Evidence for Health II: Overcoming barriers to using evidence in policy and practice.

Even the highest quality evidence will have little impact unless it is incorporated into decision-making for health. It is therefore critical to overcome the many barriers to using evidence in decision-making, including (1) missing the window of opportunity, (2) knowledge gaps and uncertainty, (3) controversy, irrelevant and conflicting evidence, as well as (4) vested interests and conflicts of interest. While this is certainly not a comprehensive list, it covers a number of main themes discussed in the knowledge translation literature on this topic, and better understanding these barriers can help readers of the evidence to be more savvy knowledge users and help researchers overcome challenges to getting their evidence into practice. Thus, the first step in being able to use research evidence for improving population health is ensuring that the evidence is available at the right time and in the right format and language so that knowledge users can take the evidence into consideration alongside a multitude of other factors that also influence decision-making. The sheer volume of scientific publications makes it difficult to find the evidence that can actually help inform decisions for health. Policymakers, especially in low- and middle-income countries, require context-specific evidence to ensure local relevance. Knowledge synthesis and dissemination of policy-relevant local evidence is important, but it is still not enough. There are times when the interpretation of the evidence leads to various controversies and disagreements, which act as barriers to the uptake of evidence. Research evidence can also be influenced and misused for various aims and agendas. It is therefore important to ensure that any new evidence comes from reliable sources and is interpreted in light of the overall body of scientific literature. It is not enough to simply produce evidence, nor even to synthesize and package evidence into a more user-friendly format. Particularly at the policy level, political savvy is also needed to ensure that vested interests do not undermine decisions that can impact the health of individuals and populations.

Evidence for Health I: Producing evidence for improving health and reducing inequities.

In an ideal world, researchers and decision-makers would be involved from the outset in co-producing evidence, with local health needs assessments informing the research agenda and research evidence informing the actions taken to improve health. The first step in improving the health of individuals and populations is therefore gaining a better understanding of what the main health problems are, and of these, which are the most urgent priorities by using both quantitative data to develop a health portrait and qualitative data to better understand why the local population thinks that addressing certain health challenges should be prioritized in their context. Understanding the causes of these health problems often involves analytical research, such as case-control and cohort studies, or qualitative studies to better understand how more complex exposures lead to specific health problems (e.g. by interviewing local teenagers discovering that watching teachers smoke in the school yard, peer pressure, and media influence smoking initiation among youth). Such research helps to develop a logic model to better map out the proximal and distal causes of poor health and to determine potential pathways for intervening and impacting health outcomes. Rarely is there a single 'cure' or stand-alone intervention, but rather, a continuum of strategies are needed from diagnosis and treatment of patients already affected, to disease prevention, health promotion and addressing the upstream social determinants of health. Research for developing and testing more upstream interventions must often go beyond randomized controlled trials, which are expensive, less amenable to more complex interventions, and can be associated with certain ethical challenges. Indeed, a much neglected area of the research cycle is implementation and evaluation research, which often involves quasi-experimental research study designs as well as qualitative research, to better understand how to derive the greatest benefit from existing interventions and ways of maximizing health improvements in specific local contexts. There is therefore a need to alter current incentive structures within the research enterprise to place greater emphasis on implementation and evaluation research conducted in collaboration with knowledge users who are in a position to use the findings in practice to improve health.

Evidence for Health III: Making evidence-informed decisions that integrate values and context.

Making evidence-informed decisions with the aim of improving the health of individuals or populations can be facilitated by using a systematic approach. While a number of algorithms already exist, and while there is no single 'right' way of summarizing or ordering the various elements that should be involved in making such health-related decisions, an algorithm is presented here that lays out many of the key issues that should be considered, and which adds a special emphasis on balancing the values of individual patients and entire populations, as well as the importance of incorporating contextual considerations. Indeed many different types of evidence and value judgements are needed during the decision-making process to answer a wide range of questions, including (1) What is the priority health problem? (2) What causes this health problem? (3) What are the different strategies or interventions that can be used to address this health problem? (4) Which of these options, as compared to the status quo, has an added benefit that outweighs the harms? (5) Which options would be acceptable to the individuals or populations involved? (6) What are the costs and opportunity costs? (7) Would these options be feasible and sustainable in this specific context? (8) What are the ethical, legal and social implications of choosing one option over another? (9) What do different stakeholders stand to gain or lose from each option? and (10) Taking into account the multiple perspectives and considerations involved, which option is most likely to improve health while minimizing harms? This third and final article in the 'Evidence for Health' series will go through each of the steps in the algorithm in greater detail to promote more evidence-informed decisions that aim to improve health and reduce inequities.

A call for global governance of biobanks.

The progress in genomic research has led to increased sampling and storage of biological samples in biobanks. Most biobanks are located in high-income countries, but the landscape is rapidly changing as low- and middle-income countries develop their own. When establishing a biobank in any setting, researchers have to consider a series of ethical, legal and social issues beyond those in traditional medical research. In addition, many countries may have inadequate legislative structures and governance frameworks to protect research participants and communities from unfair distribution of risks and benefits. International collaborations are frequently being created to support the establishment and proper running of biobanks in low- and middle-income countries. However, these collaborations cause cross-border issues ­ such as benefit sharing and data access. It is thus necessary to define and implement a fair, equitable and feasible biobank governance framework to ensure a fair balance of risks and benefits among all stakeholders.

Les progrès de la recherche génomique ont entraîné une augmentation de l'échantillonnage et de la conservation des échantillons biologiques dans les biobanques. La majorité des biobanques sont situées dans les pays à revenu élevé, mais le paysage évolue rapidement puisque les pays à revenus faible et intermédiaire développent leurs propres biobanques. Lors de la création d'une biobanque quel que soit le lieu, les chercheurs doivent prendre en compte un ensemble de questions éthiques, juridiques et sociales qui vont au-delà des questions rencontrées dans la recherche médicale traditionnelle. En outre, de nombreux pays peuvent présenter des structures législatives et des cadres de gouvernance insuffisants pour protéger les personnes participant à la recherche et les communautés de la répartition inéquitable des risques et des bénéfices. Les collaborations internationales sont fréquemment mises en place pour soutenir l'établissement et le fonctionnement approprié des biobanques dans les pays à revenus faible et intermédiaire. Cependant, ces collaborations génèrent des problèmes transfrontaliers, tels que le partage des bénéfices et l'accès aux données. Il est donc nécessaire de définir et de mettre en œuvre une gouvernance des biobanques équitable et réalisable pour assurer un juste équilibre des risques et des bénéfices entre tous les acteurs.

Los avances en la investigación genómica han dado lugar a una mayor toma y almacenamiento de muestras biológicas en biobancos. La mayoría de los biobancos se encuentran en países de ingresos altos, pero el panorama está cambiando rápidamente a medida que los países de ingresos bajos y medios desarrollan sus propios biobancos. A la hora de establecer un biobanco en una ubicación cualquiera, los investigadores deben tener en cuenta una serie de cuestiones éticas, legales y sociales más allá de las cuestiones de la investigación médica tradicional. Además, es posible que muchos países no cuenten con estructuras legislativas adecuadas y dispongan de marcos de gobierno para proteger a los participantes de la investigación y a las comunidades frente a la distribución injusta de riesgos y beneficios. Por ello, con frecuencia se crean colaboraciones internacionales para apoyar el establecimiento y funcionamiento adecuados de los biobancos en países de ingresos bajos y medios. No obstante, estas colaboraciones provocan problemas transfronterizos como el reparto de beneficios y el acceso a los datos. Por tanto, es necesario definir y poner en práctica un marco de gobernanza de los biobancos justo, equitativo y viable para garantizar un equilibrio justo de riesgos y beneficios entre todos los interesados.

Healthy by law: the missed opportunity to use laws for public health.

Health is the result of biological and social determinants; both are important. Nature dictates the laws for biological determinants; people create the laws for social determinants. Nature's laws are hard to discover and are eternal whether or not they suit humanity; people's laws are easily written and can be changed at anytime to suit humanity better. So why is it that the public health community, which expends much effort and expense probing natural laws, places negligible emphasis on collection, analysis, and making greater use of the world's public health laws?

Addressing Unmet Needs in Vaccination for Older Adults in the Asia Pacific: Insights from the COVID-19 Pandemic.

The impact of vaccinating the older population against vaccine-preventable diseases in terms of health, social and economic benefits has been increasingly recognised. However, there is a gap in the utilisation of vaccines worldwide. The population is ageing at an unprecedented pace in the Asia-Pacific (APAC) region, with the number of persons older than 65 years set to double by 2050 to around 1.3 billion. More than 18% of the population in Japan, Hong Kong, and China is over the age of 65 years. This highlights the importance of prioritising resources to address societal obligations toward the needs of the ageing generation. This review provides an overview of the challenges to adult vaccination in APAC, drivers to increase vaccination coverage, vaccination insights gained through the COVID-19 pandemic, and potential measures to increase the uptake of adult vaccines in the region.

Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development.

In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.

Defining research to improve health systems.

Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems.