Pergamon S0277-9536(96)00130-X Soc. Sc'i. Med. Vol. 43. No. 5, pp. 865-872. 1996 Copyright ~' 1996 ElsevierScienceLtd Printed in Great Britain. All rights reserved 0277-9536/96 $15.00 + 0.00 TRANSLATING SECTION T RESEARCH FINDINGS INTO HEALTH POLICY PETER DAVIS' and PHILIPPA HOWDEN-CHAPMAN 2 'Department of Community Health, School of Medicine, University of Auckland, Private Bag 92019, New Zealand and -'Department of Public Health, Wellington Medical School, P.O. Box 7343, Wellington South, New Zealand A~traet--Evidence of the influence of research on health policy is paradoxical. While there is scant evidence that research has had any impact on the direction or implementation of widespread health reforms, research on evidence-based medicine has dramatically increased, despite limited evidence that it has affected clinical practice. These developments have occurred in the context of a general decline in state intervention and provision and a post-modern questioning of researchers' authority. Models of the relationship between research and policy range from one where empirical research rationally informs decision-making, through research incrementally affecting policy, to an "enlightenment" or "infiltration" model, which may operate on a conceptual level. Health research that contributes to large-scale socio-political change may require more methodological pluralism and greater focus on key institutional structures. Case studies reviewed suggest that dissemination is enhanced if researchers involve managers and policy-makers in the development of the framework for and focus of research and if investigators assume a responsibility for seeing their research translated into policy. Public health research is more influential if topical, timely, well-funded and carried out by a collaborative team that includes academics. Evaluations are more influential if, in addition, they are commissioned by health authorities but based on local collection of data, and instruments and incentives to implement policy are available. In some areas, such as the recent policy focus on carers in the community, researchers were largely responsible for raising this policy issue, whereas in other areas, such as the relationship between unemployment and health, researchers are just one of the groups of experts making competing claims about causality. In conclusion, clear research findings are not always a passport to policy, but researchers can reframe the way health policy issues are seen, and collaboration with policy-makers initially can enhance implementation later. Copyright ~ 1996 Elsevier Science Ltd. Key words--research, health policy, policy implementation INTRODUCTION: A PARADOXICALRELATIONSHIP Over the last decade health system change has been an almost universal experience in countries of the developed world. Everywhere, it seems, governments are engaged in restructuring the funding, organiz- ation and delivery of health services. In countries such as the United States where the system has been pluralistic and free-market in orientation, attempts have been made to introduce greater central direction and control. In contrast, in those countries with well-established national health services--such as the United Kingdom and Sweden--there is now wide- spread experimentation with a range of market mechanisms. Innovation and system change, there- fore, are virtually universal features of the health scene in the developed world. Yet, the evidence that research has had any impact on this international trend is scarce indeed [1]. it would appear that the key contributory factors have been fiscal stringency, a narrow application of economic theory, shifts in ideology and values, political expediency, the failure of existing systems to undergo internal renewal, and the simple turn of intellectual fashion. All these seem to have had much more to do with the current wave of health restructuring than any measured consider- ation and application of the research on the effectiveness, responsiveness and fairness of health systems. In the case of the international wave of health restructuring, therefore, we have striking evidence of policy in the making and of implementation, but little indication of any large corpus of cumulative research that might have inspired and guided these rapid developments. In the case of medical practice, on the other hand, we have something of a contrary example; a considerable amount of research evidence on the quality of practice, but little sign of its widespread implementation or adoption by clini- cians. It remains to be seen whether the new purchasing organizations will increasingly purchase interventions of proven effectiveness [2]. Certainly there is change in medical practice--with a reason- ably constant flow of innovation as new drugs and procedures are introduced--but this is not usually conscious, directed change occurring in response to 865