Health systems in low and low middle-income coun-tries (LMICs) struggle

to deliver quality health care be-cause of limited resources, poor infrastructure and a failure to use evidence wherever possible.
There is, in fact, plausible ev-

to the needs of policymakers.

A senior policymaker once said, “For research to be useful for me it has to be able to answer just three questions. Can it work? Will it work? Is it worth it?” Such questions are often not answered by academic research alone.

INSIGHT

Tikki Pangestu

Singapore

Visiting professor at Lee Kuan Yew School of Public Policy, National University of Singapore

much-needed vaccine against the Ebola virus. This phenomenon of “vaccine hesitancy” has spread globally through many countries, rich and poor alike. It has caused serious outbreaks of vaccine-pre-ventable diseases.
The second catastrophe is re-

deny smokers their right to better health.

So how can we try to overcome these challenges?

First, we need to improve sci-entific literacy among policy makers. Second, it is important to increase the accountability

idence that policies informed by available evidence and ratio-nal analysis can produce better outcomes.

However, in most LMICs, this use of evidence remains aspira-tional. The reality is often very different — a reality in which opinion, values, beliefs, traditions and even ideology can trump facts, truth and evidence.

Why is this? There are four reasons.

First is the lack of good and rel-evant evidence. This is important because in forming policies, most policymakers in these countries place more weight on evidence derived from local research than on evidence obtained through other means. Unfortunately, such evidence is often lacking or of poor quality. In addition, the evi-dence is often not available in a timely manner and not relevant

to the needs of policymakers.

A senior policymaker once said, “For research to be useful for me it has to be able to answer just three questions. Can it work? Will it work? Is it worth it?” Such questions are often not answered by academic research alone.
Second, there is limited scien-tific literacy among policymak-ers as many do not have science backgrounds. They may there-fore undervalue the role of evi-dence in policy formulation and implementation. This led John Maynard Keynes to say, “There is nothing a politician likes less than to be well-informed. It makes decision making so much more complex and diffi cult.”

Third, while it is probably true that no policymakers want to make bad policy, the reality is that evidence is just one factor in their world. They also have to contend, among other things, with politi-cal pressures, a lack of resources, local beliefs and values, the me-dia and — importantly — electoral exigencies. So, despite the cynical tone of what Keynes said, the re-ality is much more nuanced and nicely expressed by Sir Michael Marmot: “Scientific findings do not fall on blank minds that get made up as a result. Science en-gages with busy minds that have strong views about how things are and ought to be.”

Finally, today’s toxic climate of national populism, fake news and the denial of science has downgrad-ed and downplayed the role of evi-dence in policy discourse and de-velopment. Science, truth and trust are being questioned like never be-fore. Yuval Noah Harari said, “We humans know more truths than any species on Earth. Yet we also believe the most falsehoods.”

This volatile, uncertain, com-plex and ambiguous anti-science environment has, unfortunately, has led to two catastrophic out-comes in global health recently.
In the Philippines, misinfor-

mation, disregard for evidence and political factors resulted in the withdrawal of a long-awaited vaccine to prevent dengue fever.

More worrisome still, the with-drawal led to a disastrous general decline in confidence in childhood vaccination. Reduced vaccination rates resulted in 35,000 cases of measles with 477 deaths in 2019 and the reappearance of polio af-ter a 20-year absence.

The World Health Organiza-tion said recently that measles had infected nearly 10 million people in 2018 and had killed 140,000 — mostly children — as devastating outbreaks of the vi-ral disease hit every region of the world. Violence against health workers in the Democratic Re-public of Congo has resulted in delays in the acceptance of a much-needed vaccine against the Ebola virus. This phenomenon of “vaccine hesitancy” has spread globally through many countries, rich and poor alike. It has caused serious outbreaks of vaccine-pre-ventable diseases

lated to the existence of 1 billion smokers in the world. Six to 7 mil-lion people die every year due to smoking-related illnesses, mostly in LMICs. It is estimated that In-donesia has more than 60 mil-lion smokers with nearly 200,000 deaths annually due to diseases linked to smoking. A staggering 68 percent of the country’s male pop-ulation are smokers.

While there is strong evidence that harm-reduction approaches using alternative tobacco prod-ucts are safe, are 90 to 95 percent less harmful than combustible cigarettes and can help smokers quit, the evidence is being ignored and draconian policies of banning the products and fining and even jailing users have been imple-mented — or are being considered

— in many countries, including Indonesia.

Such an approach will, in effect deny smokers their right to better health.

So how can we try to overcome these challenges?

of the decision-making process to ensure that evidence is taken into account. Third, efforts must be made to facilitate and institu-tionalize knowledge translation and communication between sci-entists, policymakers, consumers and other stakeholders, including civil society. Fourth, evidence and data should be combined with the more humanistic approach of us-ing stories that acknowledge the importance of personal autono-my — a critical ingredient for ef-fective policy and practice.

While it is clearly important to distinguish opinion and fact, it is perhaps even more important to ensure that facts are used for shaping policies that improve not just health quality but also health equality, especially in the devel-oping world. At the end of the day, this underscores the value of the research process

Source: The JakartaPost