Health Policy is NOT Evidence-Based

Updated: May 30, 2019

Nurses, think about your work day. If you work in a hospital like me, you show up, clock in, get report, and start a long day of performing dozens of types of patient care. And while you're accessing a port or donning PPE, has a patient ever asked you why? Why are you wearing that ugly yellow gown backwards? Why do I have to wear this mask?


Every now and then a patient asks a question that stops me in my tracks. Why am I supposed to do it this way? When I'm stumped, my go-to answer is "It's hospital policy." I add finding the answer to my mental checklist for the day, and 9 times out of 10, I've forgotten by the next ambulance arrival.


It's important that healthcare professionals know the policies that dictate how we do our jobs. But it's also important we know how these policies are made. And if you’re anything like me - a stone cold optimist - this next bit of information may surprise you: Health policy is not evidence-based. 


WHAT? 


I’ll repeat: Hospital-wide, state-wide, nation-wide, health policy is not evidence-based.


I’d like to think we live in a world where the policies surrounding healthcare are firmly rooted in scientific evidence — but that’s not the case. In fact, the World Health Organization uses the term evidence-informed instead of evidence-based to describe health policy. This is not an accident. Though many health policy decisions are made with consideration to scientific evidence, research is not the only determinant of health policy. 



Relevant Knowledge + Political Will --> Social Action 


The above equation is my illustration of a 1999 model developed by two researchers, Feetham and Meister. They say that in order to see a Social Action (as in, drafting a new health policy), a society needs two things: Relevant Knowledge and Political Will.


In the context of health policy, Relevant Knowledge refers to relevant health research. Political Will refers to everything else — the entire context of society (i.e. the people, the political climate, the hot topic of the moment, etc.) And this is where the hope for evidence-based health policy goes to die. 


And because the Truth is more palatable in Listicle form, allow me to introduce…


 The 7 Reasons Health Policy is NOT Evidence-Based