LETTERS
Evidence to action needs research
Shamsuzzoha B Syed1; Adnan A Hyder
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Tikki Pang wrote a very welcome editorial that discusses what evidence is needed to strengthen the linkages between evidence generation and action in the developing world.1 Dr Pang highlights several critical areas of exploration that we would like to further clarify and share our views on.
First, we applaud the editorial's broad definition of evidence, going beyond a focus on randomized controlled trials and other strictly quantitative forms of evidence. Dr Pang mentions some excellent examples of the use of types of evidence for public health action outside the confines of such traditional forms of evidence. The categorization of these different types of evidence may be useful in further exploring evidence transfer to policy in low-income settings. One such categorization is provided by Bowen and Zwi, who divide evidence that informs policy processes into five categories research; knowledge and information; ideas and interests; politics; and economics.2 Considering each of these types of evidence when exploring the evidence-policy interface on a particular research topic, may enhance the clarity of analyses at the interface.
Second, the editorial asks three vital questions regarding evidence: can it work, will it work and is it worth it? Attempting to answer each of these questions requires cognizance of the development context within which the evidence is being considered. We would like to highlight the importance of a clear focus on multiple dimensions of development, including poverty, institutional maturation and capabilities (both at the individual and community levels) in making judgments on the three questions.
Third, the editorial suggests use of resources beyond the health sector in strengthening policy-action links, and cites an example from the vaccine field. Another example of an area of exploration ripe for transfer to the health evidence-policy arena is the conduct and utilization of stakeholder analyses to determine the strength of the evidence-policy interface. The development of these methods has been spearheaded by the environmental sector and a rich literature exists on the subject.3
Lastly, returning to the central question posed by the editorial what type of evidence is needed there is a clear need to generate evidence from the interface between evidence and decision-making itself. Calls for such exploration have gained increasing recognition in the global literature.4 Analyses of the interface are beginning to gain momentum in the public health research world an example is the multicountry research consortium (to which we belong) exploring this interface in six countries in Asia and Africa.5 Further work focusing on prospective methodological analyses of evidence-policy interfaces in the developing world is urgently required to find key leverage points to strengthen this interface. We hope to contribute to this global dialogue. 
References
1. Pang T. Evidence to action in the developing world: what evidence is needed? Bull World Health Organ 2007;85:247.
2. Bowen S, Zwi AB. Pathways to 'evidence-informed' policy and practice: a framework for action. PLoS Med 2005;2:e166.
3. Beierle TC. The quality of stakeholder-based decisions. Risk Anal 2002;22:739-49.
4. Hanney SR, Gonzalez Block MA. Building health research systems to achieve better health. Health Res Policy Syst 2006;4:10.
5. Future Health Systems. Innovations for equity. 2007; Available at: http://www.futurehealthsystems.org/index.htm.
1 Correspondence to Shamsuzzoha B Syed (e-mail: ssyed@jhsph.edu).