Academic journal article International Public Health Journal

Best Practice in Using Evidence for Health Policy: Do We Know What It Is?

Academic journal article International Public Health Journal

Best Practice in Using Evidence for Health Policy: Do We Know What It Is?

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"Evidence-based policy" has become a mantra of the 21st Century. It was considered sufficiently endearing to western publics that it became the promise of both UK and Australian Labor parties before their election, and featured in both Barack Obama's and Hillary Clinton's Whitehouse campaigns. But do we know what -evidence-based policy" is? And is evidence-based policy well-informed policy?

To date, there is little research on the role of evidence in policy-makers' decisions i.e. how, when, and why policy-makers use evidence (or why they do not use it). Beyond the gold standard of classical experimental research paradigms, there is little agreement on exactly what constitutes evidence, perhaps because definitions of scholarly research vary from discipline to discipline. The policy literature suggests that the range of information (not just research evidence), used by policy-makers to make decisions is broad and varies depending on the context and nature of the decisions that have to be made (1-4). For example, scholarly reviews have been found to be more useful to program planning and justification but less important in program evaluation decision-making (5,6). Local-level UK health policymaking agencies have been found to rely on government reports and guidelines rather than published scholarly research (5). In contrast, the World Health Organisation appears to often rely on expert specialist opinion (7).

The literature suggests many direct and indirect uses for research: far from simply offering an empirical base for decision-making, it can help reconceptualise policy challenges and challenge the very basis for understanding the problem, or provide a means for reaching consensus among stakeholders (8). However, leading policy researchers acknowledge that in reality policy-making may be only aware of evidence at best (9). This is supported by a number of studies that suggest that research evidence is often used indirectly by policy-makers (10).

Barriers to the use of research evidence: "Researchers are from Venus and policy-makers are from mars'

The reasons research evidence is often not used by policy-makers are complex. Even ostensibly practical research evidence such as economic evaluations may not be used by health policy-makers for a host of reasons: they range from the perceived irrelevance of the research to budgetary constraints (11). In fact, there is some evidence that even research commissioned by government departments (not just -academic research") is often not used by policymakers (12).

Collectively, the literature on research transfer into policy suggests that there are two kinds of barriers to the take-up or use of research evidence:

1. Barriers that relate to the multi-faceted nature of policy decision-making and the ways in which it requires consideration of strategic, political, economic and other contextual factors outside the ambit of research evidence

2. Barriers that are about the limitations of research evidence itself: its relevance, timeliness, adequacy and so on (13)

Both kinds of barriers reinforce the idea, common in the policy literature that researchers are from Venus and policy-makers are from Mars. One of the key assumptions of the late 20th-early 21st Century -translational science" movement is that it is possible to build bridges between the two worlds (14). Translational science is based on the assumption that overcoming barriers to research transfer is about focusing on better articulation of ideas, knowledge and methods within the sciences, as well as between the sciences and policy-makers and practitioners. It often aims to achieve this through the translation of evidence into practical tools and resources for policymakers and practitioners (15-17). Yet many unacknowledged barriers that relate to what elite research funding agencies value, how modern universities are constituted as 'big businesses', what kinds of academic publications are valued, how academics are rewarded (or not) for engaging with local health professionals and their concerns, remain in universities. …

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