What is evidence based health policy?

Over and over again, I hear the claim that we do not know what evidence based health policy is. It is particularly discouraging to hear it from people who do not object to the need for an evidence based approach to medicine. Maybe a post can contribute to help readers (and myself) clarify the relevant concepts.

Sackett's definition of evidence based medicine can help us here:

Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.

The problems of making policy are inherently different from those of clinical practice. However, the three core aspects (research, professional expertise and values) apply very much the same. An evidence based approach to health policy aims to integrate the best research evidence with policy expertise and population values.

What type of research is relevant to Health Policy? There is no doubt that clinical questions are relevant to health policy. As a matter of fact health systems should be able to offer those clinical management options (prevention, diagnosis, treatment, rehabilitation) that offer the best results. But the latter processes of care are only some of the processes that occur at any time in a health system. And we also need information on the structure and the outcomes of health care, making many other questions that have to do with the organization and delivery of health care at least as relevant as clinical issues.

How many general practitioners do we need? What patient-physician ratio should we aim for? Does the Quality and Outcomes Framework improve quality of care? Does it increase inequalities? Would commissioning as proposed in the current health reform (as today) solve more problems that it will create? Should we pay consultants as we pay GPs? Should we offer cosmetic surgery under the NHS? Would NHS money be better spent on social care?

Evidence Based Medicine faced great barriers in its journey from revolutionary concept to mainstream approach to clinical practice. Unfortunately, I cannot anticipate a different path for evidence based health policy: many policy makers are no less evidence illiterate than the average physician some years ago. It is a challenge, but the impact our success can have on people´s health and lives is potentially immense and well worth the effort.