Monday, 14 May 2012

Just trying to make the world a better place

Posted by Jean Adams

People who work in public health research seem to have a universal desire to make the world a better place.

Mostly they also have that innate finding-out-new-stuff-is-cool streak that unites scientists of every flavour. But in public health research, getting out of bed seems more about working out how (health) things could be better.
We just want to make the world a better place....

Which is what Fuse is all about: not just finding out how we could, under ideal circumstances, improve people’s health; but also working out how we can ‘translate’ public health research evidence into public health policy and practice to make it more ‘evidence-based’. To use the jargon.

I am grateful to Fuse. Not just because they have paid my salary for the last few years, but also for getting me to think more about the problem of evidence-based policy.

I was also really pleased to be invited to a workshop on Economic Evaluation of Population Health Interventions in Glasgow last week. Admittedly, I was pretty apprehensive before-hand: all I know about health economics, I learnt during an MSc module led by one of the guys who organised the workshop. What could I usefully contribute?

Perhaps I didn’t contribute anything useful. But I did enjoy the workshop – which was very trendily multidisciplinary (maybe I was just a token public health rep?). I particularly enjoyed chatting to an ex-academic, now working for the Scottish Government, who gave me a very candid window into how government works.

Way back when, before I had really thought about it much, I thought evidence-based public health policy was all about educating the policy makers – about what scientific evidence is, how us scientists generate it, and how the policy makers should use it. If we just shouted louder, maybe they would hear us.

This is not an unreasonable approach. So much so, that an eminent science writer has just written a, much-praised, book about it. But it only takes a minute reflecting on the minimal effectiveness of health education in changing behaviour, to work out why it might not work.

Of course policy makers, and politicians in particular, take more into account than just scientific evidence of what ‘works’ when they make decisions about what they should spend our money on. Which is where the health economists come in. If we can’t convince them with straight-up ‘what works’ arguments, perhaps we can appeal to their mercenary instincts and convince them with arguments about what might save money. But this is just more-better education.

So what can we do? My first suggestion is that instead of trying to get policy-makers to think more like scientists, us scientists need to start thinking a bit more like policy-makers. And what my loose tongued academic-turned-civil-servant-health-economist reminded me of last week, was that we don’t elect our politicians on the basis of whether or not they are the sort that might be ‘evidence-based’. We elect them on the basis of ideology.

Perhaps, the only way to change policy is to appeal to ideology. Blitz the broccoli-evidence, mix it up with some yummy-ideology, and slip it down the hatch airplane style.

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