When we say evidence – what do we mean?

By 9 June 2016

Physical activity policies need to be evidence informed, but what is actually behind the term evidence and how does it inform?

During the last decades we have all, both researchers and policymakers, come to the conclusion that it is a good idea to use evidence when working with policy making. That part was kind of easy… The more difficult part is, now, how to actually do it and find out what this evidence actually means. Is it only hardcore research results? Does it include reports? Educated opinions? Or is it even more than this?

To reach the ambition of making evidence informed policies the first step we recommend is to agree on how to identify and use the important evidence.

In the past five years, we have been working on a extensive EU project (www.repopa.eu) trying to find out how best to integrate evidence in physical activity policies. During our process of research, we came to the conclusion that the evidence for this type of policy development process is much more than what is published in high ranked scientific journals. Let me tell you a story:

A Danish municipality was developing an evidence informed policy to enhance physical activity. The members of the City Council (political policy makers) had articulated the need and the civil servants (administrational policy makers) were the ones carrying out the process.

So how do they start?  What is the first need? They need to find out what the problems are in their specific context. Do people not exercise enough in their spare time or are they sedentary during their working time? Is it valid for all citizens or only for the children or the elderly? To answer these questions, they need evidence to determine the target groups for the policy. Where is this evidence? Can it be found in health profiles?

After having identified the main problems, they need to find out what to do to make a change. Is it necessary to build more bicycle lanes, to implement more physical activity in the teaching programs of the primary schools, or something completely different? This evidence can be found in scientific literature- for example in evaluations of physical activity interventions. However, with an enormous amount of papers, identifying the most relevant results is not an easy task. The municipality, in our specific story, therefore contacts a research unit and asks them to summarise the best available research evidence.

After having identified the possible best actions, the municipality needs to adapt these to the local context. They need to balance the monetary and human resources and to make sure that the actions are also equal to the norms, values and wishes of the target groups. To do so, the municipality needs evidence on the available resources and on the preferences of the target groups. This can for example be found in budgets and by asking the staff and the citizens. Having this evidence, the local policy can be drafted. Finally, this policy needs to be approved by the politicians and possibly adapted to the perspectives of those.

To complete the circle, the effect and the process of the policy is evaluated, possibly published and in that way feeds into the evidence for future policymaking processes.

The story above seems rather straightforward. The truth is that in real life the process is much more complicated and the steps are back and forth between the different evidence inputs and actions. We can discuss whether or not all the input can be called evidence or if parts are more like knowledge or information. One thing is certain though – we need to acknowledge that much more than research results are important when making evidence informed policymaking.

In our work it has become clear that mainly three types of evidence/knowledge are important for policy making in public health and physical activity.

Research evidence is one – this type provides valuable information on how to develop physical activity policies that are proved to improve health and wellbeing. However, when working at community level, research evidence cannot stand-alone.

In addition, we need knowledge on the needs and values of the target group(s). A policy will never be successfully implemented if it does not comply with this. Hence, it is important to identify and incorporate the perceptions in the target groups(s).

Finally, the third important piece of knowledge is information on the available resources for the policy. This can, for example, be expert knowledge among the professionals who are going to implement the policy, human and monetary resources. This knowledge needs to be collected from stakeholders of the policy development process.

Finally, the various evidence/knowledge inputs need to be combined and balanced to develop a policy that takes all inputs into account in the best possible way. Our future challenge is to find good ways of doing this to make the most effective physical activity policies with the aim of promoting health.