As a highly under-skilled and over-critical future public health practitioner, I feel it necessary to confess my severe deficit of knowledge regarding the policy process. Our exploration earlier in the semester of the clash in agendas, priorities and timeframes between policy makers and researchers shed light onto the fact that I am not entirely alone in my academia-induced ignorance of how policy is really happening (Choi et al 2005, Brownson el al 2005). An article a classmate passed along to me clarified for me that I was not alone in my ignorance, and gives me the confidence to share it with you bloggers and classmates.
In “Evidence and Healthy Public Policy: Insights from Health and Political Sciences”, Fafard (2008) analyzes precisely this gap in understanding between health scientists and policy makers. Fafard compares the linear view of policy making often addressed in health literature (Figure 1) to the commonly used stages cycle of the policy realm (Figure 2). It’s interesting and useful to view these visual representations of this process from the respective discipline’s, as they seem to draw out a summary of the mental models that underscore the gap in understanding between these two fields. These two simple representations provide a powerful tool for interrupting the health scientist’s false perception of the policy process by complicating their notion of a linear evidence-to-policy progression.
There are some key differences in policy practice to point out. One major issue surrounding evidence in the agenda setting phase, is how exactly the issue is being framed. As Fafard notes for example, “When an issue is framed as a technical problem, experts can and do often dominate the process of decision-making” (p. 10). A point that brings to my mind the current discourse on Health in all Policies, and the never-ending plea of the health sector for us to be a priority in the face of intersectoral priority setting. The field of resource management comes to mind as a highly interdisciplinary field where it is undoubtedly difficult to prioritize health in the discussion. So how exactly do you frame resource management in a way that encourages the integration of health evidence into decision-making processes? Recent efforts such as Ecohealth make an attempt at this reframing so as to include health experts in the decision-making.
Another important error in the health scientist’s mental model is the apparent halt at policy formulation. To the “policy maker” (“policy makers” and “decision makers”, he points out, are not very well defined in health sciences literature and in fact are can change throughout the policy process) this might however be merely a milestone in a continued process toward successful implementation and evaluation of the policy. This ties into the health scientist’s mental model inserting one decision at the end of the knowledge transfer process, whereas the stages cycle entails various decisions amongst different groups with varied levels of power throughout.
All in all it would seem that the realities of the policy cycle in fact favor the integration of evidence more than a linear model would lead the unversed health scientist to believe. Evidence can take on different forms at different stages of the process, whether it be framing an issue to put it on the agenda or evaluating the impact of a particular policy after its implementation, so there’s hope for us yet.
Brownson R.C. et al (2006). Researchers and Policy Makers: Travelers in Parallel Universes. American Journal of Preventive Medicine, 30(2), 164-172.
Choi B. et al. Can scientists and policy makers work together? Journal of Epidemiology and Community Health, 59, 632-637.
Fafard, P. (2008). Evidence and Healthy Public Policy: Insights from Health and Political Sciences.
The International Development Research Centre (IDRC) has done great work in the field of Ecohealth. It is an excellent resource for those interested in learning more about the field. (http://www.idrc.ca/EN/Programs/Agriculture_and_the_Environment/Ecosystem_Approaches_to_Human_Health/Pages/default.aspx)
The International Association for Ecology and Health has published the Ecohealth journal since 2004. In Canada, the Canadian Community of Practice in Ecosystem approaches to Health has been active since 2008. Please see this Ecohealth Presentation for further information and resources!