Speaking Truth to Power When Power is Paralyzed

I do what I do because I believe in the power of evidence to transform health and health care. I believe this not only because I’m an optimist (I am!) nor just because it theoretically makes sense. I have personally experienced – both as a policymaker and a researcher – how speaking truth to power makes a critical difference.

That’s why I was so pleased to join other experts at this year’s American Public Health Association’s annual meeting to talk about effectively communicating evidence to those with the power to make changes. Everyone in the room was amped up to Speak Truth to Power – and I was personally eager to get the conversation started! So what do you do when those in power are paralyzed by congressional gridlock and polarizing rhetoric and siloed echo chambers of information are blocking your access to key audiences?

One thing is for sure – our past practices based on maxims such as “publish or perish” are not sufficient to overcome today’s challenges (well, they were never really enough to have an impact). First of all, while nearly 2 million peer-reviewed articles are published each year, even academics report only reading about 200 of them. You can imagine for busy, generalist policymakers, this number would be even lower. Even if people are reading our peer-reviewed work, more than one article has concluded that traditional research takes 17 years to impact health care. I don’t know about you, but that seems to be about 17 years too long. Policymakers need evidence that answers their questions and informs their decisions. Evidence that is completed in days & weeks, not years. Evidence that is responsive, timely, credible, and efficient. 

Regardless of the medium – peer-review or gray lit and everything in between – we also know that our data do speak for themselves. It’s not just a matter of pushing out facts. A recent report from the National Academies outlined all the influence on how science is understood and used, including psychological, economic, political, social, cultural, and media-related factors. Even taking into account these factors, because of confirmation bias, those with the most information tend to be the most polarized. And according to the Pew Research Center for the People & the Press, Americans are more politically divided than ever. This is reflected in our gridlocked Congress. In the last 10 years, we’ve experienced 54 days of partial or full government shut down. Last year was the first time in 22 years Labor HHS passed via regular order. And part or all of the federal government has been funded by a continuing resolution in every fiscal year in the last decade.

So what’s an evidence-loving, truth-to-power speaking person to do?

1.    Remember that “Statistics are the faces of people with the tears wiped off”

Kerr White (a renowned leader in health services research) used to use this quote by Sir Austin Bradford Hill which reminds me that our job as researchers is to ensure that when we use data to speak truth the power we have to connect that data, the research findings, to the human story, “putting the tears back on” so to speak. Thus our data make us credible, but our stories make us memorable.

2.    Leverage Powerful Partners & Diverse Coalitions

As researchers, we have to acknowledge that sometimes we are not the best messenger. Can you find a stakeholder or, better yet, a group of them, who would be positively affected by your research finding? These groups of citizens can offer more credibility with policymakers than the many well-earned letters after one’s name.

3.    Learn to Play the Long Game

In a country as big as ours, change doesn’t happen overnight. It takes time to build relationships and bodies of evidence to show impact. For example, when the Child Health Insurance Program (CHIP) was initially passed in 1997, it had a sunset clause that required its active reauthorization in 10 years. This gave the research and funding community a clear deadline for when evidence of CHIP’s impact would be needed. We worked hard over that decade to have the evidence ready that advocates and policymakers needed on access, quality, disparities and outcomes.

4.    Find Common Ground

It’s easy to make assumptions about what those on the opposite side of the political spectrum are working towards, but I think you’d be surprised at the amount of common ground there still is. Listening to those who think differently from you is a critical first step to finding a way forward. Identify the challenge as they describe it and offer options to achieve desired outcomes. As you build trust, you may be able to tackle more contentious topics.

5.    Work to Change the Current System

Finally, the research community has many systemic issues we need to address to incentivize, reward and value speaking truth to power effectively. For example, we need to be innovating our current scientific processes through things like open peer review, citizen science, and new, more risky and less biased ways of awarding funding. We need to move beyond publications and funding as the only tickets to promotion and tenure for those in our field in academic settings. The reality is that the 17 year lag time from research to application isn’t an accident. Our current system is “perfectly designed to achieve the results it gets.”

I believe every researcher, practitioner, patient – person! – with truth to share has an obligation to communicate that truth more effectively to those who have the power to act on it. Communicating evidence in this environment isn’t easy, but it’s so important. Now more than ever!