide over lack of care or treatment options, while media and social narratives overplay available interventions (eg: Paxlovid, Metformin, and vaccination) and downplay recovery timelines. We cannot solve a problem we do not have data on, that we cannot describe to the people who are ostensibly experts at solving it, whether because we cannot find the words or they are not asking the right questions.
We, collectively, bureaucratically, simply don’t want to know how bad things are or how badly we are failing to solve them. Our illness itself is so inconceivably complicated and devastating, so injurious to clear thought and speech, so limiting in mobility and possibility, it is often impossible to communicate its boundaries to someone outside the injured body and its intimate sick rooms. The burden on those of us who have recovered enough to do so, feels both imperative and impairing.
I want better care for the people that I love, for everyone who is sick or will be sick. Hannah McGregor, in a recent OCADU talk titled Caring Ferociously said, “We wanted to make an archive, a spell against forgetting”. I know no better way to solve a complex problem than to learn it intimately, and the systems it lives or dies in, inside out, until I could document it on the back of my eyelids, and the undersides of my sick-bed sheets, on the dark walls of the “dark room” Lucia Lorenzi names the isolation and overwhelm of neuro-immunological illness. To use words to make a spell out of the archive of my and others’ memories and experiences. It is a refusal to be simplified to the point of untruth; to set aside my professional skills at the hospital gates; to allow the most innovative part of helping us to be the method of data collection or analysis, or an invitation to sit in rooms of experts who cannot imagine anything but oversimplifying my existence to make me feel easier to solve.
*This essay owes enormously to the thinking and writing and imagining of former colleagues and friends and other people not directly citable here, because our work lives inside the bounds of the imagined community of the public service, governed by the rules and practice for the sharing and containment of information.
The Impairing Curse is a long-form, serialized experiment in personal essay, science journalism, policy analysis, and poetry. To start at the beginning and read it in order, go to the first essay or read about fainting, water therapy, and the aesthetics and labour of illness. To support this project, share it online or subscribe.