Mind the Gap: Bridging Evidence and Policy in Health

Posted By Lana McCrea

One of the big issues confronting the health system is how to translate evidence into sound policy. It sounds deceptively easy, but in reality, there is often a yawning gap between what the science says and the strategies actually implemented. The Institute for Health and Social Policy is taking on this question with its new Evidence to Policy Speaker Series in 2014-2015. What are the best ways to tame the widening gyre?

The Problem

In an ideal world, health policy would be driven by a linear model of knowledge transfer, and compelling new scientific evidence would garner swift, effective policy responses. But the actual action cycle rarely resembles the ideal paradigm. Research is often misapplied or simply ignored. Public perception skews the focus of policymakers: issues like Ebola garner attention that is wildly disproportionate to the actual risk it presents to Canadians. Practical considerations underlie these problems as well: underfunding, decentralization, and the effort required for transforming raw research into real-world applicability.

The Dangers of Knowledge Transfer

It is easy to think that more knowledge and evidence leads to better policy. But are there any hidden dangers to consider? Once published, preliminary scientific evidence can be widely and quickly disseminated through the Internet and social media. Policy decisions may be made prematurely in response, and even if the evidence is retracted from peer-reviewed sources, the ramifications can remain. For example, there was an article in Science postulating that xenotropic murine leukemia virus-related virus (XMRV) was a causative agent for chronic fatigue syndrome (CFS), which in turn triggered blood donor deferral policies targeting individuals with any history of CFS. These policies may still apply, despite the fact that the science no longer supports the association. The MMR vaccine-autism link has long been debunked, but the impact of that information is felt to this day; people are still protesting the vaccine and many parents refuse to vaccinate their children. The distribution and application of evidence is not always optimal. Cultivating a healthy dialogue and regulating knowledge transfer are essential to avoiding premature or misguided responses.

The Appetite for Progress

One of the first hurdles to confront when moving evidence to policy is the appetite for progress. As Maureen O’Neil pointed out at the IHSP launch, research will not be implemented if there is no capacity to address the issue from a political standpoint. Even the most perfect knowledge transfer mechanisms cannot ensure that sound policy will result. The federal government’s response to Insite, North America’s first safer injecting facility (SIF), could be seen as an example of this problem. The health minister would not grant Insite anything more than a 6-month extension for the legal exemption from Canada’s drug laws, despite clear scientific evidence showing the efficacy of the service. Policy remained unaffected by research. So the preliminary questions are: Where is the appetite? Are there conflicting policy considerations? How can we approach the question of why certain approaches are taken in the first place? What happens when there is no appetite for progress?

Concerns about the diminishing role of science in policymaking have provoked some political action. Proposed in December 2013, Bill C-558 would create a Parliamentary Science Officer who answers directly to members of parliament and provide them with sound information and expert advice on scientific issues. The goal is to encourage more transparent and evidence-based policymaking. The bill has not seen much success yet, but hopefully it will not be the last initiative of its kind.

Bridging the Knowledge-to-Policy Gap

The good news is that technology can be used to bridge the gap between policy and evidence by facilitating knowledge transfer. For example, Scientific Director of the Institute of Health Services and Policy Research (IHSPR), Dr. Robyn Tamblyn, spoke about their Policy Rounds. Created by the Canadian Institute of Health Research, the IHSPR hosts webinars to create a dialogue between researchers, healthcare policymakers, and other stakeholders on pressing topics. Ms. Tamblyn also spoke about the Evidence-Informed Healthcare Renewal (EIHR) Portal, which is a comprehensive repository of documents on healthcare renewal. The portal offers a single point of access to the burgeoning body of evidence that can feed policy in this domain. Lastly, the Evidence to Policy Initiative (E2Pi) created by the Global Health Group aims to facilitate the synthesis of evidence and policy by providing the tools and information necessary for policymakers to make informed decisions. Where there is a clear demand for recommendations, E2Pi steps in to translate evidence into sound strategy options.

Alternatives to Policy

Policy isn’t necessarily the best or only route for applying evidence on the ground. Influencing patterns of work by engaging motivated teams and encouraging education may be just as effective. At the IHSP talk, Maureen O’Neil spoke about the CFHI’s flagship EXTRA program, which targets health service professionals in senior management positions. The program engages nurses, physical executives, and other health administrative executives, and develops their capacity to optimize the use of research in managing healthcare organizations with the goal of increasing evidence-informed decision-making in the health system.

Going Forward

There will always be challenges when transferring evidence into policy. The key solutions seem to be facilitating dialogue, optimizing resources, and working to create a stable structure for implementing research that is both vertically and horizontally integrated.

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