Public policies that neglect scientific findings cost money and lives, experts say

Researchers discussed models and strategies to close the gap between scientific discoveries and their uptake in health programs.

By Maria Fernanda Ziegler  |  Agência FAPESP – Bruna de Andrade Ramos, a postdoctoral fellow of São Paulo State University’s Botucatu Medical School (FMB-UNESP), is studying aspects of maternal and fetal health such as immune modulation in response to pathogens and genetic and epigenetic variability. Some of the measures validated by her research could be implemented in new public policies, she said, helping to reduce prematurity, the main mortality risk to mothers and babies.

Indian researcher Ananya Gupta is working on a project funded by the United Kingdom’s National Institute for Health Research (NIHR) to strengthen disease surveillance by and among frontline health workers, especially for the treatment of diabetes and cardiovascular disease, and disseminate findings to policymakers in Southeast Asia.

The aim of Angela Aifah’s work on a project funded by the United States National Institutes of Health (NIH) is to implement new, more effective strategies in AIDS clinics operating in Lagos, Nigeria.

All three researchers attended the Implementation Science Training School held on November 7-10, 2018, at the University of Campinas (UNICAMP) in São Paulo State, Brazil. The event was supported by FAPESP under the aegis of its São Paulo School of Advanced Science program (SPSAS) and by the Global Alliance for Chronic Diseases (GACD), a consortium of 14 public health research funding agencies in several countries, including FAPESP.

A total of 70 researchers (35 from Brazil and 35 from abroad) participated in the Training School, whose main aim was to discuss methodologies and strategies to close the gap between scientific discoveries and their uptake in health programs.

“We realized that the response to some of GACD’s calls for research in implementation science was weaker than expected, either because projects weren’t well structured or because the proponents seemed not to understand what implementation research actually involves. We therefore decided we should train young researchers. Half the participants in this event were Brazilian, and the other half were foreign. The idea was to make connections. We hope it will have given the researchers involved a better idea of implementation science, so that they can apply it for GACD or other organizations,” said Fernando Cendes, who co-organized the Training School and heads the Brazilian Neuroscience and Neurotechnology Institute (BRAINN), one of the Research, Innovation and Dissemination Centers (RIDCs) supported by FAPESP.

According to estimates, converting investment in scientific research into evidence-based public policies takes between 15 and 20 years on average. It can take longer in some countries.

The experts and researchers who attended the School discussed the following example: most people know about the health benefits of regular exercise, which include a reduced risk of contracting chronic diseases such as cancer and type 2 diabetes, as well as mental illness or lung and cardiovascular disorders, but few schools or local authorities have programs designed to do something about this.

“Science and research uptake by public policy sometimes occurs naturally, but by no means always. It usually takes a long time and a lot of effort for the results to be used in public policy development, implementation and evaluation. It often doesn’t happen at all,” said Brian Oldenburg, Director of the World Health Organization’s Collaborating Center on Implementation Research for Prevention and Control of Noncommunicable Diseases, and a co-organizer of the School.

The development of methodologies and strategies to link science and public policy has intensified in recent years, Oldenburg added.

“People used to assume that if research findings were published in high-impact journals, policymakers could create new projects while they had breakfast and read the papers. But many of them don’t read journals and don’t know about the evidence to be implemented by public policy unless they have a formal opportunity to interact with researchers,” Oldenburg told Agência FAPESP.

Smoking and pollution

Another facilitator and speaker at the School was Edward Gregg from the US Centers for Disease Control (CDC). Gregg highlighted tobacco policy as an important example of science uptake for implementation researchers to study.

“There was a long debate about tobacco with ups and downs, but smoking actually started to decline only when it was proved that tobacco was a health hazard and should be combated by public policy. They tried taxation and a ban on advertising. This was positive, but a genuine reduction came only as a result of policy based on evidence that smoking is unhealthy. Neglecting the implementation of science costs lives and money,” he said.

A project conducted in Peru with GACD’s support provided an example of how evidence-based public policy can improve the quality of life and save public money.

“Many homes in Peru have wood-fired stoves for cooking, but this type of pollution is known to be worse than the pollution found in the world’s filthiest cities,” Cendes explained. Indoor pollution correlates with diseases such as asthma, bronchitis and chronic obstructive pulmonary disease, so a group of researchers measured the impact of wood smoke on some of these Peruvians.

“The conclusion was that for the public health system, it was best and cheapest to buy and install piped gas stoves in these homes,” Cendes said. “Their inhabitants don’t get sick and there are fewer deaths and hospital admissions as a result.”

Studies like this should be analyzed and adapted for implementation in other countries, such as Brazil, according to Cendes.

In addition to proposing a closer link between the results of scientific research and lawmakers, implementation science aims to monitor and measure the results of evidence-based policies. “These projects must be backed by groups who know what to do to acquire scientifically sound data,” Cendes said.

For Pilvikki Absetz from the University of Eastern Finland, another speaker at the Training School, models and strategies are needed for good decision making on how to plan implementation and select the most efficient methods. “For example, for implementation to be sustainable and to put evidence into practice, we have to think about the level at which action should be taken – the community or organizational level, or the individual level, individuals interacting with other individuals,” she said.

For Ananya Gupta, the School helped accumulate a repertoire of different experiences in designing lifestyle intervention projects. “In the research project I’m working on now, for example, the differences between the Indian and British health systems are highly visible,” she said.

The key element in her project is the effort to design strategies that take these different contexts into account. “Without good modeling, it won’t be possible to translate the results obtained in a laboratory or in the British context to my own city [New Delhi], for example,” she added.

In addition to the Implementation Science Training School held at UNICAMP, two other events were recently hosted by FAPESP and GACD in São Paulo City: the 10th GACD Implementation Science Workshop, which assembled experts from several countries on November 12, and GACD’s 7th Annual Scientific Meeting on November 14.