Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States of America.
Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.
Health Res Policy Syst. 2018 Aug 16;16(1):81. doi: 10.1186/s12961-018-0336-7.
There is often a discordance between health research evidence and public health policies implemented by the United States federal government. In the process of developing health policy, discordance can arise through subjective and objective factors that are unrelated to the value of the evidence itself, and can inhibit the use of research evidence. We explore two common types of discordance through four illustrative examples and then propose a potential means of addressing discordance.
In Discordance 1, public health authorities make recommendations for policy action, yet these are not based on high quality, rigorously synthesised research evidence. In Discordance 2, evidence-based public health recommendations are ignored or discounted in developing United States federal government policy. Both types could lead to serious risks of public health and clinical patient harms. We suggest that, to mitigate risks associated with these discordances, public health practitioners, health policy-makers, health advocates and other key stakeholders should take the opportunity to learn or expand their knowledge regarding current research methods, as well as improve their skills for appropriately considering the strengths and limitations of research evidence. This could help stakeholders to adopt a more nuanced approach to developing health policy. Stakeholders should also have a more insightful contextual awareness of these discordances and understand their potential harms. In Discordance 1, public health organisations and authorities need to acknowledge their own historical roles in making public health recommendations with insufficient evidence for improving health outcomes. In Discordance 2, policy-makers should recognise the larger impact of their decision-making based on minimal or flawed evidence, including the potential for poor health outcomes at population level and the waste of huge sums. In both types of discordance, stakeholders need to consider the impact of their own unconscious biases in championing evidence that may not be valid or conclusive.
Public health policy needs to provide evidence-based solutions to public health problems, but this is not always done. We discuss some of the factors inhibiting evidence-based decision-making in United States federal government public health policy and suggest ways these could be addressed.
美国联邦政府在制定公共卫生政策的过程中，健康研究证据与实施的公共卫生政策之间经常存在不一致。在制定卫生政策时，不一致可能会因与证据本身价值无关的主观和客观因素而产生，并会抑制研究证据的使用。我们通过四个实例探讨了两种常见类型的不一致，然后提出了一种解决不一致的潜在方法。
在不一致 1 中，公共卫生当局针对政策行动提出建议，但这些建议并非基于高质量、严谨综合的研究证据。在不一致 2 中，循证公共卫生建议在制定美国联邦政府政策时被忽视或被否定。这两种类型都可能导致严重的公共卫生风险和临床患者伤害。我们建议，为了降低与这些不一致相关的风险，公共卫生从业人员、卫生政策制定者、卫生倡导者和其他主要利益攸关方应该借此机会学习或扩大其对当前研究方法的了解，并提高其适当考虑研究证据的优势和局限性的技能。这可以帮助利益攸关方更细致地制定卫生政策。利益攸关方还应该更深入地了解这些不一致的背景情况，并了解其潜在危害。在不一致 1 中，公共卫生组织和当局需要承认自己在提出缺乏改善健康结果证据的公共卫生建议方面的历史作用。在不一致 2 中，政策制定者应该认识到基于很少或有缺陷的证据做出决策的更大影响，包括在人群层面可能导致不良健康结果和巨大浪费的可能性。在这两种类型的不一致中，利益攸关方都需要考虑自己在支持可能无效或不确定的证据时无意识偏见的影响。
公共卫生政策需要为公共卫生问题提供循证解决方案，但这并不总是能够做到。我们讨论了一些在美国联邦政府公共卫生政策中抑制循证决策的因素，并提出了一些解决这些问题的方法。
