Beyond evidence-based policy in public health: The interplay of ideas


By Micky Willmott

Research reports often end with recommendations for what ‘policy makers’ should do. Clearly, linking research and policy (and practice) is vital, but we often seem to over-simplify the relationship between them. This recently published book by Katherine Smith is a fascinating read because it tackles this issue using two case studies which are at the heart of public health work: health inequalities and tobacco control.

The first chapter begins with a useful introduction to the rise of evidence-based policy and provides an overview of the strengths and weaknesses of the various ways of conceptualising the relationships between research and policy. Smith is particularly thought-provoking in discussing the commonly-applied ‘two communities’ approach, which posits that the disconnect between researchers and policy makers can be overcome by improving communication and trust between these two groups. Perhaps provocatively, she notes that the evidence base underpinning advocacy for ‘evidence-based policy’ is itself not clear-cut (p.24). That is not to say though, that she is against the application of research in policy. Indeed, she ends the first chapter by stating that she intends that the book “tries to keep alive the possibility that researchers have the potential to influence policy in multiple ways: instrumentally, politically and conceptually” (p.41).

In the next chapter, Smith introduces and applies two very pertinent case studies – health inequalities and tobacco control – to illustrate the difficulty in achieving evidence-based public health policy. She achieves a feat in summarising the major research and policy initiatives for both of these areas and in so doing, raises some key questions such as: as well as identifying problems, what policy solutions can we offer? What are the views of people who may be affected by the issues or solutions identified in research?

The next chapters go on to draw on Smith’s qualitative research (141 interviews and extensive documentary analyses) in the two case study areas, to argue that the relationship between research and policy is best understood as a “continual exchange and translation of ideas” (p.75), rather than of knowledge transfer or research utilisation. She elaborates this (chapters 4 – 6) to suggest that there are four types of ideas: institutionalised ideas which have become ‘unchallengeable’ and embedded in policy and discourse; critical and charismatic ideas, which in different ways may challenge the status quo and usurp institutionalised ideas; and chameleonic ideas, which can simultaneously appeal and be acceptable to a variety of policy actors but also challenge existing policy. The analysis underpinning this typology rings true my own experience of debates in public health; the feeling that as well as engaging with policy makers, public health researchers should also be radical advocates.

Chapter seven gives us at DECIPHer explicit food for thought by citing us in a list of emerging public health ‘knowledge brokers’ and recounting the response of some of Smith’s interviewees to these types of organisations. Gladly for us, she finds that centres like DECIPHer are welcomed and have potential to overcome the problem that ideas may be forgotten (“institutional amnesia”) and recycled in a changeable policy environment. However, she notes that the profile of such organisations is not always high amongst policy makers. She goes on to make some recommendations to improve and secure ‘knowledge brokerage’. These include: securing long-term investment in knowledge translation organisations; creating better links between researchers and advocacy (and other third sector) organisations; and investment in infrastructures which “provide capacity for enhancing the institutional memory of policy (e.g. topic-based virtual sources which provide brief overviews of public health research and/or researcher expertise)” (p.211).

One of the particularly interesting lessons that Smith suggests her book offers is that politics is “a central component of public health” and shouldn’t been seen as an impediment to the take-up of research (p.217). I was already inclined towards this point of view, but Smith does an admirable job of showing the significance of ideas and politics whilst upholding the principle that research has value for policy.

As Malcolm Chisholm notes in his foreword and as another reviewer has written; this book invites self-reflection – and, in my case, reflection on the wider work of DECIPHer. For me, it’s a welcome reminder of the political nature of research and the reason why I enjoy public health so much. On a more objective level, it provides an accessible, evidence-based discussion of the complexities of the two-way relationship between research and policy.

Dr. Micky Willmott is a research associate at DECIPHer, based at the University of Bristol.

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