Bridging policy and research in public health and health psychology

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Bridging the gap between research and policy

Working together for better outcome

Jim McManus

Director of Public Health

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The Issue

• Evidence – based policy or policy based evidence?

• Policy driven research or theory driven research?

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The Problem

• Outcomes Frameworks

• Connecting evidence with outcomes

• Connecting evidence with interventions

• Interests of policymakers and interests of researchers

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Levels

• Policy – finding evidence of effectiveness when often evidence of interventions lacking

• Practice – finding evidence salient enough to apply. Critical research, search and appraisal skills.

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The Problem

• Public Health is a long game

• Research is a long game

• Public sector agencies want short answers and quick results

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Communication - Writing style as an example

Academic

• Heavily referenced

• Third person

• Passive voice

• Tentative conclusions

Local Govt

• Active voice

• Summaries

• Recommendations

• Costings

• Policy options

• Impact measurements

• Feasibility

• risk

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Mapping the Policy Process

• General Context issues – domestic and international.

• Specific Policy Issues (i.e. the policy cycle)

• Who are the Stakeholders? (Stakeholder analysis)

– Arena: government, parliament, civil society, judiciary, private sector.

– Level: local, national, international

• Process matrix + political influence ratings

• What is their Interest and Influence?

[Sources: M. Grindle / J. Court ]

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The problem with our training

• Often trained as scientists or clinicians not as policymakers

• Bringing the scientific process and policy process together

• Where evidence is silent – “in the lab”

• “Pracademics”

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Ontario Drug Programme (Khan et al,2014)

http://dx.doi.org/10.1016/j.healthpol.2014.06.007

• Policymakers have cited barriers to using evidence, including lack of research relevance and timeliness.

• .Although reports often demonstrate an increase in research relevance, rarely do they provide concrete methods of enhancing research timeliness

• . Additionally, the impact of researcher–policymaker collaborations is not well-discussed.

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ARIF – Birmingham, Aggressive Research and

Intelligence Facility

• Rapid

• Horizon Scanning

• Responsiveness to commissioners

• Establish an agenda

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Major issues for academic work to be adopted

• What approaches enable politicians to be comfortable publicly and privately with scientifically led interventions and programmes in public services for highly vulnerable populations?

• How do we get political buy-in to spend and investment against a background of 25% reduction in spend?

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Starting Points

• Commissioners and local politicians essentially make policy at local level.

• They are – or ought to be – big customers of evidence from academic research

• Some issues in concerns of both academics and commissioners which, whilst legitimate, can act as barriers to others

– Academia seen as status conscious, research takes years

– Commissioners find implementation sometimes difficult

– Academics find commissioners unresponsive or want things too quickly

• The research process and policy process are usually not well articulated to each other

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Both academics and policymakers seem to want

• Greater use of evidence in priority setting and programme work

• Re-assuring political sensitivities

– Prevention and Prioritisation can deliver

• “Evidence in the real world”

– Clear roadmap for combining evidence with political aspirations of elected politicians

• Did it work?

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Methods – Policy Case Study

• Identification of candidate projects to demonstrate benefits of increasing use of scientific/public health approaches

• Trialling different ways of enabling politicians to

• Parallel semi-structured assessments of officers and politicians in acceptability and utility

• Financial assessment of benefits to organisation led by Finance

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Mapping the Policy Process

• General Context issues – domestic and international.

• Specific Policy Issues (i.e. the policy cycle)

• Who are the Stakeholders? (Stakeholder analysis)

– Arena: government, parliament, civil society, judiciary, private sector.

– Level: local, national, international

• Process matrix + political influence ratings

• What is their Interest and Influence?

[Sources: M. Grindle / J. Court ]

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Context Assessment – Policy Process

1. Problem Definition/

Agenda Setting

2. Constructing the Policy

Alternatives/ Policy Formulation

3.Choice of Solution/

Selection of Preferred Policy Option

4. Policy Design

5. Policy Implementation

and Monitoring

6. Evaluation

The Policy Cycle

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Writing Effective Policy Papers

Providing a solution to a policy problem

The policy community

• The policy process

• Structural elements of a paper

– Problem description

– Policy options

– Conclusion

• Key issues: Problem oriented, targeted, multidisciplinary, applied, clear, jargon-free.

[Source: Young and Quinn, 2002]

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Writing Effective Policy Papers

Option A Option B Option C

Effectiveness Very Positive Positive No impact

Flexibility Very Positive Positive Positive

Sustainability Positive Positive Negative

Political Feasibility High Medium Low

Administrative

Feasibility

High Medium Low

Time Short Medium Long

Cost High Medium Low

Criteria for Assessing Policy Options

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Questions from Councillors and

Commissioners

• Assurance – how do we know your idea is any better?

• Scientific evidence alone rarely satisfies politicians when there is large financial risk

• Deficit models – scientists assume we do not understand science

• Early success and political cycle

• Accountabilty – “we may well understand you, we just have other priorities”

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What Politicians/Commissioners really want

from academic research

• Implementability

• Assurance of quality of work and evidence

• Assurance of financial risk

• Scientific evidence alone rarely satisfies politicians when there is large financial risk

• Deficit models – academic should not assume commissioners do not understand science, commissioners should not assume academics do not understand implementation

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Suggested Approaches

• Getting to know each other and build relationships

• “Think and do” tanks combining academics and policymakers on research priorities

• Summary business cases addressing evidential and assurance issues

• “So what” briefs about your research written by politicians for other politicians

• User and citizen co-production of proposals

• Independent statement or scrutiny

• Early warning and debate before going into public domain for decision

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The Big Question...

• How do academics get buy in for longer term solutions when there is a need for short term delivery

Tentative Hypothesis...

• The assurance that comes from quick

wins and early signs an approach works

builds political confidence in longer-term

approaches