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Decision-making systems development. Partnerships are urgently needed between government policy bodies and academic/research organizations experienced in this area. Re-defining the starting point It is time perhaps to change the starting point, i.e. public policy-makers must be placed at centre stage and researchers should aim to serve their needs. In addition, citizens and civil society have a vital – and so far neglected – role to play in setting research priorities 14 and having an influence on policy formulation. There is an important role of the citizen or community in evidence-based policy, for example, in the increasing community engagement and citizen participation in health systems and the increasing trend towards including patient and public input into research. Research-funders and policy-makers have to become a lot more skilled at ensuring that researchers spend a lot of their time researching the questions that have the greatest potential to improve society. They should be encouraged to fund synthesis research and impact assessments in support of policy decisions. The trick here is to connect science with policy, and policy with science. It is desirable to have both “evidence-based policy” and “policy-based evidence” 15 . In other words, policies should be based on evidence, and once policies have been formulated, there should be evidence on how to achieve the set goals, and to develop, implement and evaluate needed strategies. There is no better way than to have policy-makers intimately engaged in the science. However, one must be careful to make sure that “evidence-based policy-making” does not become “policy-based evidence-making”, i.e. creating and selecting evidence that suits and justifies certain formulated policies. Sometimes policy-makers want to stretch the interpretation of research findings to reinforce the “validity” of the policies they are already decided upon. There are potential problems when researchers get too close to policy, e.g. concerns about loss of objectivity and freedom to criticize government policy, and how to guard against this. Policy-making is complex It should be acknowledged that it is too simplistic to think that policy-making could ever be based solely on scientific evidence. In addition to scientific evidence, policies are also based on values, emotions, “know-how”, intuition, “gut feeling” and the wishes of interest groups, for example. The reality of how decisions are made dictates that scientific evidence is only one consideration among several. Such evidence can even in its best form be only background. In some cases, it is perfectly possible for wise policy-makers to develop good policies without research. In other cases, policy-makers listen more to the voters than to the researchers. We should perhaps admit this and not set unrealistic expectations for the role of scientific evidence, and acknowledge that, on the other hand, failing to grab accessible evidence may delay intervention opportunities. For example, it took 263 years after the discovery of the preventive value of citrus juice against scurvy before sailors’ shipboard diets were routinely supplemented with it at the end of the 19th century. The link of smoking to lung cancer was found in 1950 but it was not until 1957 that any legislative action was initiated. How long will it take to tackle the current epidemic of obesity if our will to intervene awaits the delivery of perfect evidence that proposed solutions will work? Thus, the balance between action and further research is an interesting and important one. When do we need policy decisions and when do we need more research? ❏ Tikki Pang has been Director of the Department of Research Policy & Cooperation, World Health Organization, Geneva, Switzerland since August 1999. He has previously held positions as Lecturer then Associate Professor at the Department of Medical Microbiology, Faculty of Medicine, and then as Professor of Biomedical Sciences, Institute of Postgraduate Studies & Research, University of Malaya, Kuala Lumpur, Malaysia. Dr Tikki Pang is currently Chairman of the Working Group on Typhoid Fever, International Vaccine Institute, Seoul, Korea; Secretary, WHO Research Ethics Review Committee; Secretary, WHO Advisory Committee on Health Research; member of the editorial board of six international journals. Previously held positions include Clinical Specialist (Medical Microbiology), University Hospital, Kuala Lumpur, Malaysia; Member, National Biotechnology Committee, Ministry of Science, Malaysia (Coordinator for Molecular Biology & Genetic Engineering); Editorin-Chief & Publisher, Asia Pacific Journal of Molecular Biology & Biotechnology. 158 ✜ Global Forum Update on Research for Health Volume 4
Decision-making References 1. Haines, A, Kuruvilla S, Borchert M. Bridging the implementation gap between knowledge and action for health. Bulletin of the World Health Organization, 2004, 82, 724-731. 2. Lavis JN et al. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Quarterly, 2003, 81, 221-248. 3. Bensing JM et al. Doing the right thing and doing it right: toward a framework for assessing the policy relevance of health services research. International Journal of Technology Assessment in Health Care, 2003, 19, 604-612. 4. World Report on Knowledge for Better Health-Strengthening Health Systems, 2004. World Health Organization, Geneva. 5. Choi BCK et al. Can researchers and policy makers work together? Journal of Epidemiology and Community Health, 2005, 59, 632-637. 6. Pang T. Filling the gap between knowing and doing. Nature, 2003, 426: 383. 7. Innvaer S et al. Health policy-makers’ perceptions of their use of evidence: A systematic review. Journal of Health Services Research and Policy, 2002, 7: 239-244. 8. Frenk J. Balancing relevance and excellence: organizational responses to link research with decision making. Social Science & Medicine, 1992, 35, 1397-1404. 9. World Health Organization. Regional Office for Europe. Health Evidence Network (HEN). Available at: http://www.euro.who.int/HEN. Accessed on 15 February 2006. 10. Chubin D, Malenschein J. Staffing science policy-making. Science, 2000, 290, 1501. 11. Gray JAM. Where’s the chief knowledge officer? British Medical Journal, 1998, 317: 832. 12. Pang T, Gray M, Evans T. A 15th grand challenge for global public health. The Lancet, 2006, 367, 284-285. 13. Hamid M et al. EVIPNet: translating the spirit of Mexico. The Lancet, 2005, 366, 1758-1760. 14. Sanders D et al. Making research matter: a civil society perspective on health research. Bulletin of the World Health Organization, 2004, 82, 757-763. 15. Marmot MG. Evidence-based policy or policy based evidence? British Medical Journal, 2004, 328: 906-907. Global Forum Update on Research for Health Volume 4 ✜ 159
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Editorial Advisory Board: Luis Gabr
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Contents 096 Child immunization: ac
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Introduction Research contributions
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Introduction Type I Type II Type II
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Introduction making), takes account
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Access to health Strengthening heal
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Access to health raising public awa
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Access to health Recent trends in r
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Access to health districts with a p
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Access to health Understanding heal
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Access to health This study investi
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Access to health References continu
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Access to health combining particip
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Access to health 2002 2005 Diff. SU
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Access to health References continu
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Access to health Americans think th
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Access to health threatening and se
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Access to health References 1. Worl
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Access to health Open access to res
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Access to health References 1. Rose
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Access to health national and globa
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Access to health Senior Research Fe
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Access to health ✜ Rights alone a
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Access to health meaningful communi
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Access to health Inequality, margin
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Access to health questions, develop
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Access to health reasonable in abou
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Access to health References 1. Kohn
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Access to health The diverse pathwa
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Access to health 2001, WTO ruled th
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Access to health knowledge and educ
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Access to health References 1. Lee
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Innovation 076 Towards the developm
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Innovation ✜ Creating a viable va
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Innovation Natural sciences and env
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Innovation References 1. Morel C et
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Innovation The changes in internati
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Innovation promoting health in deve
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Innovation efficiently converted in
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Innovation future global health fin
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Innovation References 1. See http:/
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Innovation Health system strengthen
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Innovation Being healthy: the role
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Page 131 and 132: Decision-making Delivering evidence
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Page 135 and 136: Decision-making years’ experience
Page 137 and 138: Decision-making Policy-makers Compl
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Page 161 and 162: Decision-making Several strategies
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