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Evidence-based policymaking in global health – the payoffs and pitfalls
  1. Gavin Yamey1,
  2. Richard Feachem1
  1. 1The Global Health Group, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Gavin Yamey
    Evidence to Policy initiative, Global Health Group, University of California San Francisco, 50 Beale Street, Suite 1200, Box 1224, San Francisco, CA 94105, USA; yameyg{at}globalhealth.ucsf.edu

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“The good news is that evidence can matter. The bad news is that it often does not.”1

If imitation is the sincerest form of flattery, the clinicians and clinical epidemiologists who promoted evidence-based medicine in the early 1990s should feel flattered. Evidence-based medicine now has many imitators: from evidence-based nursing,2 dentistry3 and public health4 through to evidence-based social work and social interventions.5 6 To this growing list, we can now add evidence-based global health policy, a ‘movement’ that is gaining increasing prominence.7 8

We are firm supporters of this movement. Indeed, we lead a project called the Evidence to Policy initiative (E2Pi), which aims to help narrow the gap between evidence synthesis and practical policymaking in global health. Research evidence has undoubtedly been crucial in formulating countless global health policies which have saved many millions of lives.9 Improving the flow of evidence between global health researchers and policymakers is an important tool for improving health outcomes and thus supporting low-income countries in reaching the Millennium Development Goals. For example, up to 70% of deaths of young children could be prevented through the better use of existing evidence.10

However, although evidence-based policymaking in global health has scored many successes, at the same time, we believe there are several common fallacies about its ‘real world’ application. We hope this perspective will spark discussion and debate on its payoffs and pitfalls.

The impact of evidence

Evidence-based global health policymaking aims to improve global health outcomes by urging policymakers to base their policies on the best available evidence – rather than on opinion, whim or political popularity (figure 1). Who exactly is a ‘global health policymaker’? The group is enormously diverse and includes bilateral and multilateral donors, development banks, foundations, presidents and prime ministers, ministries of health and finance, and …

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