Berwick writes about health. But of course his ideas are not restricted to health. Era 2 accountability reached far beyond health into all aspects of public policy. Most of us involved in this conversation spend a lot of time reporting to the demands of era 2. It has framed how we think about evidence.
The Irish Minister for Children -who may come and speak to us about her early work to radically reshape the world of women in a Dublin community- was interested to know where public policy may head as the third era gets shaped. The history of the last 50 years of public policy in Ireland gives one answer.
At the core of the story is a classic second era reform process, a $200 million investment from the Atlantic Philanthropies with a focus on place -communities in Dublin and Northern Ireland- a preference for evidence based programmes and randomised controlled trials.
But all of this built on work in the first era, when evidence was scarce. (When my colleague Roy Parker started his research on foster children in the 1950s, he said it was easy to keep abreast of the evidence base since there were only three books to read, one of which he authored). In era 1, the relationship between state and citizen were drawn on the basis of little research. The paper described the emergence of human rights as a force for good, and scandal as a catalyst for change.
Of particular importance in the Irish story is the role of partnerships established to fuel the rapid and extended expansion of the economy, the so-called Irish Tiger. The partnerships connected people who would not ordinarily meet and got them to talk about things they might otherwise have avoided. These partnerships crossed jurisdictions of health, education and the counties. So when the Atlantic funds were ready to flow, there was a culture of and structures for collaboration on which to build.
(In the paper I say a little about what might happen as the third era takes hold in Ireland, particularly democratising knowledge so that it spreads beyond the narrow cognoscenti working in era 2 intermediaries. But this is only scratching the surface).