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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 …
Footnotes
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Competing interests Both authors have completed the Unified Competing Interests form at http://www.icmje.org/coi_disclosure.pdf and declare: (1) No financial support from any commercial entity for the submitted work. (2) RF is adviser to McKinsey and Company and chair of the health policy advisory board at Gilead Sciences; GY declares no financial relationships with commercial entities that might have an interest in the submitted work. (3) RF is married to Neelam Sekhri Feachem, the chief executive officer of Healthcare Redesign Group; GY has no spouse, partner or children with relationships with commercial entities that might have an interest in the submitted work. (4) RF has held senior positions at the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and he has advised several bilateral and multilateral development financing organisations. He directs the Global Health Group (GHG) and the Evidence to Policy Initiative, E2Pi; the GHG as well as E2Pi have received financial support from the Bill and Melinda Gates Foundation, and E2Pi has also received support from GFATM and the Clinton Health Access Initiative. He is a member of the scientific oversight group that advises the board of the Institute for Health Metrics and Evaluation. GY is the San Francisco Team Lead of E2Pi in the GHG.