An argument for evidence-based policy-making in global health
From its early origins in the 1990s, evidence-based medicine has become a major driving force in healthcare improvement worldwide and has prompted other evidence-based “movements, " including evidence-based policy-making (EBP) in global health. EBP approaches could help to narrow the “know-do gap, " the gap between evidence (what is known) and policy implementation (what gets done), which is a major barrier to achieving the health-related Millennium Development Goals. Such approaches can also help to ensure that resources are not wasted on ineffective interventions, particularly in this time of global fiscal constraint. Proponents of EBP in global health acknowledge that policy-making is a messy non-linear process, in which evidence competes with other inputs, such as politics, sociocultural factors, and personal expertise. Nevertheless, scientific evidence should be a cornerstone of sound public health policies, and significant health gains could be achieved by leveraging such evidence to its full potential. Systematic reviews are a particularly valuable form of evidence for public policy-making, as they are less likely to produce misleading results. Such reviews are increasingly being used to address questions related to the governance, financing, architecture, and delivery of global health and to broader social, economic, and intersectoral issues. Important new approaches to synthesizing non-randomized studies, including observational, qualitative, and economic studies, and to integrating the synthesis of quantitative and qualitative studies, have been developed. These are paying large dividends in improving our understanding of how to tackle global health challenges. Nevertheless, there are still many barriers and challenges to adopting evidence-based approaches in global health policy-making. The global health community has made tremendous strides in tackling these difficulties, through a variety of initiatives aimed at improving the generation, synthesis, diffusion, and uptake of “evidence that matters” to policy-makers.
