Knowledge experts, not knowledge brokers
For Filipino scientists and other experts these days, nothing is more exasperating, and oftentimes laughable, than watching vetted solutions to pressing problems fall by the wayside and lose to ideological decisions. The axiom of science is simple: We research, you listen. And in academia, this romantic notion becomes more entitled: We research, you should listen. We then disseminate high-quality information with the self-conceit that it should be prioritized and understood.
But when we enter the health policy game, we face a predictable reality: Decision-makers are painfully nonsensical and embarrassingly absurd. Then comes our second temptation: We huff and we puff, maybe roll our eyes, at our expertise being ignored. The path from research evidence to actionable policy is a quagmire.
What is required to wade through to the other end?
The answer is obvious: Experts must be willing to change. We might do well to unhinge our attention away from the supply of evidence and to pivot toward the demand for it. Calling it “expert opinion” or “scientific evidence” does little to automate a listening ear. Policy-making is an endless, frustrating negotiation with decision-makers whose free will cannot be engineered.
And decision-makers will not change — at least, not until the next election cycle. History, a glaringly dying subject in our schools of health sciences, is useful here.
When public officials insist that gasoline is a disinfectant or that motorcycle barriers are safe, these are direct descendants of colonial policy choices that emerged from the military sanitary bureau during the American occupation. Then as now, the intention is crowd control — to pacify and to attract. Military-medical strategies, rather than research evidence, are distinctive expressions of modern Philippine public health that emerged from the disciplinary tactics of white troops.
To breathe resilience and 45-percent unemployment in the same sentence is patently absurd. To claim that Filipinos would respect the “beach nourishment” of Manila Bay because the sand is white reeks of postcolonial psychology.
That is the point. It is not ignorant. It is irrational, which is something else entirely.
Experts should also take a practical lesson from the advocates’ playbook. Evidence told with emotional appeals is deliciously effective.
The models of research impact are patrician and boring. We come up with research questions, develop a methodology, collect data, analyze and interpret, deliver so-called recommendations, and hope we get reimbursed for all that work. Then, we train students and mentor early-career researchers to do the exact same thing, yet wonder why little has changed.
Little has changed because we do a poor job at pulling at the heartstrings.
But this raises a trade-off. How much objectivity and trustworthiness are experts willing to forego by making hyperbolic and perhaps manipulative statements that generate attention and get people to act on evidence?
There is no definitive answer here, but it is useful to draw from our sympathies that scientists and researchers are trained to be knowledge experts, not knowledge brokers, which is something else entirely. Storytelling, not policy memos, influences the policy agenda.
Then, there is the problem of hierarchy. A broad range of perspectives is a recipe for fairer, more useful, and more utilized policy. Accountability and responsibilities are shared. And so, experts claim co-creation of evidence, and ultimately influence, with public bodies such as service users and pressure groups.
This is not convincing. Community advocates and civil society groups might sit in consultation meetings and technical working groups, but much of this is policy co-production in name only. While health advocates and other community groups have over the years expanded their influence, physicians, and to a lesser extent other health professionals, are still the single most influential group in policy-making.
The informal, irrational contours of health policy pose a dilemma to the structured, logical ways of thinking favored by experts, and built into our institutions of health care.
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Dr. Ronald del Castillo is professor of psychology, public health, and social policy at the University of the Philippines Manila. The views here are his own.
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