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

Decision-makingsystems development. Partnerships are urgently neededbetween government policy bodies and academic/researchorganizations experienced in this area.Re-defining the starting pointIt is time perhaps to change the starting point, i.e. publicpolicy-makers must be placed at centre stage and researchersshould aim to serve their needs. In addition, citizens and civilsociety have a vital – and so far neglected – role to play insetting research priorities 14 and having an influence on policyformulation. There is an important role of the citizen orcommunity in evidence-based policy, for example, in theincreasing community engagement and citizen participationin health systems and the increasing trend towards includingpatient and public input into research. Research-funders andpolicy-makers have to become a lot more skilled at ensuringthat researchers spend a lot of their time researching thequestions that have the greatest potential to improve society.They should be encouraged to fund synthesis research andimpact assessments in support of policy decisions. The trickhere is to connect science with policy, and policy withscience. It is desirable to have both “evidence-based policy”and “policy-based evidence” 15 . In other words, policies shouldbe based on evidence, and once policies have beenformulated, there should be evidence on how to achieve theset goals, and to develop, implement and evaluate neededstrategies. There is no better way than to have policy-makersintimately engaged in the science. However, one must becareful 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 certainformulated policies. Sometimes policy-makers want to stretchthe interpretation of research findings to reinforce the“validity” of the policies they are already decided upon. Thereare potential problems when researchers get too close topolicy, e.g. concerns about loss of objectivity and freedom tocriticize government policy, and how to guard against this.Policy-making is complexIt should be acknowledged that it is too simplistic to think thatpolicy-making could ever be based solely on scientificevidence. In addition to scientific evidence, policies are alsobased on values, emotions, “know-how”, intuition, “gutfeeling” and the wishes of interest groups, for example. Thereality of how decisions are made dictates that scientificevidence is only one consideration among several. Suchevidence can even in its best form be only background. Insome cases, it is perfectly possible for wise policy-makers todevelop good policies without research. In other cases,policy-makers listen more to the voters than to theresearchers. We should perhaps admit this and not setunrealistic expectations for the role of scientific evidence, andacknowledge that, on the other hand, failing to grabaccessible evidence may delay intervention opportunities. Forexample, it took 263 years after the discovery of thepreventive value of citrus juice against scurvy before sailors’shipboard diets were routinely supplemented with it at theend of the 19th century. The link of smoking to lung cancerwas found in 1950 but it was not until 1957 that anylegislative action was initiated. How long will it take to tacklethe current epidemic of obesity if our will to intervene awaitsthe delivery of perfect evidence that proposed solutions willwork? Thus, the balance between action and further researchis an interesting and important one. When do we need policydecisions and when do we need more research? ❏Tikki Pang has been Director of the Department of ResearchPolicy & Cooperation, World Health Organization, Geneva,Switzerland since August 1999. He has previously held positionsas Lecturer then Associate Professor at the Department of MedicalMicrobiology, Faculty of Medicine, and then as Professor ofBiomedical Sciences, Institute of Postgraduate Studies &Research, University of Malaya, Kuala Lumpur, Malaysia.Dr Tikki Pang is currently Chairman of the Working Group onTyphoid Fever, International Vaccine Institute, Seoul, Korea;Secretary, WHO Research Ethics Review Committee; Secretary,WHO Advisory Committee on Health Research; member of theeditorial board of six international journals. Previously heldpositions include Clinical Specialist (Medical Microbiology),University Hospital, Kuala Lumpur, Malaysia; Member, NationalBiotechnology 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