From Fundamental Research to Policy

‘Research findings are not equally relevant everywhere’, says Eivind Engebretsen, a Professor of Interdisciplinary Health Science at the University of Oslo (UiO).

He was very encouraged when the WHO asked him and his colleagues to produce a report about the topic of his CAS project, the Body in Translation: Historicising and Reinventing Medical Humanities and Knowledge Translation.

‘Health is increasingly a cultural issue. Not only do decisions made locally have global cultural consequences, such as in the case of antibiotic resistance, but medical encounters in multicultural societies are more and more cultural encounters’.  

The WHO report is intended to serve as background for health policy makers and “propose concrete, actionable policy considerations”.

Such a tangible mission is encouraging, especially because of the nature of the CAS project, Engebretsen says; it is noteworthy that a large organisation like the WHO sees the policy relevance of critical, theoretical research.

 ‘The WHO is clearly influenced by our research, and they understand the importance of cultural contexts of health when translating knowledge from research into practice.’

Antibiotic resistance manifests itself differently

Cultural and social determinants of health are key to WHO Health 2020 and the 2030 Agenda for Sustainable Development.

Another reason why the WHO wants this report is that they are increasingly working locally, which requires local, cultural knowledge. 

The translation of knowledge acquired from research is often understood as a universal endeavour that transcends culture, as if the same research finding is relevant everywhere, Eivind Engebretsen says.

That is problematic, and is an assumption the CAS project and this report try to question.  

´The WHO has been inspired by our previous research, and our hypothesis that you cannot just implement research findings on antibiotic resistance, for instance, as a universal fact.´

Why?

´The problem of antibiotic resistance manifests itself very differently around the world. In Norway, we have had the possibility to have a strict use of antibiotics because of an efficient health system.’

India, for instance, has a huge problem with antibiotic resistance after years of prescription-free antibiotic drugs. They also have a huge problem with serious infectious diseases, and on one level, it has been important to make medicine available and easily accessible, Engebretsen says.

‘It is not possible to just implement research on how to reduce antibiotic resistance as a universal fact. The problem in India cannot be approached in the same way as in Norway’.

Day-to-day communication with patients is another form of cultural context that needs to be taken into account when formulating clinical guidelines and policy.

‘In France, patients expect to return with a prescription for some kind of medication when going to a doctor. In Norway, patients do not necessarily expect medications against a simple viral infection but we might expect to have a blood test, something which is rarer in a French context’, Engebretsen says.

According to Engebretsen, both clinical encounters and patients’ expectations of doctors are cultural phenomena.

Wrongfully enrolled in health program for elders

Professor in Practical Medicine at Oxford University and CAS Fellow to-be, Trish Greenhalgh, personally became a victim of algorithms that do not take individual differences into account.

On a spring day in 2014, Greenhalgh was riding her racing bike at 20 miles an hour.  

Suddenly, something was stuck in her fore wheel, and she was thrown up in the air before her body brutally landed on the pavement.

When she awoke from unconsciousness, her body was numb, her neck and head injured. Both arms were broken.

She needed long-term recovery treatment.

‘At the hospital, Greenhalgh was not only fighting to get well and recover, but she also had to fight the guidelines, which did not suit her at all,’ Eivind Engebretsen says.

Because Greenhalgh was 55 years old and had fallen, the otherwise sporty and healthy professor was channelled into the “preventing falls” recovery program.

´The irony here is that she turned 55 at the hospital, and just met the criteria for this treatment´, Engebretsen says.

As a doctor, Greenhalgh knew what treatment to fight for, but what would a person without this insight do in the same situation?

‘Doctors need to take into account the narrative of the patient, the cultural context, or even more global perspectives, such as sustainability of drug use’, Engebretsen says.

This aspect might be marginalised when decisions are evidence-based rather than evidence-informed, he says.

Towards evidence-informed policy-making

The WHO writes that the role of culture has been increasingly recognised, and that health policy-making has shifted from being too evidence-based to evidence-informed.

Policy-making that is informed, rather than based on, evidence, ‘situates knowledge translation within social, political and cultural contexts and acknowledges that policy-making is contingent on a range of factors.’

Do you agree that there has been a shift towards evidence-informed policy-making?

‘I hope they are right, but I think this is often not the case. Since the growth of science and the new paradigm of medicine that favours guidelines, the ideal is to base treatment on evidence’.

This has gone too far, Engebretsen thinks.

‘If guidelines are used as machines, people do not necessarily get the individual treatment they should. Guidelines need to be weighed against culture and the context of the patient’.

The WHO Health Evidence Network (HEN) Evidence Synthesis Report “Cultural Contexts of Health: Integrating cultural contexts of health into knowledge translation for health policy-making” is scheduled to be released in the fall of 2020, and will be written by CAS project leaders Eivind Engebretsen and John Ødemark, CAS Fellow Trish Greenhalgh (University of Oxford), and Dr. Shanmugapriya (Priya) Umachandran (King’s College London).

Source: DRAFT Concept Note WHO Health Evidence Network (HEN) Evidence Synthesis Report, Cultural Contexts of Health: Integrating cultural contexts of health into knowledge translation for health policy-making