Health check: the case for policy based on hard evidence

By David Donaldson

Monday November 2, 2015

Governments need to do more to ensure health policy decisions are demonstrably based on evidence, argues an academic who helped the Ontario provincial government overhaul its processes.

John Lavis
John Lavis

John Lavis, a professor in McMaster University’s Department of Clinical Epidemiology and Biostatistics near Toronto, was in Australia for the National Health and Medical Research Council’s annual symposium on research translation. He finds it strange that health policymakers are not held to the same standard as they would be in a clinical setting.

“There needs to be a strong message from all levels of government that policymakers are expected to find and use evidence to inform policy,” he told The Mandarin. “You never go to cabinet without a legal and communications input, and you shouldn’t be going to cabinet without an evidence workout.”

Building in requirements to demonstrate use of evidence won’t only lead to better outcomes, he says, but “pulls the rug out from people who are pursuing very narrow or other material interests” over the public interest.

While the varied demands inevitable in a democracy won’t disappear, a clearer, stronger evidentiary base helps politicians communicate more effectively why certain decisions are being made — and might even save them from themselves, reducing the risk of bad decisions going wrong down the track.

“Often the links between evidence and recommendations are not provided.”

The problem is not so much that the evidence isn’t there, it’s that governments don’t tend to use it systematically or transparently. Even expert review panels can end up making decisions based on their own values, rather than the latest evidence, if processes are not in place, he argues.

The solution is to give such reviews support, ensuring a synthesis of the research is included as an input to the decision-making process, that the panel includes an expert on research methods and that decisions are transparently backed up with the evidence that was used.

“Often systematic reviews are not referenced,” said Lavis. “Often the links between evidence and recommendations are not provided. Many such reports would be demolished if used in a clinical environment.”

Building research evidence checklists into briefs creates an incentive for staff to base recommendations on documented sources. “It shouldn’t be possible to get to minister or cabinet without filling out form about how you find and use evidence, what databases you searched for evidence, what type of evidence you found,” he thinks.

“You just need to know people have done their work systematically, so this is a way of documenting transparently that that work has been done.”

A rapid response network

Setting up response groups helps, too. Ontario has set up an internal rapid response network to help connect government agencies with research capacity quickly. Another model is having an external team, allowing any government from around the country to make contact when needed, though without a standing contract this process can take longer.

Governments can also incorporate use of evidence into performance management. One example could be asking public servants once a year to show where they used evidence in making a decision or recommendation, Lavis suggests. This sends the message that evidence is valued.

Lavis himself has done a lot of work creating links between research communities and government. He founded and continues to direct the McMaster Health Forum, a body that aims to empower health system policymakers and stakeholders to set agendas, take well-considered actions and communicate the rationale for actions effectively.

He founded Health Systems Evidence, a comprehensive, free access point for high-quality evidence on reforming health systems and how to get cost-effective interventions to those who need them. He also founded and oversees the periodic expansion of Health Systems Learning, which combines online and face-to-face learning opportunities for health policymakers and stakeholders about how to find and use research evidence and how to set agendas and develop and implement policies.

With the increasing ease of access to evidence across the community — including journalists, lobby groups and opposition parties — governments need to be transparent and rigorous about their use of evidence to maintain credibility.

“It’s very easy for us to see a policy and say, ‘you’re proposing this direction, but all the evidence suggests going in this direction’,” he said.

“It’s too easy these days to call people out in a very powerful way, but we’d prefer not to name and blame. You’re already looking for information, so we’re trying to help you do this better.”

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