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Evidence-based policy making (EBP) has developed over the past 40 years from conceptual roots that lie in the health care profession. Its deeper intellectual roots can be traced back even further to the Enlightenment, the policy sciences movement in the mid-20th century, and efforts to address societal ills through informed and activist government in the 1960s. Definitions of EBP may vary, but most observers agree that EBP requires rational and systematic processes for producing evidence to be applied in the policy making process. While differences in definitions of EBP tend to focus on variations on this idea, there is debate about the kinds of evidence that should be collected, EBP’s feasibility as an actual guide for policy making, and the standards of evidence that it requires. In this sense, EBP shares challenges that are similar to earlier movements that sought to rationalize policy making and policy-making processes.
EBP’s more recent conceptual roots lie in research on health care practices. In 1971, Archibald Cochrane, a British epidemiologist, highlighted gaps between the state of medical knowledge and the realities of medical practice. He advocated more systematic research on patient care as well as on the systematic application of knowledge gained through this research to clinical practice. In the early 1990s, his hope for more systematic assessments of clinical practices and their use in guiding patient care was realized when the international Cochrane Collaboration was established in Oxford, United Kingdom (UK), to execute systematic reviews of medical evidence. The work of the Cochrane Collaboration and the nearby Centre for Evidence-Based Medicine at John Radcliffe Hospital in Oxford caught the attention of policymakers in the UK, the United States, and elsewhere.
Research on evidence-based medicine gave rise to practical applications in both health care and other policy sectors. As Sue Dopson, Louise Locock, John Gabbay, Ewan Ferlie, and Louise Fitzgerald (2003) note, in the health care sector, the UK and the United States promoted the application of evidence-based research and practice in various ways, including the establishment of guidelines and research centers to encourage the use of systematic medical research findings in clinical practices. In the UK, the Labour government of the 1990s embraced the EBP concept and expanded it to other policy areas as a part of its efforts to modernize government. The Labour Government’s 1999 Cabinet Office White Paper on Modernizing Government, for example, highlighted the importance of evidence and research in policy making across the board, not just in the health care arena. In an effort to ensure that public policies actually work to achieve their objectives, the UK also increased funding for social research during this time period.
In recent years, the phrase evidence-based policy making has been used with increasing frequency. For example, the title of the Association of Public Policy Analysis and Management’s (APPAM) Annual Research Conference in Washington, D.C., during the fall of 2009, was “Evidence-Based Policy Making in the Post Bush/ Clinton Era.” This title reflects recognition of the importance of the phrase not only in the UK, where it has been commonly used, but also in North America and elsewhere as well.
However, while the EBP terminology has developed only in recent decades, the ideas underlying it have been in evidence for many years. Some trace the roots of EBP to the Enlightenment and its emphasis on applying science and knowledge for purposes of human betterment (Carolyn Heinrich, 2007). In the 1940s and 1950s, Harold Lasswell’s efforts to build a science of policy through policy analysis sought to encourage analytically based policy improvement efforts that are similar to those targeted by EBP. And, in the 1960s, governmental efforts to create a “Great Society” in the United States were predicated on the idea that rationally constructed public policies could be implemented in ways that alleviate societal ills. These policies, in turn, were accompanied by the establishment of public policy think tanks in universities and elsewhere that were designed to provide objective information to help guide efforts to improve policy making on an ongoing basis.
The attention that EBP has received is in part traceable to its grounding in basic concerns about the application of human knowledge to improve public policies, but it also has roots in the unique circumstances of the past several decades. During the 1980s, growing skepticism regarding the effectiveness of government programs led to a search for new alternatives that took better account of their costs and the cost-effectiveness. These concerns contributed to the performance measurement movement of the 1990s and a need for government programs that “work better and cost less,” to borrow a phrase from the famous 1993 Gore report in the United States. The EBP movement fit in nicely with these concerns and added a specific focus on the role of research and evidence to the performance measurement interests that came to dominate public sector management in the 1990s and the early years of the 21st century.
Challenges for Evidence-Based Policy
However, while the EBP movement coincided well with the times in which it developed, it did not escape the issues that had plagued similar movements in the past. At least three issues are worth addressing in this regard.
First, the concept of EBP assumes that researchers and/or policymakers can define what evidence is important and apply it appropriately to achieve desired policy outcomes. However, public sector programs may seek to achieve more than one goal, and choices regarding the most appropriate evidence to collect are not always clear. The evidence one needs to garner depends on the goals one chooses to pursue or assess. Where goals are numerous and differ with respect to the availability of evidence and the ease with which it can be developed, the evidence produced may be inherently biased toward goals that are easily measured. As a result, some argue that EBP and performance measurement more broadly are inherently biased toward measures of efficiency that are more easily quantified in monetary terms than measures of other values, such as those relating to equity, fairness, and democratic participation. This concern is exacerbated by the fact that producing evidence often requires money, which may be available in less abundance to those in society who are most concerned about these other values.
Second, there are debates about whether evidence produced by research efforts can be incorporated effectively into policy-making processes. Research takes time to be done in quality fashion, and time is often in short supply as policymakers make decisions to address both perceived emergencies and ambitious policy agendas. There are also issues relating to the ability of policymakers to access the right or best information as they make decisions. Because policymakers are often generalists, they may have limited ability to grasp all aspects of the evidence they receive. As a result, they may depend heavily on those who provide them with evidence, and they may ultimately rely more on the perceptions of those who provide the evidence than on the evidence itself—particularly when the evidence is complex and subject to interpretation. Finally, because policymakers in democratic political systems are (at least theoretically) held accountable to their electorates, they may perceive a need to react to public perceptions of evidence and risk rather than to the evidence itself. And where public perceptions of risk and evidence differ from the actual evidence provided by experts, systems of democratic accountability may encourage decisions based on public perceptions rather than on objective evidence.
A third difficulty that is inherent in EBP relates to decisions regarding the adequacy of evidence that is provided. Even within scientific disciplines, there is often disagreement among experts regarding the kinds of evidence that are most appropriate for answering particular kinds of questions. This is true in the social sciences as well as in the natural sciences, and it is particularly true when evidence is being gathered to help guide policy making because of varying values that may come into play in these cases. Some researchers argue that quantitative information is critically important if one is to assess policy effectiveness in objective fashion, while others argue that more qualitative assessments are also required if one is to reach balanced conclusions that address a range of legitimately held values in society. As a result, even where evidence is timely, appropriate, and clear to all involved, there are likely to be cases where differing kinds of evidence lead one to differing conclusions. And there is certainly room for debate over what kinds of evidence are most appropriate to believe in these contexts.
In all three of the aforementioned areas, EBP faces challenges that parallel the challenges faced by similar movements in the past. While EBP has the benefit of past experiences and appears to be particularly cognizant of these challenges as a result, it is still working to address these questions. What kind of evidence should be collected? How should evidence be incorporated into policy-making processes? And what standards of evidential quality should be applied? These are not simple questions, but they are important ones. There is reason to be skeptical of the extent to which these questions will be answered adequately once and for all, but—if one believes that human intelligence and the rigors of systematic inquiry can yield beneficial impacts—there appears to be little alternative to addressing them in some fashion. In the end, EBP and its predecessor movements focus on bringing systematic evidence to bear on the policy-making process and—despite the questions raised above—this may be the best kind of process that is available.
- Cochrane, A. L. (1971). Effectiveness and efficiency: Random reflections on health services. Cambridge, UK: Royal Society of Medicine Press.
- Davies, H., Nutley, S., & Smith, P. (2000). What works? Evidence-based policy and practice in public services. Bristol, UK: Policy Press.
- Dopson, S., Locock, L., Gabbay, J., Ferlie, E., & Fitzgerald, L. (2003). Evidence-based medicine and the implementation gap. Health, 7, 311-330.
- Gore, A. (1993). Creating a government that works better and costs less: The report of the national performance review. New York: Plume.
- Heinrich, C. J. (2007). Evidence-based policy and performance management: Challenges and prospects in two parallel movements. American Review of Public Administration, 37, 255.
- Nutley, S. (2003, April 23-24). Bridging the policy/ research divide: Reflection and lessons from the UK. Paper presented at National Institute of Governance Conference, “Facing the Future: Engaging Stakeholders and Citizens in Developing Public Policies,” Canberra, ACT, Australia. Retrieved July 3, 2016, from http://www.treasury.govt.nz/publications/media-speeches/guestlectures/nutley-apr03