Towards evidence-based health policy | |
Evidence-based health policy: Problems and possibilities. Vivian Lin, Brendan Gibson (editors). Melbourne: Oxford University Press, 2003 (xxvi + 374 pp). ISBN 0 19 551551. |
I really enjoyed
this book. It is well constructed, informative, intelligently written, and for the most part, intelligible. The editors have assembled an eclectic and informed group of authors who shed considerable light on the problems of underpinning policy development with “evidence”. Despite the difficulties inherent in defining what is meant by “policy”, and what constitutes “evidence”, the themes come through clearly and the lessons are many.
For those of a scientific bent, the issue would seem straightforward enough. You conduct research, come to a conclusion on the results of that research, and frame your policy and subsequent actions accordingly. But that simplified view of the world doesn’t often hold up. Interpretations of particular data by knowledgeable, rational people may differ widely, the data themselves may directly conflict, and the sum total of information may be incomplete and inadequate for generating good policy. Those people whose working lives have been dedicated to policy development see greater complexity in the influences that shape policy, and have a different view of what constitutes “evidence”. A rational policy may be in part founded on “scientific” evidence, but the more important influences might include the political setting, people’s expectations and their view of what works for them, and the financial constraints. A technically correct policy may founder on the rocks of cultural opposition or political reality. And then there are those with competing interests who interpret evidence for their own ends, and those who assemble the results of research after the event to justify a policy position that had already been taken. Such misuse of evidence does nothing to enhance the common good. The book provides various case studies that provide excellent examples of how evidence may be applied or misapplied. Health policy, a “strife of competing interests”, may also be thought of as “islands of excellence in an ocean of business as usual”. However, I take heart from this volume that evidence of effectiveness can be, and is, increasingly embraced in the formulation of health policy, as it is in healthcare. The possibilities may eventually overcome the problems. Richard A Smallwood
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