“Evidence-Informed Health Policymaking Teaching Evidence Assimilation for Collaborative Healthcare New York Academy of Medicine, 7 August 2014 Andy Oxman, Global Health Unit Norwegian Knowledge Centre for the Health Services

What is evidence? “Evidence concerns facts (actual or asserted) intended for use in support of a conclusion.” –A fact is something known by experience or observation. –Evidence is used to support a conclusion; it is not the same as the conclusion.

What is the role of evidence in policy and practice? The role of evidence is to inform policy and practice Evidence is essential, but not sufficient Judgements are needed, including judgements about confidence (the certainty of the evidence), what to expect in a specific setting, equity and trade-offs

What is evidence-informed health policymaking? An approach to policy decisions that aims to ensure that decision making is well-informed by the best available research evidence Characterised by access to, and appraisal of, evidence as an input into the policymaking process that is –Systematic to ensure that relevant research is identified, appraised and used appropriately –Transparent so that others can examine what research evidence was used to inform policy decisions, as well as the judgements made about the evidence and its implications

Comments or questions about what evidence, its role in policymaking or what evidence-informed health policy is?

Determinants of EIHP An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research

Strategies to facilitate EIHP An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research Priority settingCapacity buildingPublic understanding Monitoring and evaluation

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research Priority settingCapacity buildingPublic understanding Monitoring and evaluation Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research Priority settingCapacity buildingPublic understanding Monitoring and evaluation Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research Priority settingCapacity buildingPublic understanding Monitoring and evaluation Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research Priority settingCapacity buildingPublic understanding Monitoring and evaluation Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Clearing housesPolicy briefsRapid response servicesCapacity building Generation of relevant and reliable research

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Clearing housesPolicy briefsRapid response servicesCapacity building Generation of relevant and reliable research Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Clearing housesPolicy briefsRapid response servicesCapacity building Generation of relevant and reliable research Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Clearing housesPolicy briefsRapid response servicesCapacity building Generation of relevant and reliable research Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Access to research Clearing housesPolicy briefsRapid response servicesCapacity building Generation of relevant and reliable research Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Experience Training re the value of evidence Examples / stories Informing and engaging stakeholders Access to research Generation of relevant and reliable research

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Interest and motivation to use research Experience Training re the value of evidence Examples / stories Informing and engaging stakeholders Access to research Generation of relevant and reliable research Strategies to facilitate EIHP

An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Technical support Capacity building Design of implementation strategies Evaluation of implementation strategies Interest and motivation to use research Access to research Generation of relevant and reliable research

Strategies to facilitate EIHP An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Technical support Capacity building Design of implementation strategies Evaluation of implementation strategies Interest and motivation to use research Access to research Generation of relevant and reliable research

Strategies to facilitate EIHP An environment that is supportive of evidence-informed health policymaking Ability to use research and implement change Technical support Capacity building Design of implementation strategies Evaluation of implementation strategies Interest and motivation to use research Access to research Generation of relevant and reliable research

Strategies to facilitate EIHP An environment that is supportive of evidence-informed health policymaking Policy dialogues Political structures and processes Requirements for evaluationEvaluation Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research

Strategies to facilitate EIHP An environment that is supportive of evidence-informed health policymaking Policy dialogues Political structures and processes Requirements for evaluationEvaluation Ability to use research and implement change Interest and motivation to use research Access to research Generation of relevant and reliable research

There are many reasons why decision makers may not access and use high quality health system and public health evidence. Strategies to address each of those are needed.

“Both politically, in terms of being accountable to those who fund the system, and also ethically, in terms of making sure that you make the best use possible of available resources, evaluation is absolutely critical.” Dr Julio Frenk, Minister of Health, Mexico

Final message Both policymakers and researchers must continue struggling to help ensure that judgments about health policies are well informed by research evidence The alternative is to acquiesce to poorly informed health policies Informing Judgment: Case Studies of Health Policy and Research in Six Countries. Milbank Memorial Fund, September

Comments or questions?