Understanding the Connects and Disconnects Between Evidence, Policy, and Practice in Public Health

Implementing public health evidence into policy and decision-making can be challenging for policy-makers. This article explains the disconnect between evidence, policy, and practice and how it can be addressed.

By: Larissa DellaVentura

Larissa DellaVentura is an MBA and MPH student at Brock University in St. Catharines, Ontario.

Public health professionals such as policy-makers and government officials are often confronted with the task of using the best available evidence to guide their decision-making in policy and clinical practice. This can be challenging for public health professionals due to several contextual and system-level factors such as funding and power dynamics. The purpose of this article is to define evidence-informed decision-making; to understand the disconnect between evidence, policy and practice; and to examine how this disconnect can be addressed.

What is evidence-informed decision-making?

Evidence-informed decision-making is a systematic approach to gathering, synthesizing, and evaluating research evidence, while also considering important factors such as context and public opinion. There are many types of research evidence available each with their own strengths and limitations. Some examples include randomized controlled trials (whereby participants are randomized to either a treatment or comparison group to understand the effectiveness of a particular treatment) and systematic reviews, which summarize all existing research on a particular topic in order to address a specific research question. Figure 1 below illustrates the hierarchy of research evidence.

World Health Organization (WHO). “Evidence, policy, impact. WHO guide for evidence-informed decision-making.” Geneva. Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/publications/i/item/9789240039872

Understanding the disconnect between evidence, policy, and practice

Public health consists of three independent but related domains. These include:

Research: which refers to the development and assessment of various treatment options to improve a health outcome, deemed interventions, by researchers.
Policy: defined as regulations and procedures which guide the delivery of services and allocation of resources, and
Practice: which refers to the implementation of policies, leading to social change and service delivery.

Public health professionals understand that research evidence strengthens policy which, in turn, informs practice. An example of this might include research around the effectiveness of vaccines informing mandatory vaccination policies for COVID-19 and other infectious diseases. For evidence to support policy and practice, it is imperative that scientists clearly communicate research findings to key knowledge users such as the general population, policy-makers, or other researchers – a process often referred to as knowledge translation. Examples of knowledge translation include articles published in academic journals (where other researchers can access the study results), academic or medical conference posters, and workshops.

However, factors such as budgetary constraints, political instability, and power struggles often hinder an organization’s ability to implement effective knowledge translation strategies. Additional barriers to effective knowledge translation include context and complexity. The field of public health is centered around the health of the population whereas healthcare is primarily focused on the health of individuals. In addition, there are several actors both within and outside of the health sector with whom public health professionals need to interact such as policy-makers at various levels of government and other researchers. These two factors add to the complexity of the field and can make evidence-informed decision-making more challenging. In addition, public health is often considered to be an independent entity in the context of the relationship between research, policy, and practice. Research often takes place within universities and other academic institutions whereas policy and practice primarily take place within government Ministries and other agencies. Furthermore, it is not uncommon for an academic to have never worked in the public health field. Funding panels which are primarily composed of academics add to this pre-existing separation.

How the evidence-policy gap can be addressed

Despite the apparent challenges associated with effectively integrating evidence into policy and practice, there are several actions that can be taken to address the gap between evidence, policy and practice. The World Health Organization classifies these into several categories: i) organizational resources including material and human resources, and managerial support, ii) policy-maker and practitioner characteristics including research skills and awareness and values and experiences regarding research iii) research and researcher characteristics which includes the relevance of research to policy and practice iv) policy characteristics including political influences and guidelines which promote evidence-informed decision-making, and v) contact relationships between research producers and users including effective collaboration and mutual trust and respect. Figure 2 below further defines each of these factors.

Other strategies to overcome this disconnect include the direct involvement of public health practitioners and public health academics on key political issues. In addition, The Canadian Government has established six National Collaborating Centers (NCCs) across the country. Figure 3 below shows each of the six NCCs across Canada.

Dubois A & Lévesque M. Canada’s National Collaborating Centres: Facilitating evidence-informed decision-making in public health. Canada Communicable Disease Report. 2020;46(2-3): 31-35. https://doi.org/10.14745/ccdr.v46i23a

These are organizations which work together to summarize and translate knowledge to make it more accessible for policy-makers and public health practitioners. The closest NCC to the University of Toronto (U of T) is the National Collaborating Center for Methods and Tools (NCCMT) located in Hamilton, Ontario. The NCCMT offers a repository of tools and resources to guide public health professionals in the process of evidence-informed decision-making. The issuing of funding and other incentives for appointments of public health professionals in academics and vice-versa, on-the-job applied training for public health professionals, enhanced collaboration between public health researchers and knowledge users will also help to bridge the gap between evidence, policy, and practice.

In considering the evidence presented in this article, it is apparent that there are many factors which complicate the process of evidence-informed decision-making in practice. However, there are also several strategies and resources which can be utilized to help overcome the disconnect between evidence, policy, and practice. Understanding this disconnect will ultimately lead to policy and practice decisions which are more deeply rooted in evidence which will in turn lead to improved population health outcomes.

Disclosure statement: The author declares no financial conflicts of interest. The author is an MBA/MPH student at Brock University. All opinions and views presented herein are those of the listed author and are supported by the references listed.