Elsevier

The Lancet

Volume 364, Issue 9445, 30 October–5 November 2004, Pages 1615-1621
The Lancet

Series
Use of research to inform public policymaking

https://doi.org/10.1016/S0140-6736(04)17317-0Get rights and content

Summary

To improve health and reduce health inequalities, public policymakers need to find the best solutions to the most burdensome health problems, the best ways to fit these solutions into complex and often overstretched and underresourced health systems, and the best ways to bring about the desired changes in health systems. Systematic reviews can inform public policymaking by providing research-based answers to these questions. Public policymakers can encourage more informed policymaking by asking to see systematic reviews on priority issues, commissioning reviews when none exists, and placing more value on such work in their deliberations and in their interactions with stakeholders. Donors and international agencies can encourage more informed public policymaking by supporting national and regional efforts to undertake reviews and assess their local applicability, and by supporting regional or worldwide efforts to coordinate review and assessment processes.

Section snippets

Challenges faced by public policymakers

Improving health and reducing health inequalities, whether in general or in the specific domains implicated by the millennium development goals, constitutes a daunting task for public policymakers.3, 4 Three questions need to be answered: (1) what are the best solutions to the most burdensome health problems; (2) what are the best ways to fit these solutions into complex and often overstretched and underresourced health systems; and (3) what are the best ways to bring about the desired changes

Recognising differences in health systems

Public policymakers are likely to ask two questions when faced with the results of a systematic review of health systems research (ie, investigations addressing a second-order or third-order question), especially when no research from their country was included in the review: (1) what can be expected if the same thing is done in our country, and (2) what can be expected if things are done differently? An appreciation of the importance of context often leads investigators to answer that they do

Improving the outlook

Public policymakers, donors, and international agencies can take several steps to raise the likelihood that high quality, locally applicable systematic reviews will inform public policymaking and decisions about funding for more (or different types of) research. Public policymakers can encourage more informed policymaking by asking to see systematic reviews on priority issues, ensuring that these reviews are commissioned when none exist, and placing more value on them in their deliberations and

Conclusion

Politics will always have a role in public policymaking but improving health and reducing health inequalities in low-income and middle-income countries (and indeed in high-income countries) will be made a bit easier if high quality, locally applicable reviews are considered in the policymaking process. If anything, we have underestimated the potential for systematic reviews of health systems research. We have focused on instrumental uses of such work made possible by reviews that answer

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