- Complete sentences
- In English and
- Clearly, unmistakably points to one conclusion.
Anyone who has ever tried to frame a question, compile data, and come up with an answer knows that this is not the case. Yet, the cry continues for evidence-based health policy – the subject of a fabulously well written editorial in this week’s New England Journal of Medicine.
Authors Baicker and Chandra describe three traits of evidence-based health policy
- Policies need to be well-described and not just slogans.
- We must differentiate between policies and goals.
- Determining the size of the policy’s effects is “an inherently empirical endeavor”.
The well-described parameter is the most troublesome, I think. Success can come down to relatively tiny nuances, requiring us to use words carefully.
For example, the call for expanding Medicaid is often based upon the idea that doing so will improve health. Yet few people pause to ask what exactly “improving health” is. Getting blood glucose to a healthy range? Lowering blood cholesterol levels? Oregon’s random lottery for Medicaid enrollment did not find either of these things to happen, though those enrolled were more likely to get a diagnosis of depression. Other studies have found that people enrolled in Medicaid had less anxiety about affording medical care; does that qualify as “improving health”?
Policy makers (aka politicians) are, with very few exceptions, not population health scientists or researchers. These terms and the differences between them are just a hassle inside the big, sausage-making machine of legislatures. They do not have time for this level of detail.
In short, using evidence and data to make better decisions is a great concept, but it does not burn away the fog. The evidence available is the result of people framing research questions, which is the result of funding priorities, which is the result of still other decisions, processes, and personalities.
Evidence and data are great, but they are not the North Star that will lead us into a new, Eden utopia.