What are we doing here anyway? (Alternative title: WWPFD – What Would Paul Farmer Do?)
Last week I attended the International Health Impact Assessment (HIA) 2013 conference in Geneva, Switzerland. HIA is “a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (WHO, 2013). It is a practical approach used to judge the potential health impacts of policies, programmes or projects in diverse economic sectors (i.e. transportation, resource extraction, agriculture, housing) on a population, particularly on vulnerable or disadvantaged groups (WHO, 2013). Using best available evidence, recommendations are produced for decision-makers and stakeholders, to help them make choices about alternatives and improvements to prevent disease/injury and to actively promote health (WHO, 2013). As you can see, HIA itself is a KT tool. It’s importance as a way of achieving “Health in All Policies” is growing, but I do not bring it up now as a KT tool per se. I bring it up because of questions/themes that featured prominently in my mind while at the conference and to think a bit more about the ‘Scientist – Policymaker Divide’ and what that means for global health researchers.
The HIA process involves many stakeholders, including researchers whose judgements about potential impacts of the policy and/or program under study are meant to be objective and impartial. During one of the HIA2013 panel discussions on ‘HIA for equity and Social Justice’, one of the speakers started out by asking the audience why we were all here. “Put up your hand if you are involved in HIA because you are concerned with social justice and equity”. (Note: It was something along those lines, but I didn’t write it down verbatim). Every hand in the house went up. The speaker than commented on the fact that HIA is in fact a tool to achieve a goal, the goal being (Global? Local? Both?) equity and social justice. During the final panel session, another rhetorical question was posed: “Are HIA practitioners advocates or impartial assessors?” Given our shared desire to be ‘agents of change’ I think these are relevant questions for global/public health researchers whether or not we have any connection to HIA. And the answers really depend on why were are in this field in the first place.
Brownson et al (2006) and Choi et al (2008) both discuss, inter alia, the researcher characteristics that create challenges in the researcher-policymaker working relationship. According to Brownson et al (2006), one of the main challenges to successfully translating evidence into policy is researchers’ need/inability to balance objectivity and advocacy. They explain the disagreement that exists about the extent to which scientists should be involved in the policymaking process. One side of the argument, they say, is that “researchers who take on a public stance on a given healthy policy issue may face real or perceived loss of objectivity that may adversely affect their research. Objectivity implies that a researcher seeks to observe things as they are, without falsifying observations to match some preconceived view…[and] may be influenced by the research questions in which a researcher is personally interested” (Brownson et al, 2006, p. 166). Others argue that it is actually a researcher’s ethical obligation to take part in policy development. The fact that some researchers are not up to the challenge and possible consequences (i.e. Being the target of personal attacks and harassment due to involvement of heated policy debates) of contributing to the policy process is another challenge to evidence-based policy (Brownson et al, 2006). Another suggested problem with (stereotypical) scientists, is that they are less interested in social or policy aspects of their work, and even if they are interested, they are not required to focus on issues that have policy relevance or application (Choi et al, 2008).
Of the multiple barriers and challenges that arguably contribute to and maintain the ‘Scientist – Policymaker Divide’, I think it is interesting, and a little amusing, to consider the research scientists supposed weaknesses and barriers here. I like to think they they do not apply to those working in the field of global health, and thus I return to a version of the question raised at the conference: Why are you involved in global health research? Is it because you are concerned with social justice and equity? And I would like to add a few more. What would Paul Farmer do?*** Who are our global health research role models? How have they successfully married objective research and advocacy? And isn’t that the point?
It is not surprising to me that at the Canadian Society for International Health Conference in 2008, after giving a keynote address, Dr. Paul Farmer was mobbed by a group of young, aspiring global health researchers (and no, I was not part of the mob) and medical students. I think in the field of global health research, we are here because we want to affect policy – the sea of hands at the HIA conference attests to that – but the question is what is the best means to that end. If being too ‘vocal’ (I’m imagining myself with a picket sign in front of the office building of a Canadian company that mines golds in rural Guatemala shouting solidarity chants…) in trying to influence policy makes your research ‘biased’ and thus less likely to be used as evidence, then perhaps we need to be more creative in how we communicate evidence, but we should not stop trying.
**I would love to hear your thoughts on other activist/advocate researcher role models.
Brownson RC, Boyer C, Ewing R, McBride TD. Researchers and policymakers, travelers in a different universe. American Journal of Health Promotion 2006; 30(20):164-172.
Choi B et al. Can scientists and policymakers work together? Journal of Epidemiology and Community Health 2005; 59:632-637.
HIA 2013. Conference website: http://www.unige.ch/medecine/eis2013/accueil_en.html
World Health Organization. (2013). WHO Health Impact Assessment. http://www.who.int/hia/en/