Date: Tuesday, 23 March 2010 Time: 10.30am-12pm Venue: Seminar Rooms 2 and 3, S. Rajaratnam School of International Studies (RSIS), Nanyang Technological University, S4, Level B4

Click play to listen to the audio recording of the seminar.

Speaker: Dr Tikki Pang, Director, Research Policy and Cooperation, World Health Organization

Chairperson: Amb. Barry Desker, Dean, RSIS

INTRODUCTION

No policymaker wants to make bad policy and most policymakers know that good policies should be informed by scientific evidence. This was the argument put forth by Dr Tikki Pang at his seminar on Knowledge Translation – The Bumpy Road from Research to Policy. Policymakers often wonder if researchers "have anything useful and relevant" to say and to offer in this critical task. Researchers, on the other hand often wonder “why can't they hear us?" and do not appreciate that scientific evidence is only one factor in policymaking. This disconnect highlights the 'know-do' gap between 'knowing' and 'doing' which exists between these two constituencies. However, a narrowing of this gap can lead to positive, dramatic results. The purpose of this seminar was therefore to find ways to strengthen linkages between the two to ensure that the benefits of research are effectively used to improve health outcomes.

PRESENTATION

Bridging the Gap between Research and Policy

Bridging the gap between research and policy or between ‘knowing’ and ‘doing’ is particularly important for a world currently faced with major, multiple and diverse health threats, and with a global financial crisis. Specifically, challenges to global health include outbreaks of pandemics and infectious diseases, chronic diseases, increasing antibiotic resistance, market failures in developing medicines for diseases of the poor, the health impact of climate change, weak healthcare systems in developing countries etc. Dr Pang noted that although there is an increasing awareness of the challenges faced by global health, precious little attention is given to 'research on research', which includes the important question of how science can inform the development of effective policies to ensure that medical interventions reach those in greatest need.

The purpose of research, he reiterates, is to discover and produce better drugs, vaccines and diagnostics, inform decisions and policymaking, help change behaviour in response to diseases, empower people etc. Dr Pang singled out systematic reviews as (arguably) one of the most important drivers of effective research. A systematic review is a literature review focused on a single question, and that tries to identify, appraise, select and synthesise all high-quality research evidence relevant to that question. Systematic reviews of high-quality, randomised controlled trials are crucial to evidence-based medicine. An understanding of systematic reviews and how to implement them in practice is becoming mandatory for all professionals involved in the delivery of health care. Systematic reviews, however, are not limited to medicine and can be applied in a broad range of fields.

Problems and Challenges

The reason for the existing gaps between research and policy is the different mindsets and attitudes of researchers and policymakers. Moreover, researchers are also increasingly becoming more concerned with individual patents and royalties and less about whether or not their research evidence is translated into policy. The gaps that exist between policymakers and researchers are best illustrated by the following contrasting points:

• Policymakers are interested in complex policy problems whereas researchers are interested in the simplification of problems
• Policymakers are interested in reducing uncertainties whereas researchers are interested in finding the truth
• Policymakers are interested in the speed with which policies can be delivered and implemented whereas researchers need time to think and produce research evidence.
• Policymakers are interested in manipulation whereas researchers are interested in explanations
• Policymakers are interested in feasible and pragmatic solutions while researchers are interested in thoughtful deliberations

To narrow this gap, lessons can be drawn from success stories of evidence informing policies as discussed below.

Success Stories: What Happens When Evidence Inform Policies?

a. International Level: WHO Framework Convention on Tobacco Control

The WHO Framework Convention on Tobacco Control (WHO FCTC) was the first treaty negotiated under the auspices of the World Health Organization. It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. It has since become one of the most widely embraced treaties in UN history and as of today, it has 168 Parties signed to it. The WHO FCTC was developed in response to the globalisation of the tobacco epidemic and is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. The convention aims to discourage demand for tobacco by employing price and tax measures as well as non-price measures. It also aims to reduce the supply of tobacco by banning or penalising illicit trade in tobacco products, preventing the sale of tobacco to and by minors, and by supporting economically-viable alternative trade activities and industries.

b. National Level: Thailand’s 30-Baht Universal Coverage Scheme

In 2001, the Government of Thailand introduced a universal coverage scheme with the aim of ensuring equitable health care access for even the poorest citizens. For a flat user fee of 30 Baht per consultation, or for free for those falling into exemption categories, every scheme participant may access registered health services. The exemption categories include children under 12 years of age, senior citizens aged 60 years and above, the very poor, and volunteer health workers. The main objectives for universal coverage are equity i.e. the equal sharing of health care expenditure and the equity of access to the same quality of health services; efficiency i.e. the efficient use of resources by good administrative and management practices; choice i.e. people have the right to choose their health services in order to reduce the problem of an imperfectly competitive market; and good health for all i.e. universal healthcare coverage aims not only to provide curative care but also to prevent disease and promote health where appropriate.

c. Community and District Level: Tanzania Essential Health Interventions Project

The Tanzania Essential Health Interventions Project (TEHIP), launched in 1997, is a research and development partnership involving Tanzania's Ministry of Health and Canada's International Development Research Centre. The project's goal is to determine the feasibility of an "evidence-based" approach to health planning – an approach whereby decisions on how to allocate scarce health care resources are made based on information obtained locally rather than on the unproven assumptions of a central agency – and measure its impact. TEHIP's basic premise, in other words, is that the health of a population can be improved, not just by spending more money, but by spending money more wisely, according to where the needs are greatest.

Future Outlook: Light at the End of the Tunnel

There has been a growing realisation among researchers of the need to collaborate with policymakers and the benefits that accrue from such collaborations. At the same time, there is also an expansion of a pool of knowledge relevant for policymaking. All of these have led to growing attention on policymaking structures and tools so as to create capacities to absorb and make use of research evidence. Further suggestions include:

• Developing a strong evidence-informed culture
• Ensuring accountability, implementation, evaluation and enforcement
• Building the right capacity and trust
• Establishing individual, sustainable, responsive platforms for dialogue and distribution
• Undertaking more relevant research including research and methodology.

Discussion

1. Effective Use of Research Evidence

Concern was raised over the use of research findings by policymakers when they deliver statements such as “research shows that….” This is nothing, some argued, but an attempt on the part of policymakers to abdicate responsibility and accountability. To avoid such manipulation of research evidence, it is important for the general public to understand that uncertainties are also part of science. As such, they should question whether such statements refer to one particular strain of evidence, two strains of evidence, or a body of research evidence. The use of systematic reviews in analysing such claims can help distil the truth of such policy statements.

2. Building Structures

Structures are important in bridging the gap between ‘knowing’ and ‘doing’. This, however, differs from country to country. Factors such as autonomy, inclusiveness, and incentives can contribute positively in bridging the gap between researchers and policymakers. The American and Canadian practice of “in-and-out” is especially instructive as a way of bridging the gap. The US establishes numerous fellowship schemes through which policymakers and researchers “switch roles” on a regular basis. This allows policymakers and researchers to understand better the nature and limitations of one another’s jobs. Thailand is another good example. The country’s two primary research institutes maintain a degree of autonomy from the government. They however provide a space for healthy interactions between policymakers and researchers and this bodes well for the translation of research evidence into effective policies. Exchanges between policymakers and researchers can also be better facilitated by “knowledge brokers” who are familiar with the work of both policymakers and researchers and who are able to play the communicator role between both sides effectively.

ABOUT THE SPEAKER

Dr Tikki Pang is presently the World Health Organization’s (WHO’s) Director of Research Policy and Cooperation based in Geneva, Switzerland. Prior to joining WHO, he was Professor of Biomedical Sciences, at the Institute of Postgraduate Studies and Research, University of Malaya, Kuala Lumpur, Malaysia.

He holds a PhD in Immunology-Microbiology from the Australian National University, Canberra, Australia. He is a Fellow of the Royal College of Pathologists (UK), the Institute of Biology (UK), the American Academy of Microbiology (USA), the Academy of Medicine of Malaysia, and the Academy of Sciences for the Developing World (TWAS); and a Member of the International Molecular Biology Network (IMBN). Also, he is currently Secretary of the WHO Research Ethics Review Committee, and Secretary of the WHO Advisory Committee on Health Research.

Dr Pang has published more than 200 scientific articles and 7 books. His research interests are in epidemiology, pathogenesis, laboratory diagnosis and prevention of infectious diseases, and in health research policy, health research systems, best practices in research, development of research capabilities in developing countries, and linkages between research and policy.