Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

There is extensive health and public health literature on the 'evidence-policy gap', exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda - should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise 'evidence-based' policymaking above other factors? The latter includes governance principles such the 'co-production' of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.We conclude that successful engagement in 'evidence-based policymaking' requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn 'where the action is', and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just 'evidence-based', choices.

Development of a chemical kinetic model for a biosolids fluidized-bed gasifier and the effects of operating parameters on syngas quality.

In an effort to decrease the land disposal of sewage sludge biosolids and to recover energy, gasification has become a viable option for the treatment of waste biosolids. The process of gasification involves the drying and devolatilization and partial oxidation of biosolids, followed closely by the reduction of the organic gases and char in a single vessel. The products of gasification include a gaseous fuel composed largely of N2, H2O, CO2, CO, H2, CH4, and tars, as well as ash and unburned solid carbon. A mathematical model was developed using published devolatilization, oxidation, and reduction reactions, and calibrated using data from three different experimental studies of laboratory-scale fluidized-bed sewage sludge gasifiers reported in the literature. The model predicts syngas production rate, composition, and temperature as functions of the biosolids composition and feed rate, the air input rate, and gasifier bottom temperature. Several data sets from the three independent literature sources were reserved for model validation, with a focus placed on five species of interest (CO, CO2, H2, CH4, and C6H6). The syngas composition predictions from the model compared well with experimental results from the literature. A sensitivity analysis on the most important operating parameters of a gasifier (bed temperature and equivalence ratio) was performed as well, with the results of the analysis offering insight into the operations of a biosolids gasifier.

Why Should Health Researchers Use Policy Theories? Comment on "Modelling the Health Policy Process: One Size Fits All or Horses for Courses?"

Powell and Mannion suggest that 'health policy process' research should draw more lessons from 'the wider policy process literature.' While health research could continue with sector specific models, the wider literature is 'conceptually stronger.' In that context, I clarify how and why health researchers should use policy theories. I describe a review of the use of policy theories in public health research to show that many researchers use them to not only understand policy-making but also influence policy and policy-making. Most policy theories are not designed for that purpose, but it is still possible to produce practical lessons. I outline the issues that arise when repurposing theory-informed insights, such as that policy change takes a long time, and the scale of policy-making is potentially overwhelming. I then highlight the valuable role of theories in raising dilemmas in relation to modes of governance and evidence production.

COVID-19 and the second exams fiasco across the UK: four nations trying to avoid immediate policy failure.

In 2021, the UK and devolved governments tried to avoid the school exams fiasco of 2020. Their immediate marker of success was to prevent a similar U-turn on their COVID-19 school exams replacement policies. They still cancelled the traditional exam format, and sought teacher assessments to determine their grades, but this time without using an algorithm to standardise the results. The outcomes produced some concerns about inequity, since the unequal exam results are similar to those experienced in 2020. However, we did not witness the same sense of acute political crisis. We explain these developments by explaining this year's 'windows of opportunity' overseen by four separate governments, in which the definition of the problem, feasibility of each solution, and motive of policymakers to select one, connects strongly to the previous U-turn. A policy solution that had been rejected during the first window became a lifeline during the second and a likely choice during the third. This action solved an immediate crisis despite exacerbating the problem that ministers had previously sought to avoid ('grade inflation'). It produced another year of stark education inequity, but also ensured that inequity went from part of an acute political crisis to its usual status as a chronic low-attention policy problem.

How can policy and policymaking foster climate justice? A qualitative systematic review.

Background: Climate change research has established general requirements for policy and policymaking: transformational changes in policy and policymaking to foster 'climate justice', including a 'just transition' or movement towards environmental sustainability with equitable processes and outcomes. However, there is a major gap between these requirements and actual policies and policy processes. We identify how researchers use policy theories to understand this gap. Methods: We conducted a qualitative systematic review (2022) to identify peer reviewed journal articles on climate change, policy, justice, and equity in three databases (Web of Science, Scopus, Proquest). Each article had to provide a non-trivial reference to policymaking concepts or theories. We used an immersive and inductive approach to identify key themes and show how the use of policy concepts and theories informs climate change research. Results: A total of 108 texts meet the inclusion criteria (with some bias towards Global North research since all texts are in English). Most provide general definitions of climate justice, require fair outcomes and processes, and list what is required to meet those aims. However, they also identify unjust processes and outcomes in relation to who is recognised, gets to define the problem, and wins or loses from solutions. Researchers contrast their preferred social justice approach (informing 'civic environmentalism) to a dominant neoliberal approach (corresponding to weak 'ecological modernization'). Conclusions: Researchers focus on what they need from policy and policymaking to produce climate justice. Few engage meaningfully with policy theories to describe how policymaking actually works. More engagement would help to set meaningful expectations regarding policy change and avoid a needless tendency to treat policymaking like a 'black box'.

There is a strong and coherent message in environmental research: climate change represents an urgent global crisis. Although it is everyone's problem, there are major inequalities regarding who causes it and who suffers its impact the most. These problems relate not only to geography but also factors such as income, gender, and race. Governments need to address climate change by transitioning to sustainable energy, transport, food, and other systems. They need to ensure climate justice by fostering inclusive policy processes (who is heard, and who defines the problem?) plus equitable contributions (who pays to solve the problem?) and outcomes (who wins or loses?). They also need to collaborate to create fair policy processes that produce both transformational and equitable policy change. However, this research struggles to explain the gap between these requirements versus actual policies and policymaking. To some extent, the cause seems obvious: there is too much empty talk by powerful political actors, and too little motivation or political will to do the right thing. Yet, policy theories show that these gaps also have systemic causes that would persist even when addressed by sincere and energetic policymakers. Therefore, our objective is to identify how environmental researchers engage with policy theories to better understand and address this problem. Generally speaking, studies criticise the dominance of one approach that rejects radical change and puts too much faith in market mechanisms and technological innovation. Few studies use policy theories to identify how policy processes could facilitate a radically new approach. More conceptual engagement would help to set meaningful expectations for policy change and avoid a tendency to treat policymaking like a mysterious 'black box' rather than a well-studied process.

Policy networks and competing interests in the development of the Mexican sugar-sweetened beverages tax.

INTRODUCTION: Sugar taxes threaten the business models and profits of the food and beverage industry (F&BI), which has sought to avert, delay or influence the content of health taxes globally. Mexico introduced a sugar-sweetened beverage (SSB) tax in 2014 and other regulatory measures to improve population diets. This paper examines how policy networks emerged within and affected the development and implementation of the Mexican SSB tax. METHODS: This qualitative study analyses 31 interviews conducted with key stakeholders involved in the soda tax policy process and 145 documents, including grey literature and peer-reviewed literature. The policy network approach was used to map contacts, interconnections, relationships and links between the state, civil society and commercial actors involved in the SSB tax. These findings were used to examine the responsiveness, participation and accountability of the soda tax policy formulation. RESULTS: Complex interconnections were identified between state and non-state actors. These included advisory relationships, financial collaborations and personal connections between those in high-level positions. Relationships between the government and the F&BI were not always disclosed. International organisations and academics were identified as key financial or technical supporters of the tax. Key governance principles of participation, responsiveness and accountability were undermined by some of these relationships, including the participation of non-state actors in policy development and the powerful role of the F&BI in evaluation and monitoring. CONCLUSION: This case study exemplifies the importance of links and networks between actors in health policymaking. The F&BI influence endangers the primary aim of the SSB tax to protect health. The identified links highlight the normalisation of connections among actors with competing aims and interests toward health, thereby jeopardising attempts to tackle obesity rates.

Policy-Making Context Matters, But Can (and Should) It Be Operationalised? Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis".

Squires et al note that too many people use terms like 'context' imprecisely. The result (to avoid) is a catch-all term that lacks explanatory value and hinders the efforts of policy designers. Their list of 66 factors is a useful exercise to unpack what people mean when describing context. However, some problems will arise when the authors seek to move from research to practice. First, the list is too long to serve its purpose. Second, in many cases, it categorises rather than operationalises key terms. The result is the replacement of one vague term with a collection of others. Third, many categories describe what policy designers might need, rather than what they can reasonably expect to happen. In that context, wider studies of implementation and complex systems provide cautionary tales in which the outcomes of research become overwhelming rather than practical.

The COVID-19 exams fiasco across the UK: four nations and two windows of opportunity.

All four UK and devolved governments performed a 'U-turn' on their COVID-19 school exams replacement policies. After cancelling exams, they sought teacher estimates on their grades, but supported an algorithm to standardise the results. When the results produced a public outcry over unfair consequences, they initially defended their decision but reverted quickly to teacher assessment. We explain these developments by comparing two 'windows of opportunity' overseen by four separate governments, in which the definition of the problem, feasibility of each solution, and motive of policymakers to select one over the other lurched dramatically within a week of the exams results. These experiences highlight the confluence of events and choices and the timing and order of choice. A policy solution that had been rejected during the first window, and would have been criticised heavily if chosen first, became a lifeline during the second. As such, while it is important to understand why the standardisation process went so wrong, we focus on why the policymaking process went so wrong. Supplementary Information: The online version contains supplementary material available at 10.1057/s41293-021-00162-y.

Why is health improvement policy so difficult to secure?

Many governments seek to improve population health, and some seek to reduce health inequalities. Yet, there remains a large gap between their policy statements and actual outcomes. Perennial questions in public health research include: why is this gap so large, why does it endure, and what can be done to close it? This essay uses political science and policy studies insights to address these questions, focusing on the distinctive issues that relate to (1) broad aims like 'prevention', (2) specific strategies for health improvement, or (3) new events. On the one hand, the idea of 'prevention' has widespread appeal, when governments think they can save money or reduce inequalities by preventing problems happening or worsening. While health protection seeks to inoculate populations against communicable diseases, health improvement strategies, including 'Health in All Policies' (HiAP), primarily address non-communicable diseases (NCDs). Further, the coronavirus disease 2019 (COVID-19) pandemic highlights the unequal spread of ill health, showing that preventive health ideas should be at the core of policy. On the other hand, there is a large gap between rhetorical and substantive commitment to prevention, a continuous HiAP implementation gap, and a tendency for COVID-19 health protection to overshadow health improvement. Explaining each problem clearly helps to identify the factors that generally undermine prevention policies and those specific to more detailed strategies like HiAP or events like COVID-19. We do not prioritise leadership or 'political will' as the policymaking problem. Instead, we identify the systemic factors that apply to even the most sincere, competent, and energetic policymakers. Health improvement policy is typically undermined by a lack of: clarity about what prevention means in practice; congruity between the prevention agenda (emphasising the need for major change to policy and policymaking) and routine government business; and, capacity to overcome obstacles to policy change.

Policy design for territorial equity in multi-level and multi-sectoral political systems: Comparing health and education strategies.

The EU has many plans to foster equity and spatial justice. However, each has separate reference points, and it is difficult to find an overall vision. To demonstrate, we analyse two sectoral strategies to identify their implications for spatial justice strategies. Education focuses on early investment and public service reform. Health prioritises intersectoral action to address the 'social determinants' beyond the control of health services. Both warn against equating territorial cohesion or spatial justice with equal access to public services. These findings could inform European Commission strategy, but it tends to respond with renewed rhetoric rather than reconsidering its approach.

La UE tiene muchos planes para fomentar la equidad y la justicia espacial. Sin embargo, cada uno tiene puntos de referencia distintos, y es difícil encontrar una visión global. Para demostrarlo, este estudio analizó dos estrategias sectoriales para identificar sus implicaciones en las estrategias de justicia espacial. La educación se centra en la inversión temprana y la reforma de los servicios públicos. La salud prioriza las acciones intersectoriales para abordar los 'determinantes sociales' más allá del control de los servicios sanitarios. Ambos sectores advierten del peligro de equiparar la cohesión territorial o la justicia espacial con la igualdad de acceso a los servicios públicos. Estos hallazgos podrían informar la estrategia de la Comisión Europea, pero ésta tiende a responder con una retórica renovada en lugar de reconsiderar su enfoque.

Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers.

There is widespread support for the introduction of Drug Consumption Rooms (DCRs) in Scotland as part of a policy response to record levels of drug-related harm. However, existing legal barriers are made more complex by the division of relevant powers between the UK and Scottish Governments. This paper reports on a national, qualitative study of key decision-makers in both local and national roles across Scotland. It explores views on the political barriers and enablers to the adoption of Drug Consumption Rooms and the potential role of these facilities in the wider treatment system. It also considers approaches to evidence, especially the types of evidence that are considered valuable in supporting decision-making in this area. The study found that Scottish decision-makers are strongly supportive of DCR adoption; however, they remain unclear as to the legal and political mechanisms that would make this possible. They view DCRs as part of a complex treatment and support system rather than a uniquely transformative intervention. They see the case for introduction as sufficient, on the basis of need and available evidence, thus adopting a pragmatic and iterative approach to evidence, in contrast to an appeal to traditional evidence hierarchies more commonly adopted by the UK Government.

The UK government's COVID-19 policy: assessing evidence-informed policy analysis in real time.

In March 2020, COVID-19 prompted policy change in the UK at a speed and scale only seen during wartime. Throughout, UK government ministers emphasised their reliance on science and expertise to make the right choices at the right time, while their critics argued that ministers ignored key evidence and acted too little too late. Lessons from this debate should have a profound effect on future action, but only if based on a systematic analysis of policymaking as the problem emerged in real time. We should not confuse hindsight with foresight. To that end, I combine insights from policy analysis guides, policy theories, and critical policy analysis to frame this debate. The pandemic exposes the need to act despite high ambiguity and uncertainty and low government control, using trial-and-error strategies to adapt to new manifestations of the problem, and producing unequal consequences for social groups. Lessons will only have value if we incorporate these policymaking limitations and unequal socioeconomic effects and ask the right questions when holding the UK government to account.

The future of education equity policy in a COVID-19 world: a qualitative systematic review of lessons from education policymaking.

Background: COVID-19 had a major global impact on education, prompting concerns about its unequal effects and some impetus to reboot equity strategies. Yet, policy processes exhibit major gaps between such expectations and outcomes, and similar inequalities endured for decades before the pandemic. Our objective is to establish how education researchers, drawing on policy concepts and theories, explain and seek to address this problem. Methods: A qualitative systematic review (2020-21), to identify peer reviewed research and commentary articles on education, equity, and policymaking, in specialist and general databases (ERIC, Web of Science, Scopus, Cochrane/ Social Systems Evidence). We did not apply additional quality measures. We used an immersive and inductive approach to identify key themes. We use these texts to produce a general narrative and explore how policy theory articles inform it. Results: 140 texts (109 articles included; 31 texts snowballed) provide a non-trivial reference to policymaking. Limiting inclusion to English-language produced a bias towards Global North articles. Our comparison with a review of health equity research highlights distinctive elements in education. First, education equity is ambiguous and contested, with no settled global definition or agenda (although some countries and international organisations have disproportionate influence). Second, researchers critique 'neoliberal' approaches that dominate policymaking at the expense of 'social justice'. Third, more studies provide 'bottom-up' analysis of 'implementation gaps'. Fourth, more studies relate inequity to ineffective policymaking to address marginalised groups. Conclusions: Few studies use policy theories to explain policymaking, but there is an education-specific literature performing a similar role. Compared to health research, there is more use of critical policy analysis to reflect on power and less focus on technical design issues. There is high certainty that current neoliberal policies are failing, but low certainty about how to challenge them successfully.

The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies.

Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways.   Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.

COVID-19 and the policy sciences: initial reactions and perspectives.

The world is in the grip of a crisis that stands unprecedented in living memory. The COVID-19 pandemic is urgent, global in scale, and massive in impacts. Following Harold D. Lasswell's goal for the policy sciences to offer insights into unfolding phenomena, this commentary draws on the lessons of the policy sciences literature to understand the dynamics related to COVID-19. We explore the ways in which scientific and technical expertise, emotions, and narratives influence policy decisions and shape relationships among citizens, organizations, and governments. We discuss varied processes of adaptation and change, including learning, surges in policy responses, alterations in networks (locally and globally), implementing policies across transboundary issues, and assessing policy success and failure. We conclude by identifying understudied aspects of the policy sciences that deserve attention in the pandemic's aftermath.

Multilevel governance, public health and the regulation of food: is tobacco control policy a model?

Campaigns against risk factors for non-communicable diseases (NCDs) caused by smoking and obesity have become increasingly common on multiple levels of government, from the local to the international. Non-governmental actors have cooperated with government bodies to make policies. By analysing the policies of the World Trade Organization, the World Health Organization, the European Union, and the United Kingdom and United States governments, we identify how the struggles between public health advocates and commercial interests reached the global level, and how the relatively successful fight to 'denormalize' tobacco consumption has become a model for anti-obesity advocates. It highlights three factors important in policy change: framing the policy problem, the policymaking environment and 'windows of opportunity'-to analyse the struggle between 'harm regulation' and 'neoprohibition' approaches to an international obesity prevention regime.

The politics of institutionalizing preventive health.

Prevention is an attractive idea to policymakers in theory, particularly in health where the burden of spending and care is increasingly taken up by complex and chronic conditions associated with lifestyle choices. However, prevention in general, and preventive health in particular, has proven hard to implement in practice. In this paper, we look to one tangible legacy of the recent rise of the prevention agenda: agencies with responsibility for preventive health policy. We ask how this form of institutionalizing preventive health happens in practice, and what consequences it has for the advancement of the prevention agenda. We draw on qualitative data to compare the trajectories of newly formed agencies in Australia, New Zealand and England. We find that building and maintaining legitimacy for such agencies may come at the expense of quick progress or radical action in service of the prevention agenda.

Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study.

BACKGROUND: In 2011, England introduced the Public Health Responsibility Deal (RD), a public-private partnership (PPP) which gave greater freedom to the food industry to set and monitor targets for salt intakes. We estimated the impact of the RD on trends in salt intake and associated changes in cardiovascular disease (CVD) and gastric cancer (GCa) incidence, mortality and economic costs in England from 2011-2025. METHODS: We used interrupted time series models with 24 hours' urine sample data and the IMPACTNCD microsimulation model to estimate impacts of changes in salt consumption on CVD and GCa incidence, mortality and economic impacts, as well as equity impacts. RESULTS: Between 2003 and 2010 mean salt intake was falling annually by 0.20 grams/day among men and 0.12 g/d among women (P-value for trend both < 0.001). After RD implementation in 2011, annual declines in salt intake slowed statistically significantly to 0.11 g/d among men and 0.07 g/d among women (P-values for differences in trend both P < 0.001). We estimated that the RD has been responsible for approximately 9900 (interquartile quartile range (IQR): 6700 to 13,000) additional cases of CVD and 1500 (IQR: 510 to 2300) additional cases of GCa between 2011 and 2018. If the RD continues unchanged between 2019 and 2025, approximately 26 000 (IQR: 20 000 to 31,000) additional cases of CVD and 3800 (IQR: 2200 to 5300) cases of GCa may occur. INTERPRETATION: Public-private partnerships such as the RD which lack robust and independent target setting, monitoring and enforcement are unlikely to produce optimal health gains.