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

InnovationThe role of KnowledgeTranslation in bridgingthe “know-do gap”Article by Ariel Pablos-Méndez (pictured) and Ramesh ShademaniDuring the 20th century, knowledge in all its formscontributed to unprecedented global health gains 2 . Yetill-health and premature deaths from preventablecauses persist, especially among poor children and women,in spite of available cost-effective interventions 2,3 . Studiesshow that more than half of the deaths to children under fiveyears old can be prevented by the use of availableinterventions 2,3,4 . Such studies indicate that most of theburden of premature death and illness among the poor is dueto problems for which solutions are known and prevention ispossible. Even in war-ravaged countries, most deaths arefrom easily preventable and treatable illness rather thanviolence 5 . The achievement of the health MillenniumDevelopment Goals (MDGs) in many developing countries isquestionable. The obvious “know-do gap” was recognized bythe Mexico Ministerial Summit on Health Research inNovember 2004 6 and by the 58th World Health Assembly inMay 2005 as a major obstacle to the attainment of theMillennium Development Goals.Bridging the know-do gap is the foremost challenge andopportunity for public health in the 21st century. Newinitiatives and platforms to strengthen specific aspects of thehealth systems such as health information systems, humanresources, and equitable access and coverage have emerged.Knowledge and its links to action is another platform forhealth system strengthening.Evidence and knowledge for problemsolvingThere is widespread agreement that policy and practiceshould be informed by the best available evidence that isapplicable in a given setting. However, there is debate onwhat constitutes evidence and how to harness it in practice,and whether it is sufficient to bring about sustainable changein complex social settings. The goal of traditional researchers,conditioned by funding and tenure systems, is often to getpublished in a respected medical journal – assuming theirfindings will be translated into practice by somebody else atsome point. In addition, learning about effective developmentprojects taking place in poor countries is sometimes hinderedby the lack of general knowledge of what works and how 8 . Ashift from “moving” evidence to solving problems is overdue.The contribution of knowledge to health gains has beendominated by consideration of benefits of science andtechnology, neglecting to exploit and use other valid sourcesof knowledge: knowledge from practice and the sharing andreplication of people’s experience. The tacit dimension ofknowledge, the social context of knowledge, and the variousknowledge-creating mechanisms in practice are gainingimportance, paradoxically, following the ICT revolution whichmainly handles increasing volumes of disembodied explicit(i.e. codified) information 9 . A strategic approach to creatingand promoting evidence from practice in priority areas shouldcontribute to bridging the know-do gap.Knowledge has been recognized by economists as the mostimportant factor of production in the new economy. Aknowledge economy (including health sector) is “one inwhich the generation and exploitation of knowledge has cometo play a predominant part in the creation of wealth. It is notsimply about pushing back the frontiers of knowledge; it isalso about the more effective use and exploitation of all typesof knowledge” 10 .The golden era of modern research, which started after theSecond World War, was a period in which research findingsoutside strategic government projects were published 11 andpassive diffusion followed. The 1970s saw the birth ofevidence-based medicine which took a push strategy withboth active dissemination of practice guidelines andeducation for their local interpretation and adaptation;technology assessment also emerged at a time when privateindustry took over most product R&D. Conceptualframeworks derived from the social theory of diffusion ofinnovation at the time included Research Transfer andResearch Utilization; the private sector developed value chainmodels, and marketing strategies. The success of evidencebasedmedicine, however, plateaued in the 1990s and thenew millennium dawned with fresh thinking on this oldfrontier. In Canada, for example, institutions were reorganizedor created, crafting the term Knowledge Translation andemphasizing linkage and exchange models 12 .104 ✜ Global Forum Update on Research for Health Volume 4