Dilemmas in evidence-based decision-making

One thing that is well established is that while researchers are searching for all this evidence published in the literature, policymakers are cracking on with getting the work done, and there is certainly a disconnect between researchers and policymakers when it comes to this evidence and its application in public health. The key questions that come to mind are where are the researchers to get the work done? What do the policymakers need, and how robust is the evidence available to them? So, there is a huge dilemma faced in evidence-based decision-making, and this study by Petticrew et al. in 2004 is a very interesting study. It helped to uncover the everyday realities and challenges that policymakers face in utilising evidence for decision-making.

I know some of you may be wondering why the political sensitivity is important in the face of public health challenges, however, as was discussed in module one, we cannot make progress with improvements in health without considering the social determinants for health. Policymakers, in this study, emphasise that there is a need for researchers to have a good understanding of the political climate or context, and to know that a politically relevant study may be more marketable in comparison to a high-quality study, which may not have any political relevance. Policymakers also value evidence which helps to justify the cost the intend to incur by proposing certain interventions.

The issue of evidence effectiveness versus evidence cost effectiveness, because truly, it is possible that an intervention may be effective, but the cost of conducting such an intervention may be prohibitive. So, for instance, if we know that donning a hasmat suit is associated with reduced transmission risk of COVID-19. Now imagine the policymaker adopting the purchase and distribution of hasmat suits freely to the entire population living in the city of Johannesburg, South Africa, for example. I know you think that that is ridiculous, I think so too, so, at every point, policymakers need to balance effectiveness of interventions with cost and cost-effectiveness, in a bid to justify their policy choices, and ultimately make the right choice.

We will delve into further details about cost-effectiveness in one of the future modules, if you take the health economics module. So, here’s the dilemma faced in evidence-based decision-making, and this is a diagrammatic representation of some of the key questions that emerged from the Petticrew et al. paper. The first is what action can we take? Number two, is the action of choice politically relevant? Number three, has the evidence been proven to work, and number four, what are the financial implications? These are all decisions that decision makers have to rest their decisions on.

Decision makers have to be able to respond to these questions, and then be able to put the responses imagined from these questions together to make sensible decisions going forward. What actions can we take? Is the action or choice politically relevant? Has the evidence been proven to work? What are the financial implications?