Dennis,
Thanks for your reply. I greatly appreciate hearing your thoughts on this
matter and certainly find myself in agreement with much of what you write.
Perhaps it is wishful thinking on my part that evidence would have some
bearing on policy. As you observed, the opposite seems to more often be
true. Yet I do think we have some obligation to be prepared to provide the
evidence (rather than to ask, "do I really have to justify this?"). As I
see it, the fact that we may not sway others with power is no reason to
neglect rigorous evaluation and self-critique of what we do. Moreover, from
time to time (though, admittedly, not often enough), there come along
policymakers who are sympathetic to our cause. We can do our part to
support them by providing the arguments that "speak the language" of their
colleagues (the economic arguments we'd discussed). As you wrote, this
evidence alone is not sufficient to produce change, but it is necessary.
And when that evidence is in the right hands, I remain (naively?) hopeful
that we will do better.
Thanks again for this dialogue.
Warmly,
Mark
From: Dennis Raphael <[log in to unmask]>
Reply-To: Social Determinants of Health <[log in to unmask]>
To: [log in to unmask]
Subject: Re: Looking for info re: expenditures on determinants of health
Date: Tue, 30 Nov 2004 09:08:19 -0500
Hi Mark:
You work on the assumption that "policy follows evidence". I
suggest the
opposite is likely more accurate: "Evidence follows policy" in
that once
the powers-that-be have made a decision based on ideology and values, then
they seek evidence to justify the action. The evidence about the social
deteminants of health has been around since 1850. Some jurisdictions act
upon this; others do not. Do you think that one more study is going to
convince policymakers to implement something that goes against their world
view?
How much evidence would be necessary to develop family-friendly policies in
the USA? Or what study would convince Americans to reinstitute useful
progressive tax policies? Or why are labour unions disdained in some
nations despite their profound positive effect upon individual health and
healthy public policy?
Thanks for the debate!
dennis
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