Researchers in academia frequently complain that results of diligently conducted studies are not avidly absorbed and immediately applied by policymakers. This discontent is most often expressed in the domains of public health and related social sciences. Policymakers, on the other hand, complain that researchers do not address complex real-world questions and fail to provide readily implementable solutions.
The purpose of public health research is to provide evidence-informed, context-relevant, resource-optimised, culturally compatible and equity-promoting recommendations for policy and practice. All these criteria are not absolute. The context may be changed through other societal interventions. Resources can be enhanced to make intended interventions possible. Culture is dynamic and changes over time. However, emphasis on evidence and equity should remain the sine qua non of policy recommendations in public health. Policymakers are concerned about the necessity, implementability, scalability and sustainability of any intervention. Enlightened policy demands scientific credibility, financial feasibility, operational steerability and political viability of a proposed programme. This requires information from many streams of enquiry: biomedical, epidemiological and clinical research on the problem; health economics research on the cost-effectiveness and affordability of the proposed solution; implementation research in health systems to demonstrate deliverability, and social science research that gauges the attitudes of policymakers, health system managers, other stakeholders and the public towards the proposed measure. Researchers seldom collaborate to create such a confluence of multidisciplinary knowledge.
Often, scientific methods adopted by researchers look for the independent effect of a specific intervention on a clearly defined primary outcome. For this, they try to exclude or minimise the impact of other factors that can influence the outcome, while those variables too are at play during the study. While providing a good measure of association with one variable, such a narrow focus delivers an incomplete assessment of the cumulative contributors to the outcome. Multicomponent interventions are better to study multifactorial influences. Quite often, health system studies require both quantitative as well as qualitative research methods. Such ‘mixed methods’ research helps to identify what is not working well, while providing insights into why it is not working well.
To represent the real world, research must ensure diversity in the study population. Researchers may prefer to study a selective, homogenous population group for reasons of access, ease of recruitment and follow-up, efficiency, and economy of conducting the study with limited resources. However, the results of the study may not be generalisable to a larger, heterogeneous population. Single studies also run the risk of producing results by chance alone, while small sample sizes will place a wide uncertainty band across a seemingly impressive study result. A large, multicentric study, with diverse population groups that are well represented, will be convincing to policymakers.
Policymakers also demand early access to research results, so that they can choose among possible options. Traditionally, researchers conduct studies that involve long periods of data collection and analysis. Often, they need to publish in peer-reviewed academic journals before they can share the results with policymakers or the public. Policymakers cannot wait long for results. Indeed, the situation may even change meanwhile due to other measures initiated by them. A balance may have to be struck, where routinely gathered and readily available data within the health system are objectively analysed while designing studies which can report on meaningful intermediate outcomes prior to the final result.
For establishing better and faster communication of research results between policymakers and researchers, knowledge-transfer platforms have been proposed. However, this suggests a post-facto consultation. It is better to consult at the very inception of the study, so that researchers can understand the priorities of policymakers and judge how well their research matches those priorities. Policymakers too will get a better understanding of the purpose, process and products of the proposed research.
It is even better if policymakers or health system managers agree to join the advisory committee that periodically reviews the project’s progress. This will foster better understanding of the proposed research among the potential end-users and facilitate early uptake of useful products. Involvement of community representatives too, in such bodies, will provide ground reality checks to researchers. It will also inspire confidence among policymakers that the community would be receptive to a policy change that the research may generate.
Knowledge for policy making comes from many sources. Tacit knowledge provides a useful input for enabling early policy decisions. In the initial stages of the Covid-19 pandemic, WHO and CDC of the USA did not advise masks for public use. This was despite the experiential wisdom available from countries in South-east Asia and East Asia which had combated earlier outbreaks of respiratory viruses. Along with fervour for hard evidence, researchers must evaluate knowledge from multiple streams to shape policy. Accurate communication of research results to policymakers—in jargon free language—is a talent that researchers must acquire. Brevity is essential. Policymakers will want to know: what the problem is, who is most affected, how widespread it is and why it is important (in terms of public health, economic and social impact). They will also want to know what the proposed policy intervention is, what the impact is, how sustainable it is, and the timeframe required to achieve this impact. Also important is the question around the source of financial and human resources, and who will support or not support the initiative. Researchers must present the answers to these with confidence and clarity.
One question that policymakers have on their minds, but do not explicitly ask, is: “How will it make me look?” Researchers must address this politely in their presentation, profiling the credit that will potentially accrue from the proposed action, and the possible discredit from inaction. That may be the clincher!
(Views are personal)
Cardiologist, epidemiologist and President, Public Health Foundation of India (PHFI)