“Inequalities in Health Research Has Had Little Policy Impact” Katherine Smith, PhD.

January 16, 2012 - I met with Katherine Smith last week to discuss her research into the dearth of policy effects of the British research into inequalities in health. The last fifteen years have been an exceptionally fertile time for inequalities in health research, but not for the policies that would reduce such inequalities. Katherine explored the issue and argued convincingly against the orthodox Canadian view that there are distinct policy and research communities that must be brought together through knowledge brokerage. She believes instead that it is necessary to engage the public in the issues and create broad public acceptance of policies that might help. John Wilkinson, one of the foremost British researchers, now appears to be following this kind of advice by travelling everywhere to present his views to a wider community.

At first the gap between research and policy had looked like an authority struggle: the authority of research seems to be at odds with the authority held by politicians and policy makers. But in Canada well meaning policies have had very mixed policy results in the past. The present appalling health status of First Nations people has quite a lot to do with the policies that were developed jointly by expert researchers and policy makers in the past. What was missing was participation by those affected. At a conference several years ago someone pointed to a photograph of seven young women on a reserve taken in 1939. At the time anti- tuberculosis programs were being developed for reserve populations. By 1943 all seven were dead – of tuberculosis. “The lesson”, he said, “was that we should not presume to believe that our expert interventions will always work. Indeed we must beware of their dangerous consequences.” Another and perhaps more powerful lesson is to assure active the participation of those affected.

At the Patients’ Association of Canada (PAC), we have come to believe that expert advice is only part of the policy making requirement. Patients and their families must participate at all levels of decision making in health care.Our perspective and our contributions can help make research results more acceptable to those of us who are to be served by policy. We can help frame policies so that they are meaningful to us and can be more easily implemented. We may even be able to identify potential harms since we are the people affected. The tremendous historical disparity between the authority of experts and that of the population they are supposed to help is already eroding. PAC works hard to enhance the contributions of the patient and family perspective to the health system. Join us!