Combining health and social protection measures to reach the ultra ...

Innovation
The role of Knowledge
Translation in bridging
the “know-do gap”
Article by Ariel Pablos-Méndez (pictured) and Ramesh Shademani
During the 20th century, knowledge in all its forms
contributed to unprecedented global health gains 2 . Yet
ill-health and premature deaths from preventable
causes persist, especially among poor children and women,
in spite of available cost-effective interventions 2,3 . Studies
show that more than half of the deaths to children under five
years old can be prevented by the use of available
interventions 2,3,4 . Such studies indicate that most of the
burden of premature death and illness among the poor is due
to problems for which solutions are known and prevention is
possible. Even in war-ravaged countries, most deaths are
from easily preventable and treatable illness rather than
violence 5 . The achievement of the health Millennium
Development Goals (MDGs) in many developing countries is
questionable. The obvious “know-do gap” was recognized by
the Mexico Ministerial Summit on Health Research in
November 2004 6 and by the 58th World Health Assembly in
May 2005 as a major obstacle to the attainment of the
Millennium Development Goals.
Bridging the know-do gap is the foremost challenge and
opportunity for public health in the 21st century. New
initiatives and platforms to strengthen specific aspects of the
health systems such as health information systems, human
resources, and equitable access and coverage have emerged.
Knowledge and its links to action is another platform for
health system strengthening.
Evidence and knowledge for problemsolving
There is widespread agreement that policy and practice
should be informed by the best available evidence that is
applicable in a given setting. However, there is debate on
what constitutes evidence and how to harness it in practice,
and whether it is sufficient to bring about sustainable change
in complex social settings. The goal of traditional researchers,
conditioned by funding and tenure systems, is often to get
published in a respected medical journal – assuming their
findings will be translated into practice by somebody else at
some point. In addition, learning about effective development
projects taking place in poor countries is sometimes hindered
by the lack of general knowledge of what works and how 8 . A
shift from “moving” evidence to solving problems is overdue.
The contribution of knowledge to health gains has been
dominated by consideration of benefits of science and
technology, neglecting to exploit and use other valid sources
of knowledge: knowledge from practice and the sharing and
replication of people’s experience. The tacit dimension of
knowledge, the social context of knowledge, and the various
knowledge-creating mechanisms in practice are gaining
importance, paradoxically, following the ICT revolution which
mainly handles increasing volumes of disembodied explicit
(i.e. codified) information 9 . A strategic approach to creating
and promoting evidence from practice in priority areas should
contribute to bridging the know-do gap.
Knowledge has been recognized by economists as the most
important factor of production in the new economy. A
knowledge economy (including health sector) is “one in
which the generation and exploitation of knowledge has come
to play a predominant part in the creation of wealth. It is not
simply about pushing back the frontiers of knowledge; it is
also about the more effective use and exploitation of all types
of knowledge” 10 .
The golden era of modern research, which started after the
Second World War, was a period in which research findings
outside strategic government projects were published 11 and
passive diffusion followed. The 1970s saw the birth of
evidence-based medicine which took a push strategy with
both active dissemination of practice guidelines and
education for their local interpretation and adaptation;
technology assessment also emerged at a time when private
industry took over most product R&D. Conceptual
frameworks derived from the social theory of diffusion of
innovation at the time included Research Transfer and
Research Utilization; the private sector developed value chain
models, and marketing strategies. The success of evidencebased
medicine, however, plateaued in the 1990s and the
new millennium dawned with fresh thinking on this old
frontier. In Canada, for example, institutions were reorganized
or created, crafting the term Knowledge Translation and
emphasizing linkage and exchange models 12 .
104 ✜ Global Forum Update on Research for Health Volume 4