Evidence Use in Health Policy Making: An International Public Policy Perspective (International Series on Public Policy)

This open access book provides a set of conceptual, empirical, and comparative chapters that apply a public policy perspective to investigate the political and institutional factors driving the use of evidence to inform health policy in low, middle, and high income settings. The work presents key findings from the Getting Research Into Policy (GRIP-Health) project: a five year, six country, programme of work supported by the European Research Council. The chapters further our understanding of evidence utilisation in health policymaking through the application of theories and methods from the policy sciences. They present new insights into the roles and importance of factors such as issue contestation, institutional arrangements, logics of appropriateness, and donor influence to explore individual cases and comparative experiences in the use of evidence to inform health policy. Preface 6 Acknowledgements 11 Contents 12 Chapter 1: Studying Evidence Use for Health Policymaking from a Policy Perspective 14 Introduction 14 The Multiple Meanings of ‘Use’ of Research Evidence 17 A Public Policy Perspective 19 Politics as Power and Contestation 21 An Institutional Perspective to Analyse Evidence Use in Policy Processes 23 Outline of the Book 25 References 29 Chapter 2: The Many Meanings of Evidence: A Comparative Analysis of the Forms and Roles of Evidence Within Three Health Policy Processes in Cambodia 33 Introduction 34 Methods 35 Policy Studies Perspectives 37 One Country, Three Health Policy Issues 39 Tobacco Control 39 HIV/AIDS 39 Performance-Based Financing, and the Case of the Government Midwifery Incentive Scheme 40 The Nature of Evidence Used 42 Tobacco Control 42 HIV/AIDS 44 Performance-Based Financing, and the Case of the Government Midwifery Scheme 47 Institutional Features and Logics of Evidence Use 50 Discussion 53 Conclusions 55 References 56 Chapter 3: The Role of Evidence in Nutrition Policymaking in Ethiopia: Institutional Structures and Issue Framing 62 Introduction 63 The Case of Ethiopia 65 Methods 67 Framing of Nutrition 68 Challenges to an ‘Upstream’ and Multisectoral Approach 71 Implications for ‘Evidence Informed’ Nutrition Policy 74 Discussion 76 Conclusion 78 References 80 Chapter 4: The Use of Evidence in Health Policy in Ghana: Implications for Accountability and Democratic Governance 85 Introduction 85 Evaluation and Accountability Within a Policy Space 87 Evidence and Health Sector Assessment in Ghana 88 Accountability, Evaluation and Power in Ghanaian Health Policy 91 The Accountability Implications of Uses of Evidence 93 Technical Evaluation and Accountability Mechanisms 94 Evidence Use and Policy Value Judgements 96 Conclusions 97 References 98 Chapter 5: Using Evidence in a Highly Fragmented Legislature: The Case of Colombia’s Health System Reform 101 Introduction 101 Methodology 103 The Role of the Legislature in Colombia 104 Colombia’s Highly Contested Health Policy Subsystem 108 Evidence Use in the First Phase of Health Reform (1992–2010) 109 Evidence Use in Second Phase of Health Reforms (2010–2016) 113 Conclusion 115 Annex 1: Laws and Draft Laws Reviewed 116 References 118 Chapter 6: The Politics of Evidence Use in Health Policy Making in Germany: The Case of Regulating Hospital Minimum Volumes 121 Introduction 121 Strategic Uses of Evidence in Health Policy-Making 125 Methods 127 Minimum Volumes in Hospital: Policy Idea and Scientific Evidence 128 Devising the Legislative Framework 129 Setting Minimum Volumes: The Role of the Federal Joint Committee 131 Adjudication by the Social Courts 135 Discussion and Conclusion 138 References 140 Chapter 7: Electronic Cigarettes Regulation in the UK: A Case Study in Evidence Informed Policy Making 146 Introduction 146 E-Cigarette Regulation in the UK 148 Issue Framing and Evidence Informed Policy 149 The UK E-Cigarette Policy Debate 150 The Potential Health Benefits of E-Cigarettes 152 Classifying E-Cigarettes 153 Marketing 154 Discussion and Conclusion 155 References 156 Chapter 8: Ministries of Health and the Stewardship of Health Evidence 163 Introduction 163 Ministries as Stewards of Health and Health Evidence 164 Institutional Systems of Evidence Advise for Health Policy 166 Health Decisions and Needs 168 Country Case Studies 170 Ghana 170 Colombia 172 Cambodia 173 Ethiopia 175 England 177 Germany 178 Discussion: Issues and Challenges 181 Decisions on Packages of Services 182 Use of Routine Data to Guide Decisions 183 Health-Issue Specific Decisions 184 Arm’s Length Public Health Advisory Bodies 185 Conclusions 186 References 188 Chapter 9: Evidence Use and the Institutions of the State: The Role of Parliament and the Judiciary 193 Introduction 193 Institutions of the State and Their Role in Using Evidence for Health Policy-Making 195 Legislatures: The Role of Parliaments 197 The Judiciary: The Role of Courts 201 The Institutions of the State Matter for the Study of Evidence Use in Health Policy and Health System Governance 204 References 205 Chapter 10: Evidence and Policy in Aid-Dependent Settings 208 Introduction 208 Evidence Use as a Power/Knowledge Nexus 212 Comparative Analysis 213 The Generation or Creation of Policy Relevant Evidence 214 Evidence Use Within the Policy Process 216 Systems and Routines of Evidence Utilisation 218 Discussion: Influence and Resistance Over Multiple Forms of Evidence Use 219 Conclusions 222 References 223 Chapter 11: Conclusion: Reflecting on Studying Evidence Use from a Public Policy Perspective 227 Returning to the Question: What Does It Mean to Use Evidence in Policymaking? 227 Instrumental Uses of Evidence 229 Political Contestation and Strategic Uses of Evidence 231 The Construction of Issues and Impact on Evidence Use 233 Adding Institutional Analysis 236 Reframing Evidence Based Policy Making for the Public Health Sector 238 Future Research Agendas 240 References 241 Index 245 This open access book provides a set of conceptual, empirical, and comparative chapters that apply a public policy perspective to investigate the political and institutional factors driving the use of evidence to inform health policy in low, middle, and high income settings. The work presents key findings from the Getting Research Into Policy (GRIP-Health) project: a five year, six country, programme of work supported by the European Research Council. The chapters further our understanding of evidence utilisation in health policymaking through the application of theories and methods from the policy sciences. They present new insights into the roles and importance of factors such as issue contestation, institutional arrangements, logics of appropriateness, and donor influence to explore individual cases and comparative experiences in the use of evidence to inform health policy. Justin Parkhurst is Associate Professor at the London School of Economics and Political Science (the LSE)'s Department of Health Policy, UK. He has conducted research on a range of global health policy issues and on the politics of evidence. He served as the Principal Investigator of the GRIP-Health programme of work. Benjamin Hawkins is Associate Professor at the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK. His research focuses on the role of research evidence and corporate actors in health policy making. In addition, he works on European integration, multi-level governance international trade and political economy approaches to health policy. Stefanie Ettelt is Associate Professor at the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK. Her work examines the tensions between structure and agency in explaining the influence of evidence and research on policy-making and health system governance, particularly from a comparative perspective. Front Matter ....Pages i-xiv Studying Evidence Use for Health Policymaking from a Policy Perspective (Justin Parkhurst, Stefanie Ettelt, Benjamin Hawkins)....Pages 1-19 The Many Meanings of Evidence: A Comparative Analysis of the Forms and Roles of Evidence Within Three Health Policy Processes in Cambodia (Helen Walls, Marco Liverani, Kannarath Chheng, Justin Parkhurst)....Pages 21-49 The Role of Evidence in Nutrition Policymaking in Ethiopia: Institutional Structures and Issue Framing (Helen Walls, Deborah Johnston, Elisa Vecchione, Abdulfatah Adam, Justin Parkhurst)....Pages 51-73 The Use of Evidence in Health Policy in Ghana: Implications for Accountability and Democratic Governance (Elisa Vecchione, Justin Parkhurst)....Pages 75-90 Using Evidence in a Highly Fragmented Legislature: The Case of Colombia’s Health System Reform (Arturo Alvarez-Rosete, Benjamin Hawkins)....Pages 91-110 The Politics of Evidence Use in Health Policy Making in Germany: The Case of Regulating Hospital Minimum Volumes (Stefanie Ettelt)....Pages 111-135 Electronic Cigarettes Regulation in the UK: A Case Study in Evidence Informed Policy Making (Benjamin Hawkins)....Pages 137-153 Ministries of Health and the Stewardship of Health Evidence (Justin Parkhurst, Arturo Alvarez-Rosete, Stefanie Ettelt, Benjamin Hawkins, Marco Liverani, Elisa Vecchione et al.)....Pages 155-184 Evidence Use and the Institutions of the State: The Role of Parliament and the Judiciary (Stefanie Ettelt)....Pages 185-199 Evidence and Policy in Aid-Dependent Settings (Justin Parkhurst, Siobhan Leir, Helen Walls, Elisa Vecchione, Marco Liverani)....Pages 201-219 Conclusion: Reflecting on Studying Evidence Use from a Public Policy Perspective (Justin Parkhurst, Benjamin Hawkins, Stefanie Ettelt)....Pages 221-238 Back Matter ....Pages 239-245