Legislators learning to interpret evidence for policy

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Science  12 Sep 2014:
Vol. 345, Issue 6202, pp. 1244-1245
DOI: 10.1126/science.1256911

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Should decision-makers allocate budgets for health services, using the best available evidence? Although the answer seems obvious, most resource allocation is unrelated to evidence of what works best. The well-recognized knowledge-to-action gap (1) has spawned a complex industry of lobbying and knowledge translation. Bridging the gap is a business opportunity for lobbyists, who help to translate evidence in ways that best present a particular interest. Partly to offset these selective, if not frankly biased, interpretations, the last decade has seen an industrial-scale thrust toward systematic reviews to synthesize available evidence (2, 3). But systematic reviews mostly systematize what has been published. For many decisions on health services, there is simply no evidence with the quality one gets from a randomized controlled trial (RCT). Thus, policy decision-makers have to find their way through evidence of varying quality and relevance, only rarely packaged to clarify the population health impact of different choices. A 2012 international forum on evidence-informed health policy-making in low- and middle-income countries called for building the capacity of potential research users to evaluate and use research evidence (4). There are, of course, many levels of research users among health policy-makers and decision-takers. To date, initiatives to build the capacity of research users to interpret evidence have not included actual legislators themselves; instead, they target technical officers and advisers on the assumption that they will then advise the elected representatives appropriately (5). We will describe an effort to help legislators themselves understand the elements of the evidence they need to make decisions (6).