Evidence based policy: don't be timid

EDITOR—Black's discussion of the problems of evidence based policy seems to conclude that it is all very difficult.1 Without wanting to appear too gung-ho about the prospects for getting health managers and policymakers to use research more productively, I think that such timidity is not the best way forward. Researchers should be asserting the value—to policymakers and society—of the evidence they produce. They are already engaging with policymakers and other stakeholders to build the kind of “policy community” that Black concludes is needed.

Firstly, few people would argue with the principle that health policy should be evidence based—it should make full and proper use of research findings and research methods in policy development, implementation, and evaluation. But it is misleading to impute, as Black seems to, that this would mean that every policy decision should be based on research evidence and that other values or factors would be ignored. It simply means that research evidence plays its part alongside other influences in the policy process, when it has often been almost entirely absent in the past.

Secondly, Black sets up a mechanistic, linear model of research dissemination and implementation that no researcher or policymaker I know would support, and then proceeds to knock it down rather easily. Researchers and policymakers are not as naive and uninformed about each other's worlds as Black suggests, and one of the most encouraging trends of recent years has been the increasing dialogue and interplay between the two groups. Donald's commentary captures the sense of a change in the zeitgeist, towards a more evaluative, interactive, and symbiotic relation between research and health policy and practice.2

Thirdly, those who are interested in seeing the greater use of evidence in health policy and management decision making can learn much from the development of evidence based clinical practice.3 Black's paper is reminiscent of some of the early scepticism about evidence based medicine and the concerns expressed about its potential impact. Although the form of evidence based health policy and management may be very different from evidence based clinical practice, many of the underlying principles and lessons are eminently transferable.