Knowledge, Power and Evidence-Based Decision Making: Its Worth Asking a Few Questions

Of course its important to base public health programs and policy on evidence-based, peer reviewed research. That makes sense to many of us, right? 

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But wait, have you ever read or heard something in the media that sounds a little … off … but then were reassured that the results, facts or intervention you were hearing about is based on evidence?

In many of our discussions and readings for the course, there has been mention of themes such as the influence of ideology in decision-making, research, knowledge and power. Over the semester, I have been thinking a lot about evidence based decision-making and the way in which it is rubber-stamped in many settings to be the ‘best in the business’ in approaching public health interventions and campaigns.

Is evidence based decision-making really the be all, end all? Can I just stop thinking and analyzing and simple go along with a program that is “based on evidence”?

Probably not. In fact, it might be good to consider the following: knowledge and privilege and  ideology when thinking about evidence-based research and decision-making. 

KNOWLEDGE AND PRIVILEGE

Various social, political and economic determinants influence how knowledge is produced, used and communicated, “knowledge .. can be used to produce, concentrate, and exercise discursive power in ways that privilege some definitions of health and social problems and marginalize others” (Murphy and Fafard, 2012, p. 276). Academics Murphy and Fafard (2012) highlight how behavioural interventions to “treat” autistic individuals have been developed from ‘evidence’ and ‘knowledge’ from academic research but are strongly based on an understanding that autistic individuals must be ‘treated’. Other research involving autistic adults and affected individuals as noted by the authors, “see autism as a form of neurological diversity that, rather than being cured or treated, should be recognized as a legitimate identity” (Murphy and Fafard, 2012, p. 276).

When reviewing interventions based on evidence, make sure its clearly understood how the “problem” is defined and what the definition of the “problem” means for the proposed “solution”. 

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I would argue that there really is no ‘evidence’ that is immune from an ideological or strong value-based context or development. In the infamous ‘Beyond the Sound of One Hand Clapping’ article, Lomas (1997) discusses how values and ideology impact the formulation and receptivity to research, “ideologies declare a person’s or an organization’s view of how the world ought to work” (p. 12, emphasis from original text). This is a fundamental point to keep in mind when research proposals are being developed but also in examining what KIND of research is being selected to advocate for a health policy or intervention.

One example of the importance of being critical, asking questions and picking through the whole study or methods, are the serious criticisms that various academics have made about research from the Ottawa-based think tank, the Fraser Institute and the World Bank (Cohen, 2001; Evans, 2009; Armstrong and Armstrong, 2008). Now whether or not these criticisms of the “peer reviewed” studies of the Institute or the Bank or other research bodies, are founded, as public health workers working with policy makers, we need to be aware what research is being used and how the process in which findings of ‘evidence-based research’ are formed. As Choi et al (2005) note “one must be careful to make sure that ‘evidence based policy making’ does not become ‘policy based evidence making’ – that is creating and selecting evidence that suits and justifies certain formulated policies” (p. 635).

Ultimately, I think it is always worth to ask the following questions when you hear the words, EVIDENCE-BASED RESEARCH

Who funds the study?

Who endorses it?

What ideology is associated with the authors, journal or endorsers?

Does other research confirm this evidence? Is the affected communities or individuals involved?

How is the intervention defined? What is the problem and how does it shape what the solution is?

REFERENCES

Armstrong, Pat and Armstrong, Hugh. (2008). Health Care. Winnipeg: Fernwood Publishing.

Choi, Bernard, Pang, Tikki, Lin, Vivian, Puska Pekka, Sherman, Gregory, Goddard, Michael, Ackland, Michael, Sainsbury, Peter, Stachenko, Sylvie, Morrison, Howard and Clottey, Clarence. (2005). Can scientists and policy makers work together? Journal of Epidemiology and Community Health. 59: 632-637

Cohen, Marjorie Griffin. (2001). Do Comparisons between hospital support workers and hospital workers make sense? Hospital Employee’s Union.

Evans, Robert. (2009). The Iron Chancellor and the Fabian. Healthcare Policy. 5:1, 16-24.

Lomas, J. (1997). Improving research dissemination and uptake in the health sector: Beyond the sound of one hand clapping. McMaster Univerity Centre for Health Economic and Policy.

Murphy, Kelly and Fafard, Patrick. (2012). Knowledge Translation and Social Epidemiology: Taking power, politics and values seriously. In Rethinking Social Epidemiology: Towards a Science of Change. Springer. 

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