摘要：Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process , to understand approaches to enhance the likelihood of policy adoption; (2) content , to identify specific policy elements that are likely to be effective; and (3) outcomes , to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence. IT HAS LONG BEEN KNOWN that public health policy, in the form of laws, regulations, and guidelines, has a profound effect on health status. For example, in a review of the 10 great public health achievements of the 20th century, 1 each of them was influenced by policy change such as seat belt laws or regulations governing permissible workplace exposures. As with any decision-making process in public health practice, formulation of health policies is complex and depends on a variety of scientific, economic, social, and political forces. 2 There is a considerable gap between what research shows is effective and the policies that are enacted and enforced. The definition of policy is often broad, including laws, regulations, and judicial decrees as well as agency guidelines and budget priorities. 2 – 4 In a systematic search of “model” public health laws (i.e., a public health law or private policy that is publicly recommended by at least 1 organization for adoption by government bodies or by specified private entities), Hartsfield et al. 5 identified 107 model public health laws, covering 16 topics. The most common model laws were for tobacco control, injury prevention, and school health, whereas the least commonly covered topics included hearing, heart disease prevention, public health infrastructure, and rabies control. In only 6.5% of the model laws did the sponsors provide details showing that the law was based on scientific information (e.g., research-based guidelines). Research is most likely to influence policy development through an extended process of communication and interaction. 6 In part, the research–policy interface is made more complex by the nature of scientific information, which is often vast, uneven in quality, and inaccessible to policymakers. Several models for how research influences policymaking have been described, 7 – 9 most of which involve moving beyond a simple linear model to more nuanced and indirect routes of influence, as in gradual “enlightenment.” 10 Such nonlinear models of policymaking and decision-making take into consideration that research evidence may hold equal, or even less importance, than other factors that ultimately influence policy, such as policymakers' values and competing sources of information, including anecdotes and personal experience. 11 Although not exhaustive, Table 1 highlights several important barriers that should be considered when one is attempting to develop effective policy. 12 – 16 TABLE 1 Barriers to Implementing Effective Public Health Policy Barrier Example Lack of value placed on prevention Only a small percentage of the annual US health care budget is allocated to population-wide approaches. Insufficient evidence base The scientific evidence on effectiveness of some interventions is lacking or the evidence is changing over time. Mismatched time horizons Election cycles, policy processes, and research time often do not match well. Power of vested interests Certain unhealthy interests (e.g., tobacco, asbestos) hold disproportionate influence. Researchers isolated from the policy process The lack of personal contact between researchers and policymakers can lead to lack of progress, and researchers do not see it as their responsibility to think through the policy implications of their work. Policymaking process can be complex and messy Evidence-based policy occurs in complex systems and social psychology suggests that decision-makers often rely on habit, stereotypes, and cultural norms for the vast majority of decisions. Individuals in any one discipline may not understand the policymaking process as a whole Transdisciplinary approaches are more likely to bring all of the necessary skills to the table. Practitioners lack the skills to influence evidence-based policy Much of the formal training in public health (e.g., masters of public health training) contains insufficient emphasis on policy-related competencies. Open in a separate window Although there have been many calls for more systematic and evidence-based approaches to policy development, 5 , 6 , 17 – 21 missing from the literature is a clear articulation of the definition of evidence-based policy along with specific approaches that will enhance the use of evidence in policymaking.
