Absence of evidence is evidence of absence in health policy

Since 2011, the Evidence Network, a group of Canadian health policy researchers, has been channeling evidence related to health policy issues into the media. What have they achieved? Ernest Hoffman talks with founder Noralou Roos to chart their progress and gauge their impact. By Ernest Hoffman By any objective measure, the Canadian public is awash…

Since 2011, the Evidence Network, a group of Canadian health policy researchers, has been channeling evidence related to health policy issues into the media. What have they achieved? Ernest Hoffman talks with founder Noralou Roos to chart their progress and gauge their impact.

By Ernest Hoffman

By any objective measure, the Canadian public is awash in health information, and Canadian media outlets recognize the importance of public health issues.  Whether it’s the Fifth Estate’s ongoing Rate My Hospital feature, the watered-down chemo controversy, or the recall of placebo birth control pills, health news is big news.  Add to this the imminent expiration of the Canada Health Accord in 2014, and the federal government’s recent decision to cut funding to the council that oversees it, and there’s more than enough to sustain a healthy debate.

But is this debate well-informed? Does it make good use of available evidence?  

One may argue that there remain significant barriers which impede academic research on health policy from reaching the public’s awareness.  Well-trained and highly-motivated journalists can be put off by the byzantine Canadian medical research structure.  Blaming the journalist on a deadline for errors and omissions is easy, but it won’t give them the judgment of a health policy expert.  Could the research community itself contribute part of a solution?

A network of experts

Enter Dr. Noralou Roos, founder of the Evidence Network on Canadian Health Policy, an ambitious initiative to get the latest and best findings in health sciences and policy research into the broader public conversation by engaging the media.  “I’m a traditional sort of researcher, and got into this business almost by accident,” says Roos, Founding Director of the Manitoba Centre for Health Policy and one of the 100 most-cited scientists in Canada.  “I’ve always thought academics should do a better job of communicating what they do to journalists.”

Roos acknowledges that communication could be better on both sides.  “Academics typically talk to other academics.  We get promoted or recognized because we publish in places like the Journal of the American Medical Association or the New England Journal of Medicine,” she says.  “While journalists do follow those high-profile publications, they don’t tend to follow health policy issues, which is what we were really interested in. How do you communicate these high-profile health policy issues to the media?”

A recent article in Heathcare Policy explains how Evidence Network established relationships with key health information partners  including the Canadian Health Services Research Foundation, Health Council of Canada, Canadian Institute of Health Information, and Canadian Institutes of Health Research, among others — and built bridges between the research and journalistic communities.

Like Canada’s approach to health, Evidence Network is now adapting in order to meet new challenges.  What began in 2011 as a database with dozens of journalist-friendly experts on every facet of Canadian healthcare has evolved to take an even more active role in the journalistic process — publishing more op-eds, organizing events and harnessing social media.

Experts as commentators

In 2011, a meeting with comment editor Gerald Flood at the Winnipeg Free Press led to the first major phase of Evidence Network’s development.  “I explained that we were trying to do and I asked him, ‘How do we do this in an effective way?’”  Flood suggested she work with Troy Media, a service that distributes commentaries of various kinds to Canadian media outlets large and small.  Instead of waiting by their phones or inboxes for journalists’ inquiries, Evidence Network’s experts could now get their message directly into the country’s newspapers.

This strategy proved very effective, with 146 different Evidence Network op-eds, letters and articles published 421 times in major media publications from April 2011 to the end of 2012.  Counting niche, ethnic, online and community media, EN articles have been published well over 1000 times.  Some of the most read, shared and commented EN articles from recent months include Michael Wolfson’s look at how the Canadian healthcare system contributes to social equality, which ran in the Globe and Mail, and John Millar’s call for government action on obesity, which ran in the Toronto Star.  “I think editors start knowing who you are,” says Roos.  “Occasionally they’ll call up and ask us if we have something on this or that, or they’ll save something that we sent them and publish it two, three months later.” 

Earlier this year, these expert commentaries were grouped together by topic into an e-book, which was distributed free to the public in every major format. For a collection of health policy articles, the response from the public was surprisingly strong, even to Roos.  “In Canada, 5000 sales is a bestseller,” she says.  “We’ve had almost 4200 reads of this e-book, which is great.”

The Evidence Network is now in the process of adding three new topic areas to the website: mental health, obesity and pharmaceutical policy.  “These are topics which are frequently in the media,” says Roos.  “We’ve been talking with key individuals researching these issues, and they were keen to figure out how to communicate what they’re doing.”

Social media

Another area where Evidence Network has learned from journalists is the use of social media to reach a broader audience, including Twitter, YouTube, Facebook, Reddit, Pinterest and LinkedIn.  “I’m trying to figure out how this new world works,” says Roos.   “We’ve been encouraging people to join the LinkedIn group because we do have discussions there, but there are a lot of academics who’ve never used LinkedIn, or Facebook, or any of this — so trying to persuade them that this is an important way of communicating is also challenging at times.”

They’ve also begun to develop infographics as a way of communicating complex health issues such as spending, wait times, and changing habits in a simple way. The goal is to get the infographics shared across social networks and websites, sparking an interest in the issue which leads to a desire to learn more.

Policy impact

And it’s not just the public that ends up learning something they didn’t know.  On more than one occasion, Evidence Network’s articles have come to the awareness of policymakers, prompting them to reach back into the research community for more information that they weren’t aware of.  “One of our experts did an op-ed on the financial aspects of aging in the Toronto Star, and got a call the next day from the Federal Finance Committee that was meeting, and they wanted him to come and testify,” says Roos. 

Something similar happened in Manitoba while a major inquiry into the death of a child who was in care was underway.  “I wanted to talk to the inquiry, to tell them to focus also on the broader issue of why these kids in care are doing so poorly in general, in terms of educational outcomes, a whole series of things,” she says.  “And there was just no interest in anybody hearing from me about our research until one of our colleagues, Marni Brownell, wrote a commentary.”  The piece was published in several newspapers across Canada, including the Winnipeg Free Press.

The very next day, Brownell got a call from the inquiry to meet with them, and they ended up taking into account the broader context which the research represented.  “When you can give examples like this, academics do become interested, because they realize that the media is a very powerful way of reaching people who can use evidence and research to make a difference in how things function.”

Trudy Lieberman

Evidence Network is now preparing to focus on health care journalists. Trudy Lieberman, the immediate past president of the Association of Health Care Journalists, will be coming to Canada in the fall to meet with medical researchers and editorial boards in Montréal, Ottawa, Toronto, Winnipeg and Vancouver.  She will also be studying the Evidence Network as a functioning model for her work on an international project which she’s establishing. 

“She’s trying to set up a network of English-speaking healthcare journalists around the world, focusing on the issues which reporters need to know about, and who they talk to in different countries if they want more background on how this system works versus that system,” says Roos.  The visit is funded by the Fulbright Foundation and will include the Canadian Journalism Foundation and the Canadian Association of Journalists. 

“[Lieberman's] developed a course on health policy reporting for American journalists, we’re going to Canadianize it for Canadian journalists,” says Roos.  “And to put journalists in touch with Trudy, and these international individuals who are doing the same thing will also be very interesting.”

Ernest Hoffman is currently an MA journalism student at Concordia University.