DEBATE DEBATE

Debate on the paper by Celia Almeida & Ernesto Báscolo

Debate sobre el artículo de Celia Almeida & Ernesto Báscolo

Michael Thiede

Health Economics Unit, University of Cape Town, Cape Town, South Africa. mthiede@heu.uct.ac.za

"Talk of bulls": a comment on Almeida & Báscolo

The question of how health systems research is and may be used in policy decision-making has been the subject of numerous learned articles and international workshops. The ways in which the so-called research-to-policy transfer is viewed or modeled often reflects the academic discipline and ideological background of the authors. The most obvious differences exist between the rational or linear models of the relation between research and policy on the one hand, and the complex, indirect and not necessarily logical models on the other. The paper by Almeida & Báscolo provides an excellent overview of different approaches and analytical frameworks to describe and learn from the interactions of research and policy. Almeida & Báscolo do not conceal the fact that they are dissatisfied with what they have found. In their conclusion, they complain about the "excessive formalization of instruments and pragmatic simplification".

Obviously the boundaries between research and policy are not clear-cut and can therefore not be managed easily. It has become obvious that the "two-communities" perspective may be deceiving ¹. After all, neither the research nor the policy community is homogenous and there may even be overlaps in how the world is viewed from each side. Interestingly enough, however, all models relate to a phenomenon that, albeit being paraphrased on a couple of occasions, is not once mentioned explicitly in the review paper: communication. This is particularly surprising as quite a few of the models draw on institutionalism, be it from a sociological or a rational choice perspective. Even if the latter approach frequently neglects communication, institutionalism and communication are conceptually closely linked.

The analysis of communicative processes, taking into account the lessons of social science in terms of organizational relationships as well as the functions of language, promises to point towards a model of effective communicative interaction between researchers and policy-makers. Even if researchers and policy-makers can possibly rely on a culturally ingrained "pre-understanding", effective communication, i.e. an effective research-to-policy transfer, requires a mutual understanding based on the intent on both sides to engage in a communicative process, which again to a certain degree necessitates the willingness to relativize one's position in the light of the other's perspective. In this sense, communication means more than the mere transfer of information. The ideal process, which is socially superior to other forms of human action, is what Habermas termed "communicative action" ². While the analysis of communicative processes means leaving behind linear models, the goal to derive strategies to improve the use of research results in health policy decision-making may not be as distant as under the application of a more remote paradigm. After all, the research-to-policy transfer can even be interpreted as communication in its most basic sense, namely as a process of conveying information. Effective communication is what we would like to see as a result: an impact on policy formulation and implementation.

When policy research is perceived as threatening by policy-makers, when researchers do not get their messages across to policy-makers, and when basic research is not considered relevant by policy-makers, then communication is not effective. The underlying communicative processes need to be analyzed. Recommendations from the research-to-policy literature on the right format of easily digestible research findings or on engaging with advocacy coalitions only tackle the symptoms, not the root causes for the failure to communicate effectively between the two spheres.

The commodification of internationally streamlined research and the standardization of tools and output formats in the interest of supposed quality management do not necessarily contribute to developing an atmosphere conducive to effective communication between policymakers and researchers at a national level. An increasing amount of research commissioned by health authorities and international organizations may affect the self-image of the researcher and thereby jeopardize effective communication from the outset.

Almeida & Báscolo spark off a cascade of insights into the reasons of successes and failures of the use of research results in health policy decision-making. Ultimately, the degree to which research will be considered in health policy depends on researchers being able to effectively provide counter-evidence to the widespread proverbial belief that it is not the same to talk of bulls as to be in the bullring.

1. Gibson B. Beyond "two communities". In: Lin V, Gibson B, editors. Evidence-based health policy: problems and possibilities. Melbourne: Oxford University Press; 2003. p. 18-32.

2. Habermas J. The theory of communicative action. Volume one: reason and the rationalization of society. Boston: Beacon Press; 1984.