The Report focuses on bridging of the "know do" gap, the gulf between what we know and what we do in practice, between scientific potential and health realization. The bridging of this gap is central to achieving the health-related Millennium Development Goals (MDG’s) by 2015. The gap exists for each of the MDG’s and represents a fundamental and pragmatic knowledge translation challenge that must be addressed to strengthen health systems performance towards achieving the MDG’s. The Report will expound the message that we must turn scientific knowledge into actions, which improves people’s health, and that health improvement through knowledge applications is a critical factor in human development and alleviation of ill-health and poverty worldwide.
Monitoring equity and research policy
Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research. Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. Civil society organizations (CSOs) are already at the forefront of such research.
This article from the Bulletin of the World Health Organization highlights health inequities both between and within countries, and how this is reflected in research, focusing on poverty and gender. The authors argue that there has been little research into the social causes of ill-health among groups, or factors affecting health inequity that are beyond the control of the individual. They highlight the publication bias in medical journals, where research into diseases that most affect the poorest people is often less likely to be published.
Health systems constraints are impeding the implementation of major global initiatives for health and the attainment of the Millennium Development Goals (MDGs). Research could contribute to overcoming these barriers. An independent task force has been convened by WHO to suggest areas where international collaborative research could help to generate the knowledge necessary to improve health systems. Suggested topics encompass financial and human resources, organisation and delivery of health services, governance, stewardship, knowledge management, and global influences. This article from The Lancet medical journal is part of a wide-ranging consultation and comment is invited. (Registration is required to access this article.)
This new collection turns a critical anthropological eye on the nature of health policy internationally. The authors reveal that in light of prevailing social inequalities, health policies may intend to protect public health, but in fact they often represent significant structural threats to the health and well being of the poor, ethnic minorities, women, and other subordinate groups. The volume focuses on the "anthropology of policy," which is concerned with the process of decision-making, the influences on decision-makers, and the impact of policy on human lives. This collaboration will be a critical resource for researchers and practitioners in medical anthropology, applied anthropology, medical sociology, minority issues, public policy, and health care issues.
"In today's cost-conscious health care environment, translating evidence-based quality innovations into clinical practice is a challenge. Limited resources mean providers and health systems must follow proven methods for diffusing and adopting effective interventions.” For this study, the authors conducted case studies of four varied clinical programs to learn key factors influencing the diffusion and adoption of evidence-based innovations in health care.
This paper examines some recent yardsticks used to sort the evidential sheep from the research goats by questioning why, how and when such research standards should be brought to bear. It concludes that the drive to cast standards as formal checklists of quality indicators is premature, and that appraising quality is not and cannot be a technical preliminary to research synthesis. Open and critical debate on the interpretation of research findings remains the surest way to establish and maintain investigatory standards.
The use of international comparisons is an essential element of modern, professional policy making. Looking abroad to see what other governments have done can point us towards a new understanding of shared problems; towards new solutions to those problems; or to new mechanisms for implementing policy and improving the delivery of public services. This toolkit pack is intended to provide help and guidance in the use of international comparisons in policy making.
Health impact assessment differs from other purposes for which evidence is collated in a number of ways. This has implications for commissioning and conducting reviews. Methods must be developed to: facilitate comprehensive searching across a broad range of disciplines and information sources; collate appropriate quality criteria to assess a range of study designs; synthesise different kinds of evidence; and facilitate timely stakeholder involvement. Good practice standards for reviews are needed to reduce the risk of poor quality recommendations. Advice to decision makers must make explicit limitations resulting from absent, conflicting, or poor quality evidence.
"...As studies have shown, evidence is rarely applied to decision making in accordance with a rational, linear model. In practice, evidence is often generated through doing – in the enactment of policy. Evidence may be only one component of any decision making process, but it can be made an integral part of a culture of inquiry based on continual learning and development. Leaders and managers need to appreciate the complex relationship between research evidence and practice, and to ensure the right conditions are created to allow practitioners to reflect on, and learn from, the practice of what they do and how they do it. In this way, learning becomes a supply of evidence to be drawn on as practitioners continue to implement and reshape policy..."