Evidence attack in public health: Diverse actors’ experiences with translating controversial or misrepresented evidence in health policy and systems research

ABSTRACT

Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.

KEYWORDS:

• Evidence-informed decision-making
• controversy
• health policy and systems research
• misinformation
• censorship
• infodemic
• knowledge translation

Acknowledgements

The authors would like to acknowledge Dr. Devaki Nambiar and Dr. Hari Sankar for their invaluable inputs on the India case, as well as Drs. Manuela De Allegri and Valéry Ridde for their input on PBF cases. We would also like to extend our gratitude to the Translating Evidence to Action Thematic Working Group of Health Systems Global for convening an exciting panel of cases at the Health System Research Symposium 2020 that inspired this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analysed in the cases are available from authors on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.