Final Report Summary - GRIP-HEALTH (Getting Research Into Policy in Public Health : transforming the evidence-to-policy response through utilisation of political insights)
The GRIP-Health project was set up to learn about how to improve the use of research and evidence to inform health policymaking by specifically working to study the uptake and use of evidence from a political perspective. The project thus brought political science insights to the field of public health, recognising the deep dsesire of the public health community to use evidence to improve decision making, but studying why and how political factors can affect the ways this comes abuot. We particularly looked at how health policy issues could be politically contested, and how policy decisions must be made within political institutional settings, both of which have important implications for evidence use. Our project identified a number of key issues that can be used to inform future efforts to improve evidence use. First, we worked to re-shape the discussion around what is meant 'evidence based' policymaking in health and social policy. While that term is widely used, in fact it often is too simple to help guide evidence use in a meaningful way. There is often an implicit belief behind such calls that evidence should be used in ways faithful to scientific good practice - e.g. evidence should be used rigorously, or not manipulated. Yet no single piece of evidence can dictate what a policymaker should do. Policy involves many competing interests, each of which may have relevant evidence to inform them. As such, one key output from our work was to develop an alternative to the idea of calling for 'evidence based' policy, to instead define the concept of the 'good governance of evidence' - a way of thinking that allows principles of scientific good practice (such as rigour, quality, and appropriate evidence use) to be combined with principles of democratic decision making (emphasising the importance of representation, accountability, and transparency, for instance). Our research has helped to learn about the nature of political institutions and political environments that shape evidence use in low, middle, and high income settings. We undertook research in six countries of various income levels and found a great deal of variation between how evidence was understood, when it was relevant, and what factors shape its use. In particular we identify in our country case studies a number of ways that factors such as the framing of the health issue and the institutional bodies using evidence will be important factors shaping the use of evidence, outside of any technical considerations about the quality or methods used to generate that evidence. For example, in some settings courts or legal processes make the judgements about what health services are included in insurance programmes, and this affects evidence use due to the different thinking about evidence in legal processes. We also saw how international aid donor agencies could influence health policy by deciding which evidence is created in the first place (through research funding) or by having influence over the processes and structures that apply evidence to health planning. Thus it is not so simply as to call for more evidence to inform policy, but we must understand how evidence advisory systems are structured, asking about which evidence is brought to bear, when, and by which bodies, if we want to consider how to improve the system. Ultimately this project has led to a number of conceptual insights as well as country specific findings that help us improve the way we think about evidence use, leading to recommendations and ideas about how to go about building systems of evidence advice that serve to improve the use of evidence in the future.