A Risky Business? The Politics of Knowledge Transfer in Public Health

Lead Research Organisation: University of Edinburgh
Department Name: Sch of Social and Political Science


Against a backdrop of increasing commitments to evidence-informed public health, a wealth of studies explore how evidence is used in public-health decision-making, some of which have informed emerging guidelines for increasing research 'impact'. Much of this work appears to conflate increasing the use of research evidence with improving its use, despite the vast array of studies demonstrating that policymakers often employ evidence symbolically (Boswell, 2009). Moreover, advice for researchers on improving the policy 'impact' of their research frequently assumes that policymakers will welcome these efforts, if appropriately articulated (e.g. Lavis et al, 2005; Pope et al, 2006), in spite of claims many are already oversaturated with evidence (Stevens, 2011). Finally, often ignoring 'policy network' type theories, public health studies rarely consider the role of 'research mediators', such as third sector & private interests (Kromm, 2010). This project will use qualitative methods to begin addressing these gaps.

First, via a literature review & interviews with public health policymakers, the project will explore how individuals involved in developing UK public health policies perceive & experience efforts to increase/improve the use of evidence. Specifically, it will examine how these actors view tools & systems designed to support the use of evidence in policy decisions, such as policy-orientated systematic reviews, impact assessments & 'impact' guidelines/incentives for academics. It will consider whether policymakers are concerned about any of the following risks, identified as possibilities in existing research: (i) policymakers, already oversaturated with evidence (Stevens, 2011), will become increasingly overburdened (Smith & Meer, 2012); (ii) the 'symbolic' use of evidence will increase (Boswell, 2009; Smith & Meer, 2012); & (iii) evidence-based policy requirements will make it harder to pass new public health legislation (Smith et al, 2010a). I will also explore whether policymakers' perceptions of evidence-based public health policy appear to be changing over time or in relation to particular tools/systems by comparatively drawing on my existing (PhD & Post-Doctoral) data.

Second, the project will examine the role of potential 'research mediators', notably third sector & commercial organisations involved in public health policy groups (e.g. Public Health Responsibility Deals). Again using a literature review & interview data, but supplementing this with relevant documentary analysis (e.g. of policy submissions) & a series of short placements within third sector organisations, the project will explore how these actors inform the relationship between public health research & policy. This strand of the project will complement a growing interest in public health advocacy (Chapman, 2007; Kromm, 2010) & corporate public health policy influence (Freudenburg et al, 2008; Gilmore et al, 2011).

Finally, the findings from the above will inform a Delphi survey of public health researchers & research users which will examine how different groups think the use of research in policy ought to be incentivised & governed. The results will inform bespoke recommendations for different groups, plus a manual & short course for research users & mediators.

Theoretically, the findings will enable me to: unpack policymakers' experiences of tools/incentives to promote evidence use; outline the roles of 'research mediators' in the relationship between public health research & policy; & develop the ideational framework for understanding relationships between research & policy I set out in my PhD (see Case for Support) by incorporating 'research mediators'. Practically, the project will enable me to collaboratively develop (with participants) sector-specific recommendations for using evidence to improve public health policies. All of this should reinforce my emerging reputation as a leading knowledge transfer & health policy scholar

Planned Impact

This project seeks to influence the ways in which various groups approach the promotion of public health evidence in policy, with the intention of supporting evidence use that improves public health policies & their outcomes (whilst minimising any associated risks). The following six groups are the most likely beneficiaries:
1. Public health policymakers: the project aims to ensure that researchers who attempt to engage with policymakers do so in ways which are feasible & beneficial for policymakers. It will explore how policymakers perceive & experience ongoing commitments to 'evidence-based policy' & newer emphases on 'research impact' & will seek to identify any concerns relating to these agendas. It will subsequently attempt to ensure relevant guidance addresses any identifiable concerns. The views of this group have already shaped the research proposal & will continue to inform the research as it progresses, including at the dissemination stage. This will involve a cross-sector seminar, a policy briefing, a project web-site, blog contributions, the offer of bespoke oral presentations & the development of a manual & Continuing Professional Development course.
2. Third sector organisations with an interest in public health: the project will provide important insights into how these actors view the relationship between public health research & policy and what role they play within this. The findings will be used to help ensure these groups are appropriately considered within guidelines for improving the use of public health evidence in policy. As above, the views of third sector public health organisations have informed the proposal and will continue to do so throughout the project. The findings will be promoted to this group via similar methods to those used for policymakers, a process which will be aided by the networks developed during the placements.
3. Academics interested in studying, theorising &/or improving knowledge translation and research impact: the project will weave together existing theories about knowledge transfer (including my own) with data and theories concerning the role of key 'research mediators' (third sector & commercial interests). This group will be invited to the workshop and will be targeted via conference papers, short commentaries (e.g. on the LSE impact blog, OpenDemocracy and the Times Higher Education Supplement) & all five peer-review journal articles: (see Academic Beneficiaries & Case for Support)
4. Public health researchers: the project will aim to improve the available guidance for public health researchers interested in achieving effective & ethical research impacts. It will seek to increase awareness within this group of: (i) policymakers' perceptions of the various tools & systems that are currently being promoted as means of increasing the use of evidence in policy; & (ii) the potential role of 'research mediators', such as third sector & commercial organisations, in the relationship between public health research & policy. Information for this group will be promoted via public health blogs & virtual networks, conference papers & at least three of the five peer-review journal articles (see Academic Beneficiaries & Case for Support for further details)
5. Organisations working to improve the relationship between research and policy, such as the ESRC, MRC and RCUK: the project will make a series of specific recommendations as to how 'impact' guidance provided by research funders & others might be improved in the basis of the findings, paying particular attention to the incorporation of potential 'research mediators'.
6. The impetus for all of the above is to improve the use of public health evidence in policymaking in ways that will lead to better health outcomes. Hence, the final group of potential beneficiaries, indirectly but still crucially, are those individuals and communities who currently bear the brunt of the UK's major public health problems
Description This work undertaken during this project has generated new knowledge about:
- Policy and advocacy experiences of using 'evidence-tools' such as 'impact assessments', cost-benefit analyses, systematic reviews and economic modelling. It identifies a range of perceived benefits to, and disadvantages of, these tools as mechanisms for enhancing the use of evidence in public health decision-making and debates. Tools, such as economic scenario modelling, which can provide concrete answers to policy questions but which are perceived (in contrast to cost-benefit analysis) to be sufficiently complex for real-life policy problems appear to be the most popular 'evidence-tools' among policy actors. Systematic reviews were widely critiqued for failing to provide clear policy guidance; the only examples participants identified as having played an important role in policy debates had been commissioned/used to support a preferred policy position had already emerged. Impact assessments tended to be seen as potentially time-consuming exercises which were also largely developed on a post-hoc basis.
- Policy, third sector and academic experiences of the UK research 'impact agenda'. This work identifies ten concerns about the research impact agenda and makes a series of suggestions for how incentive, monitoring and reward frameworks for research impact might be improved to better reflect the available evidence concerning policy change. My aim is to use this work to develop/inform new guidance in this area.
- Public health researchers' varying support for policy responses to health inequalities. This work identifies a high degree of consensus around the types of policy responses that researchers believe are most likely to reduce health inequalities but a lack of specificity within this. It also demonstrates that researchers responses to questions about preferred policy solutions vary when they are asked to based their responses on their 'expert opinion' compared to 'the strength of the available evidence'.
- Public health researchers', third sector and policy actors' varying views about the actual and desirable relationship between public health research and advocacy.
- Public health research, policy and advocacy perspectives on the actual and desirable role of different kinds of commercial interests in public health debates.
- The complex ways in which corporate advocacy coalitions work to influence long-term policy change.
- The preferred future health inequalities research agendas of different sectors.

In addition, through a series of short-term secondments to third sector organisations (and some related longer-term relationships that emerged), the work is informing the development of a cross-sector network of organisations within an interest in addressing health inequalities in Scotland.

The findings have also informed the following new research questions about the complex relationship between evidence and democracy:
- How do policy actors (in public, private and third sector organisations) assess 'public perceptions' of particular policy issues, such as health inequalities, and of potential policy responses?
- How are efforts to promote health inequalities research, and research-informed policy solutions, to the wider public being received?
- Does public opinion about health inequalities, and potential policy responses, appear to change when people are given an opportunity to engage with the available evidence?
Exploitation Route Public health researchers could use the findings to improve the means by which they work to achieve research impact, including through evidence-informed advocacy. Health inequalities researchers can also use this work to inform decisions about which areas of future health inequalities research to prioritise. I will be working to raise awareness of relevant aspects of the findings for these audiences through academic publications, conferences and related blogs.

Third sector organisations could use this research to improve their use of research evidence and I will shortly be develop some guidance materials for third sector organisations on accessing, using and citing research evidence and working with academic researchers. I will also be returning to some of the third sector organisations which hosted me for short-term placements to provide more bespoke advice.

Finally, I will be using the findings to inform a series of debates with academic and policy actors around the 'research impact' agenda and I will use both the existing results and the results of these debates to develop some suggestions for research funders and those involved in the architecture of REF in the UK to consider improving the way in which 'research impact' is incentivised, monitored and rewarded.
Sectors Communities and Social Services/Policy,Government, Democracy and Justice,Other

URL http://www.sps.ed.ac.uk/staff/social_policy/katherine_smith
Description My findings have informed debates about how NGOs/third sector organisations and academics concerned with public health ought best to engage with one another in order to maximise the benefit of public health research in public health campaigns and policy debates. To date, my research has directly informed conversations about this at each of the organisations in which I undertook a placement as part of this project: Cancer Research UK, Action on Smoking and Health Scotland (ASH Scotland), the British Medication Association (BMA), the Institute of Alcohol Studies (IAS) and Alcohol Focus Scotland (AFS). I also drafted briefing documents on health inequalities for ASH Scotland and IAS, a book chapter and policy report with colleagues at IAS, and other briefing notes relating to health inequalities for Cancer Research UK and the BMA. All of these briefing notes have been published by the respective organisations and I have formed ongoing relationships with all of these organisations except the BMA (see information on placements for more details). I have led a series of debates and conversations about such engagement with my fellow academics and given invited talks, based on this research, in the Scottish Parliament and European Parliament. One of the key findings from this research related to the lack of public engagement in research, policy and advocacy discussions on health inequalities. I have subsequently followed this up in three key ways: (1) through a deliberative, citizens' jury research project (funded by a Leverhulme award); (2) by working collaboratively on subsequent projects with AFS, ASH Scotland, Cancer Research UK, IAS and NHS Health Scotland; and (iii) by developing forums/groups at which advocacy organisations and academics can exchange ideas and work collaborative (the Group for Research on Tobacco and Inequalities at the University of Edinburgh, SKAPE - the Centre for Science, Knowledge and Policy at Edinburgh, and the People's Health Movement in Scotland). I also draw on this research and these relationships in my teaching and have been able to facilitate a range of MSc and UG dissertation placements in these organisations. Several of the research outputs from the subsequent citizens' juries project remain in process / in press and some of these will now be informed by the citizens' juries follow up work - as soon as these are available, my plan is to provide both communities with guidance documents relating to the findings which will be presented in person and provided online and which will be updated to reflect feedback. This has been delayed due to a combination of illness last year and taking up several leadership positions within the University of Edinburgh but is scheduled to be published in 2019. I am also currently working with the Scottish Government on their Public Health Reform programme and am suggesting ways in which this research can inform those plans (which should be finalised in Autumn 2019, when a new organisation, Public Health Scotland will launch, hopefully with some innovative approaches to engaging with researchers, NGOs and members of the public). In addition, I drew on the findings of this project in an editorial for the BMJ which challenged a Cabinet Office (UK government) anti-lobbying clause which would have restricted the freedom of researchers to draw on publicly funded research in contributing to public and policy debates (http://www.bmj.com/content/352/bmj.i1446). This clause, which was widely criticised, was subsequently dropped.
First Year Of Impact 2014
Sector Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice,Other
Impact Types Societal,Policy & public services

Description Independent Experts or Socially Engaged Advocates - How should health inequalities researchers work to achieve evidence-informed social/policy change? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Paper given at the British Sociology Association Annual Conference, Leeds, April 2014. Talked sparked discussion and follow up emails requesting more information.

Follow up emails for more information.
Year(s) Of Engagement Activity 2014
Description Researchers, Campaigners and Corporations: Who is trying to influence policy responses to health inequalities in the UK and what role is evidence playing in these debates? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact The talk informed a lot of discussion within this stream of the conference.

I was subsequently invited to Australia to give a follow-up talk and to develop related research proposals and articles with colleagues at ANU.
Year(s) Of Engagement Activity 2015
Description The Origins of Better Regulation in the EU: How and why British American Tobacco worked to promote 'Better Regulation' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Talk stimulated a lot of Twitter debate and questions from some MEPs, NGOs and private sector groups operating in Brussels and the UK.

After my talk, the number of people viewing related outputs online increased substantially.
Year(s) Of Engagement Activity 2015
Description We Need to Talk about Impact: Social policy and the UK Research 'Impact' Agenda 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation keynote/invited speaker
Geographic Reach International
Primary Audience Other audiences
Results and Impact The talk sparked a great deal of discussion and was responded to by an invited panel of policy advisors and practitioners. It was attended by the head of Policy Press who followed it up with a book proposal enquiry (to see if I'd be willing to write a book on the topic).

I received several emails from colleagues interested in the topic, was invited by colleagues at Edinburgh to re-present the paper and (in future) to hold a larger debate about the issues raised in the paper.
Year(s) Of Engagement Activity 2015
Description What will reduce health inequalities and how might this be achieved? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited plenary paper given at a Royal College of Physicians of Edinburgh Symposium on Health Inequalities evidence, Edinburgh, May 2014. Talk sparked a lot of audience discussion and questions.

After my talk, I was invited to write the results up in the RCPE journal and to inform a report by NHS Health Scotland for the Scottish Government and to give a smaller, repeat talk to an academic audience at the University of Edinburgh. Subsequently an advisor to the Scottish Government attended the smaller talk and told me that Ministers had read the results of the research.
Year(s) Of Engagement Activity 2014