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Insight: Attacks on evidence, trust and truth wreak havoc on global health
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For healthier children: A health official from the Waelengga community health center (Puskesmas) in Watunggene subdistrict, Kota Komba district, East Manggarai regency, Flores, East Nusa Tenggara, prepares a polio vaccine for a baby on the first day of national polio immunization week. (thejakartapost.com/Markus Makur)
H
ealth systems in low and low middle-income countries (LMICs) struggle to deliver quality health care because of limited resources, poor infrastructure and a failure to use evidence wherever possible.
There is, in fact, plausible evidence that policies informed by available evidence and rational analysis can produce better outcomes.
However, in most LMICs, this use of evidence remains aspirational. 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 relevant 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 evidence 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 scientific literacy among policymakers as many do not have science backgrounds. They may therefore undervalue the role of evidence 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 difficult.”
