In a study of the relationship between evidence and child health policy in two states in southern Australia, researchers from the University of South Wales have discovered that isolated snippets lifted from research have been hugely influential. “Killer facts,” the authors call them.

Published in Evidence and Policy, the article by Shelley Bowen and colleagues at the University of New South Wales highlights the conspicuous impact of two examples.

The first was identified in descriptive research by Bruce Perry at the US Child Trauma Academy that demonstrated how early childhood neglect or abuse affects brain development.

It was presented as a sequence of images showing the difference in brain development between a normal child and one who had suffered trauma. In this case, the Australians attribute the power of the example to the vividness of the visual presentation.

The second “killer fact” related to a cost-benefit analysis of the Perry Preschool Study program that reported a return of $7.16 for every dollar invested in prevention and early intervention.

Here, the authors say, the power was in the text message, which they decribe as: “short, sharp, with dollars at the core”. To most of the people it swayed, where the information came from, or to what exactly it referred, was irrelevant.

The New South Wales study adopted a “tracer approach”, tracking the formulation of a group of policies through retrospective in-depth interviews with politicians, political advisers, journalists, pressure groups, civil servants and practitioners, and analyzing newspapers and policy documents.

At the outset, almost all of the respondents described the importance of research as a gold standard. But further probing for definitions of “evidence for policy” generally revealed an expanded conception embracing a range of persuaders. They included knowledge and opinion of academics and political advisers, statistics, government reports, stakeholder consultation and the media.

Similarly, as “killer facts” were harvested from research, so research in general was used to add a veneer of credibility to choices made. While many interviewees referred to randomized controlled trials, in particular to David Olds’s evaluation of home visiting, little thought was given to how it applied in the Australian context. [See: If it’s a good program, why not make it into a series?]

Tellingly, nine systematic reviews on antenatal and postnatal visiting programs carried out during the same period went unnoticed. Timing of publication was also mentioned as a key factor in influencing policy: what was considered to be current and up-to-date carried far more weight.

Beyond the obvious influence of political advisers, practitioners and the media, the political context was found to be strongly significant. “Government elections in New South Wales and South Australia triggered the social and health policy platform of early childhood development,” the team concluded.

The authors concede that it is hazardous to generalize from just two case studies, but argue that the broader lessons about policy formulation may have wider application. They also acknowledge that the time that elapsed between the implementation of the policies and the interviews might mean that the views and opinions of those questioned were clouded by hindsight.

As a way forward for evidence-informed policy, they recommend constructing a conceptual framework for government, defining concepts and providing guidance on adapting and applying research.

References

Bowen S, Zwi A B, Sainsbury P and Whitehead M (20090, “Killer facts, politics and other influences: what evidence triggered early childhood intervention policies in Australia?” in Evidence and Policy, 5, 1, pp. 5-32

Olds D L, Eckenrode J, Henderson C R, Kitzman H, Powers J, Cole R, Sidor K, Morris P, Pettitt L M and Luckey D (1997), “Long-term effects of home visitation on maternal life course and child abuse and neglect: fifteen-year-follow-up of a randomized controlled trial”, in Journal of American Medical Association, 278, 8, pp 637-43

Perry B D, Pollard R, Blakely T L, Baler W L and Vigilante D (1995), “Childhood trauma, the neuro-biology of adaptation and ‘use-dependent’ development of the brain: how ‘states’ become ‘traits’”, in Infant Mental Health Journal, 16, 4, pp 271-9