Taking Politics Seriously: Rethinking Knowledge Translation for Public Health Policy

1. Taking Politics Seriously: Rethinking Knowledge Translation for Public Health Policy Presentation to the Public Health ISHSP Seminar – Evidence to Policy McGill University April 19, 2017 Patrick Fafard Global Strategy Lab / Graduate School of Public and International Affairs University of Ottawa

2. Key messages • KT approaches are rarely designed for diffused decision-making, institutional hierarchies, and policy networks. • Effective KT for policy should be tailored to the size and breadth of the intended audience. • Effective KT should also reflect different policy contexts and dominant policy instruments.

3. My presentation today • From KT 1.o to KT 3.0 – • On the need to define policy maker • On the importance of policy instruments • On the importance of policy advisory systems

4. From KT 1.0 to KT 2.0 Success of conventional KT • Better clinical practice • Better healthcare programs • Better public health campaigns

5. From KT 1.0 to KT 2.0 Conventional tools • Plain language summaries • Knowledge brokers • “Integrated KT” • Etc.

6. But … KT for policy is a challenge (1)

7. But … KT for policy is a challenge (1) • For political science and other social sciences the question becomes not: “ ‘why is policy not evidence-based?’ but, ‘why would we ever assume it could (or even should) be?’ ” (Smith 2013: 4).

8. What is missing? • Policy is more than evidence • The primacy of politics • The complexity of the policy making process

9. What is missing? Conventional KT tools and techniques cannot effectively contribute to public health policy making

10. Define “policy maker” • “Few studies provide clear definitions of policy, evidence or policymaker” (Oliver et al. 2014).

11. Policy is not made by individuals • “the vast majority of work attempting to promote evidence us through knowledge transfer mechanisms has considered strategies targeting individuals” (Parkhurst 2016, 31).

12. Policy is made by groups

13. Policy is made by groups – who will disagree

14. … and will manipulate evidence Oreskes and Conway 2010 Michaels 2008

15. Audience breadth:policy is made in a hierarchy …

16. Policy Hierarchy: dept& gov’t • Limits of KT that focuses on: • Lower-level specialists • Only the Department of Health or public health staff

17. Policy Hierarchy: dept& gov’t • Limits of KT that focuses on: • Lower-level specialists • Only the Department of Health or public health staff or ignores: • Ministers and their staff • Other governments/ international organizations

18. Policy Hierarchy: dept& gov’t • Limits of KT that focuses on: • Lower-level specialists • Only the Department of Health or public health staff or ignores: • Ministers and their staff • Other governments/ international organizations All of whom have somewhat different objectives and perspectives

19. Policy Hierarchy: different questions Health: • will the improve population health… Final decision: • will it improve the budget situation? • give autonomy to people? • promote economic growth?

20. Policy Hierarchy: sugar-sweetened beverages (SSBs) • Not enough to show that SSBs are a cause of obesity

21. Policy Hierarchy: sugar-sweetened beverages (SSBs) • KT to specialist health staff: It’s about health • KT to senior health department staff … staf of other departments: It’s about health ... and jobs, growth, votes, foreign policy, etc.

22. Policy Networks

23. Policy Networks The most influential policy networks are made of insider groups, “acceptable to government, responsible in their expectations, and willing to work with and through government. … They are consulted before documents are sent out for consultation. They don't lobby. They have lunch.” (Rhodes 2006).

24. Policy Networks Networks can be variably: • open and closed • dominated by government • in competition with one another test • SSB taxation network: • Big soda - distort the evidence • Dept. of industry - resist regulation • Dept. of Finance -resist / change tax policy options

25. Policy Networks: SSBs Networks can be variably: • open and closed • dominated by government • In competition with one another • SSB taxation network: • Big soda - distort the evidence • Dept. of industry - resist regulation • Dept. of Finance -resist / change tax policy options

26. Policy Hierarchy/ Networks: sugar-sweetened beverages (SSBs) • KT from academics to public health staff in the Department of Health even if a “success” … • … will have minimal policy influence

27. Policy “Instruments”

28. Policy “Instruments” • To “do stuff” governments choose one or more policy “instruments”: • Money – taxes; subsidies • Voice – public education; parliamentary debate • Law – regulation; statute

29. KT needs to be tailored to policy instruments • Legislation/ regulation • Highly codified / relatively slow /somewhat transparent • Likely rules about what constitutes evidence • Spending/ taxation • Much less transparent / decisions can be made quickly • Less clear what constitutes relevant or influential evidence

31. Policy “Instruments”

32. Policy Advisory Systems • KT activities do not occur in isolation of other attempts to influence policy • KT happens in parallel to other attempts to proffer policy advice • Systems of evidence advice (Parkhurst 2016) • Policy advisory systems (Craft and Wilder 2015) • Knowledge brokering systems/ platform (Lavis 2013)

33. Policy Advisory Systems

34. Policy Advisory Systems

35. Policy Advisory Systems

36. Policy Advisory Systems

37. Policy Advisory Systems

38. Policy Advisory Systems Vary Relatively closed • Advice on choice of annual influenza vaccine Test

39. Policy Advisory Systems Vary Relatively closed • Advice on choice of annual influenza vaccine Relatively open: • Advice on childhood obesity

41. By way of conclusion • Policy will continue to appear to be ‘irrational’ based on things other than the best-available research evidence. • In a democracy that is as it should be

42. By way of conclusion • KT for public health policy … • requires more than engagement with a single person • more than engagement with the health sector • must adapt to the policy network • must be adapted to the dominant policy instrument • must be seen as part of a policy advisory system

43. Thank you! / Merci! Patrick Fafard Associate Director Global Strategy Lab/ Associate Professor Graduate School of Public and International Affairs University of Ottawa pfafard@uottawa

44. Questions? Je ne cherche pas à connaître les réponses, je cherche à comprendre les questions. Confucius

45. Additional Slides

46. High Level Argument • “politics is much more than an undesirable and largely unexamined independent variable invoked to explain the gap between what governments do and what the research evidence says government should do” • “policy-making is an inherently political process that cannot be reduced to maximizing the take-up of relevant research evidence”

47. References • Jonathan Craft and Matt Wilder, “Catching a Second Wave: Context and Compatibility in Advisory System Dynamics,” Policy Studies Journal, 2015. • JN Lavis, Permanand, G, Catallo, C, BRIDGE Study Team, 2013, How can knowledge brokering be better supported across European health systems, Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies (Policy Brief No 16, BRIDGE SeriesDavid Michaels, Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health, 1st ed. (Oxford University Press, 2008). • Justin O. Parkhurst, The Politics of Evidence: From Evidence-based Policy to the Good Governance of Evidence (Abingdon, Oxon ; New York, NY: Routledge, 2017).

48. References (suite) • Kathryn Oliver, Theo Lorenc, and Simon Innvær, “New Directions in Evidence-based Policy Research: a Critical Analysis of the Literature,” Health Research Policy and Systems 12, no. 1 (2014). • Naomi Oreskes and Erik M. Conway, Merchants Of Doubt (Bloomsbury US, 2010). • R A W Rhodes, “Policy Network Analysis,” in The Oxford Handbook of Public Policy, by Michael Moran, Martin Rein, and Goodin, Robert E. (New York: Oxford, 2006), 425–47. • Katherine Smith, Beyond Evidence Based Policy in Public Health, The Interplay of Ideas (Palgrave Macmillan, 2013).