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

Decision-makingdesire to publish. The core of the issue in using evidencedifferently lies in the differences in decision-makingimperatives. Not only might scientific evidence conflict withvalues and beliefs of policy-makers, but the policy-makeruses evidence in the battle to control problem definition andpolicy solutions. Policy-makers thus look for evidenceto support their claims, and thus systematic bias occurs inthe way that policy-makers look for and use data. Anotherfacet of this issue is that policy-makers are often concernedthat highlighting knowledge gaps will reduce supportfor their programmes. They thus end up making uninformeddecisions.Further complicating the issues are the weaknesses in logicin both scientific and policy-making approaches to settingpriorities and achieving outcomes. Science and policy-makingare chaotic in different ways. Most scientific research isderivative, and unhelpful from a policy perspective. The 23rdpaper on smoking and a certain disease may still bepublished, but it is not really advancing science unless thestudy is somehow markedly better than previous studies; toooften, it is not. In other words, there is a lot of indifferent or“junk” science out there, and policy-makers are cleverenough to recognize this. Policy-making is built on a historyof related policies, but is also reactive to numerous andcompeting stakeholder demands. At the end of the day,policies are the result of compromises and are constantlyframed and re-framed in response to changing contexts.Also, researchers are always wanting to hedge theirfindings – they recognize the limitations of their data and arestriving to provide proof “beyond reasonable doubt” –however, policy-makers need a simple one-line answer towhat are often, at least to the researchers, complex issues. Inpresenting their results, researchers traditionally rely on somany caveats that policy-makers do not know what tobelieve. Policy-makers frequently have to exercise moralFacilitatorsNumber of studiesPersonal contact between researchersand policy-makers 13Timeliness and relevance of the research 13Research that includes a summary withclear recommendations 11Research that confirms current policy orendorses self-interest 6Good quality research 6Community pressure or client demand for research 4Inclusion of effectiveness data 3TOTAL studies 24BarriersNumber of studiesAbsence of personal contact betweenresearchers and policy-makers 11Lack of timeliness and relevance of research 9Mutual mistrust between researchers and policy-makers 8Power and budget struggles 7Poor quality of research 6Political instability or high turnover of policy-making staff 5TOTAL studies 24Table 2: Facilitators and barriers to use of research by policymakers,identified in a systematic review of 24 interview studies(tabulation of data provided by Innvaer et al., 2002 7 )judgements in the face of uncertainty, so decisions are taken“on the balance of probabilities”. They usually have plenty ontheir plates, and gravitate towards evidence that speaks totheir own experiences, or that of their constituents. They seeka “one size fits all” or “cookie cutter” approach. Policy-makerswant a “bottom line”, but researchers are uncomfortablegiving one.Researchers and policy-makers also tend to have differentaccountability mechanisms. Researchers are essentiallyaccountable to editors of peer-reviewed journals, fellowresearchers and those who fund their research. They may beinterested in policy but, at the end of the day, are not requiredto focus on issues that have policy relevance or application.On the other hand, policy-makers are usually accountable topolitical parties, government and taxpayers, if not the voters,and must focus on things that are consistent with politicalagendas. Complicating this however is the increasingpressure on researchers to comply with views of governmentsthat are increasingly responsible for setting priorities in theway research funds are allocated. So smart researchers willhave their research proposals reviewed by policy-makersbefore submitting their grant proposals.There is unfortunately no correlation between the quality ofscience and the policy derived from it. Good science does notalways guarantee good policy; bad or even no science doesnot necessarily lead to bad policy. It is true that good policydoes not always depend on waiting for good evidence. Forexample, condom promotion makes good common sensewhen setting policies to tackle sexually transmitted diseases.On the other hand, having a policy, no matter how carefullythought out, is no guarantee that it works. Having a policy forclean water, for example, does not necessarily make the waterclean. It must be realized that science is needed both to helpdevelop the policy and to evaluate the policy.Another issue is related to the public image. Researchersare often respected as “wise and objective people”, free frompolitical and economic interests and pressures. Policy-makersare often regarded as “powerful people”, but are notnecessarily respected. It is not that either researchers orpolicy-makers are “wrong” or “bad”. One responds toscientific rationality, while the other responds to politicalpressures. Furthermore, the societies within which they workalso have norms and expectations, which might beconsidered “cultural rationality”. The coming together of thesecompeting rationalities is necessary to resolve the seemingincompatibilities and ultimately ending up with the adoptionof evidence-based health policies.Some suggestions on bridging the gapHow can we bridge this chasm and gap between researchersand policy-makers? Arguably, a key first step might be anattempt to understand what may be the predictors of success(and failure) in the way researchers and policy-makerscommunicate and value each others’ efforts. Innvaer et al.reviewed 24 interview studies with health policy-makers (atotal of 2041 interviews) concerning their perceptions of theuse of research evidence in health policy decisions 7 . The mostcommonly reported facilitators were personal contact (13/24156 ✜ Global Forum Update on Research for Health Volume 4