Association for Public Policy Analysis & Management

Although contemporary debate in the U.S. has raised concerns about "alternative facts" and decision making in a "post-truth" era, few people with actual policy-making responsibility would argue that decisions should not be informed by the best possible information. The value of evidence in health policy making, along with the realistic recognition of the complex and muddied ways in which research evidence has limited but nonetheless potentially multiple kinds of beneficial impact on policy decision making, motivate this study. While the literature on the use of research evidence in policy making is rich in perspective and ideas about what is likely to advance or hinder the impact of analytically-grounded evidence, and some studies have systematically acquired empirical information to support their conclusions, the state of understanding in the field remains remarkably impressionistic. Here I bring a layered, conceptual approach to these issues, informed largely by work in political science, including much of my own, and illustrate it by vignettes and anecdotes from the health policy domain. I start with a model of the social learning process that informs policy making, separating out two distinct pathways of policy and political lessons, three forms of knowledge, and three types of participants in social learning who vary in their lesson and knowledge mix. I then focus on just the presumably policy-learning dimension, revealing the further penetration of political dynamics into issues that on the surface seem to be matters of solely policy analysis and the underlying research evidence, what the W. T. Grant Foundation described some years ago as “empirical findings derived from systematic research methods and analyses.” From there I present a process-model framework for unpacking the process—from production to use—through which research evidence has a role in policy making. Using this framework we can identify the normatively optimal role of research evidence (from the standpoint of the analytical community), the more prevalent role played in the real world by politically tinged “evidence,” the place of the social-political-institutional context in shaping what kinds of policy-analytic information work their way into the system. This approach helps identify the appropriate targets of opportunity for enhancing the significance of evidence from health services and policy research.