Policy, evidence and theory; contextualising a glossary of policymaking
We welcome the glossary of theories presented last month by Smith & Katikireddi (2012) and applaud the intention to introduce wider thinking from the political sciences on these subjects to health researchers. Drawing on our practical experiences in the fields of healthcare management and health services research, we would like to identify three related areas which may also be useful for the public health audience. We suggest this commentary solely to help the glossary to be more widely used and increase its impact.
Firstly, although several useful definitions of policymaking are described, we feel that 'policy' tends to be interpreted too broadly by public health practitioners, and narrowing down the definition of policy in relation to the concepts of 'management' and 'governance' might be useful. Management' refers to the organisation and leadership of practice, and is primarily concerned with execution and implementation(Mitchell & Shortell, 2000)). 'Governance' in non-profit contexts most frequently refers to the funding and oversight roles of government agencies (Provan & Kenis, 2008). We believe that understanding the differences between policy, management and governance are essential for public health researchers to explore how public health, and indeed health services and public policy more generally operate and can be influenced. As it stands, the glossary predominantly focuses on policy, rather than management and governance. However, the theories of policymaking should not be blindly transferred to the fields of management and governance as these are often concerned with policy implementation, rather than policymaking.
Secondly, the glossary notes the existence of knowledge brokerage and policy entrepreneurship, which are part of a wider debate about how policy is made, and the role of evidence in policy making. The degree to which research evidence can, should and actually is used in policy making has been an area of extensive debate, and it is worth highlighting a number of seminal sources dealing with these issues. Nutley, Walter and Davies describe the importance of evidence use by policy makers (Nutley et al., 2007). Much of the work in this area is informed by the work of Carol Weiss (1979) with her helpful categorisation of the meanings of research utilisation into seven categories: as' knowledge-driven', 'problem solving', 'interactive' 'enlightenment', 'political',' tactical' 'instrumental', and 'research as an intellectual enterprise'(Weiss, 1979). More recently, Lomas and colleagues have contributed the 'linkage and exchange' model, focusing on relationships between researchers and policymakers, now acknowledged to be a fundamental part of knowledge translation (Lomas & Brown, 2009). Ray Pawson and colleagues have worked extensively on bringing realist interpretations to the use of evidence in policy (Greenhalgh et al., 2004; Pawson, 2006). More recently, a more critical stance about the definitions and uses of evidence has been taken by Marston and watts (Marston & Watts, 2003)) with the impact of evidence-use on population outcomes also in doubt (Macintyre, 2003).
Thirdly and finally, we note that the impetus for producing the glossary was an observation that "public health's efforts to influence policy often appear to be uninformed by the empirically-based theories about policymaking developed within social and political sciences". We welcome the focus on empirically-led theory, but questions remain about the extent to which the models and rhetoric around policymaking are indeed data-, as opposed to theory-driven. While it is true that many models of policy making exist, we believe that it is not clear whether models are employed analytically to understand empirical datasets, or tested across different scenarios. This would be a useful exercise for all researchers interested in evidence-based policy.
Greenhalgh, T., Robert, T., MAcfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. The Milbank Quarterly, 82.
Lomas, J. & Brown, A. D. M. A. (2009). Research and advice giving: A functional view of evidence-informed policy advice in a Canadian ministry of health. [References]. Milbank Quarterly., 87, 903-926.
Macintyre, S. (2003). Evidence based policy making. BMJ, 326, 5-6.
Marston, G. & Watts, R. (2003). Tampering with the evidence: A critical appraisal of evidence-based policy-making. The Drawing Board: An Australian Review of Public Affairs, 3, 143-163.
Mitchell, S. & Shortell, S. (2000). The Governance and Management of Effective Community Health Partnerships: A typology for Research, Policy and Practice. The Milbank Quarterly, 78, 241-289.
Nutley, S., Walter, I., & Davies, H. T. O. (2007). Using Evidence: How Research Can Inform Public Services. The Policy Press.
Pawson, R. (2006). Evidence-based Policy.
Provan, K. G. & Kenis, P. (2008). Modes of Network Governance: Structure, Management, and Effectiveness. Journal of Public Administration Research and Theory, 18, 229-252.
Weiss, C. H. (1979). The Many Meanings of Research Utilization. Public Administration Review, 39, 426-431.
Conflict of Interest: