Women's Health Bureau
Health Canada
January 1999
A Policy Advice Framework Report
to the
Centres of Excellence for Women's Health Program
Women's Health Bureau
Health Canada
January 1999
Also available in French
under title:
"Cadre de formulation des conseils en matière de politiques
Rapport à l'intention des Centres d'excellence pour la
santé des femmes"
This synopsis and the comprehensive report on which it is based were produced by Professor Diana Majury, Carleton University, for the Women's Health Bureau, Health Canada. Neither is intended to represent the policies or views of Health Canada.
TABLE OF CONTENTS
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Policy is an amorphous concept. It can be defined in many ways, and the differences among those definitions have significant repercussions for those interested in policy-directed research. In its narrowest definition, public policy is solely about what governments do, or choose not to do. However, public policy is generally thought of in much wider terms. Non-government institutions and organizations contribute to, and participate in, the creation and monitoring of approaches, rules and structures that inform and govern our interactions. In so doing, they too are makers of public policy. Those interested in influencing policy need to develop a comprehensive picture of the key policy sites and players operating in the area that they wish to influence. To have an impact on public policy, it is necessary to understand how the policy sites and players interrelate and interact and to use this knowledge to monitor policy priorities.
Fundamental to understanding the policy picture is to recognize that policy is a process, not a product. Policy making is an organic and a political process, subject to the power dynamics and uncertainties that are inherent in politics. The policy-making process is long and complex, with many, often conflicting, influences being brought to bear, both directly and indirectly. It is affected by geographic location, timing, recent events (from local to global), future prospects, the economic climate, current trends and ideas, and the fundamental values of the participants and of society. For those interested in participating in the policy-making process, all these factors need to be taken into consideration when determining how, where and with whom to try to intervene.
Research produced via the Centres of Excellence for Women's Health is intended to provide the basis for policy advice, directed to making the Canadian health system more responsive to the needs of women and the promotion of women's health. The comprehensive report on which this synopsis is based outlined decisions that need to be made and contextual factors to be considered in making those decisions. There are no right answers or right decisions; thus, the report could not provide a definitive model for the creation and promotion of policy advice. Nonetheless, the Centres need to make decisions in order to narrow and clarify the focus of their work and to establish the processes for the production and promotion of that work. These decisions need to be premised on the values, goals and vision of the Centres, realistically determined in the light of current contextual factors, and then clearly articulated.
The information on which the report was based was obtained primarily through interviews with 54 key informants whose names were provided by the Centres and Health Canada's Women's Health Bureau. In addition, current Canadian literature -- reports, papers, conference proceedings and articles -- discussing policy-making processes was relied upon.
| You have to be clear on what you stand for. You have to have a strong and clear mission statement. And you have to be assertive. You have to reach out to the people who are interested in your issue and your vision. The key is to establish a personality and from there to build recognition and trust with the people who are most likely to be able to use your work. (Key Informant) |
One of the most important tasks for the Centres is to clearly establish who they are -- their values, their goals and vision -- in as specific and concrete a manner as possible. If values and goals have been clearly set out and agreed upon, it is much easier to make difficult decisions relating to, for example, relationships with participants (policy workers, community workers, academics), the choice of research topics and strategies for promoting policy advice. Clarity around the Centres' values increases the likelihood of clarity and transparency when dealing with others. When defining themselves, the Centres will need to take into consideration a number of contextual and pragmatic factors, including:
These factors are discussed below.
2.1 The Goals and Mandate of the CEWHP
The first and most obvious factors for the Centres to consider in defining themselves are the goals and mandate of the CEWHP. It is the CEWHP that establishes the parameters within which the Centres have to operate. The time line and funding base have been set, as well as the mandate which stipulates that policy consideration must be central to the research.
Extensive negotiations and ongoing discussions have taken place between the Centres and the Women's Health Bureau. The results of these deliberations form the basis from which the Centres can pursue their vision. These program parameters also provide a reality check against which the Centres can assess the feasibility and appropriateness of their specific goals, projects and strategies.
2.2 The Socio-Political Context
Awareness of, and sensitivity to, the socio-political context within which policy is being developed are key to being able to influence the policy process. The Centres need to be in touch with the values, goals and attitudes of the communities they work with, of the policy makers they seek to advise, and of Canadian society. Values checking should be an ongoing research project for the Centres. Understanding the context they are working in will enable the Centres to position themselves, their research and their advice in relation to underlying values - to try to shift or challenge prevailing attitudes and values, to endorse them, or to draw upon them to support the advice being promoted. It will be particularly important for the Centres to be cognizant of values relating to health, gender and the economic climate.
Policy makers at all levels are currently viewing health from a broad perspective. The focus is on health determinants and the impact of social conditions. Such an expansive and flexible definition of health is compatible with the social change perspective of the Centres. At the same time, a health determinants approach is so broad and open-ended that, in relation to policy direction and the focus of the Centres, it risks dilution and diffusion to the point of ineffectiveness. The focus needs to be narrowed.
With the ascendency of evidence-based decision making, research has become an increasingly central concern. Nonetheless, academic research per se is still somewhat of an enigma to policy developers and policy makers. To be recognized as evidence, research needs to be simplified, packaged and sold as "evidence."
Economic issues and implications are important components of policy advice for most policy makers. While the preoccupation with fiscal restraint and expenditure reduction may be waning, they remain factors to be addressed. Ignoring the economic context and implications of advice risks having it ignored by policy developers and policy makers. In addition, the Centres need to be sensitive to the implications of cutbacks and downsizing that have had devastating impacts on their partners, particularly community and advocacy groups. The Centres need to factor this into the resources they allocate for input, dissemination and uptake within and by the community.
The acceptance of gender as a factor to be addressed in policy making is recent. It is not yet clear how secure the acceptance is, how deep it goes, and whether it will actually have much impact on policy or practice. Understanding by policy developers and policy makers of gender analysis at this time is fairly simplistic. Considerable education and values shifting would be required to develop their understanding to a level that addresses the systemic and interactive nature of gender oppression.
The Centres are engaged in difficult political and strategic choices about how to do their "gender work." Some key informants cautioned against diluting the gender analysis or gender focus to make it palatable to policy makers; others warned of alienating or putting off policy makers with an approach that is seen as too rigid or too extreme.
To the extent that the Centres are working directly with policy developers and policy makers who do not have a systemic and interactive understanding of gender, one of the Centres' roles is education. In order for the interaction to be worthwhile, the Centres need to assess whether the specific policy audience can be educated on this issue or if the more direct route of lobbying and political pressure may be more effective.
As part of the process of defining themselves, the Centres need to clarify how they understand social change and how policy change is brought about. Social change can be viewed as a bottom-up process pushed forward by social activism, with the community at the centre generating the ideas and momentum for change. Alternatively, social change can be viewed as a top-down process, with the decision makers at the centre setting the agenda and plotting the policy course with assistance from experts and input from the public.
These two visions of social change would lead to different models for public policy research. A bottom-up vision would rely largely on community leadership and involvement, research topics would be generated and directed by the community, the policy advice would be developed and promoted by the community. The role of the Centres would be to provide the community with solid research to direct their advocacy efforts. A top-down vision of social change would mean far greater involvement and input by policy workers. Centre research, as well as the advice generated from that research, would be responsive to the needs and agendas of policy makers. The role of the Centres would be to provide policy makers with solid research to ground and focus their policy-making efforts in directions more sensitive and responsive to women's needs and interests.
The two models are not necessarily mutually exclusive. An attempt could be made to integrate a bottom-up/top-down approach. There are any number of possible models along the spectrum between these two extremes. The important point is that each Centre needs to articulate for itself the model upon which it is operating and the assumptions that underlie that model. Each Centre needs to develop its own vision of the process of social change and how it relates to the principal audience for its research - community, or policy developers and policy makers - as well as to each Centre's organizational structure and the processes it develops to do its work.
In the policy context, the Centres play at least three roles:
In virtually everything they do, the Centres function simultaneously in all three roles.
As bodies with the explicit mandate of conducting research on women's health issues, the Centres are viewed by many outsiders as setting the research agenda for women's health in this country. External expectations are unrealistically high in terms of the quantity, quality and integrated nature of the work that will be produced through the CEWHP. The Centres need to clarify, for themselves and for the communities with whom they work and interact, what they see as their role in policy development and in creating a research agenda for women's health. Similarly, they need to clarify their collective expectations with respect to the work to be produced by the Centres, jointly and severally, as well as by the CEWHP. The Centres may then wish to produce and widely disseminate a public document outlining the goals and projections of the work that the CEWHP will produce during its current mandate.
As policy makers, the Centres have the opportunity and the obligation to develop and model policy processes that reflect their values, goals and vision and what they see as important components of the process -- from how research subjects are selected, to who is involved in the process and how they are involved, to what work is produced and how it is produced, to what is done with that work and how it is done.
In their role as policy promoters, the Centres need to decide whether they will primarily promote directly to policy makers or indirectly through community and advocacy groups. The target audience will have a major impact on what research projects are chosen, how the research questions are framed, and how the research is conducted, reported and disseminated. Promotion needs to be front and centre throughout the process, and must be audience directed and audience specific.
The Centres' role as facilitators and brokers is one that many key informants see as important. This is the role through which the Centres can create "a culture of sharing, networking and interdisciplinarity" that will then permeate their other roles as policy promoters and policy makers. One task that Centres could take on in this context is that of "neutral coordinator" for specific women's health issues. These would be issues in which there is a great deal of work being done but the work is dissipated and unfocused. Centres may be well situated to coordinate work that is already underway, by providing organization and direction.
Another way in which the Centres can play a facilitator/broker role is through the production of review documents and synthesis reports. To many policy key informants, reports that synthesize and analyze existing research, draw out the policy implications and offer policy advice are among the most needed and valuable resources in the policy development process. Centres can also act as information brokers and clearinghouses.
There are often different and conflicting assumptions about what is intended and what is expected when the term "partnership" is used in relation to a major program such as the CEWHP. If the term is used without being clarified, problems will undoubtedly arise.
Each Centre needs to clarify:
As a critical step in the partnership process, Centres need to determine if the partnership model is the most appropriate option in relation to their goals and the work being undertaken, and if so why, and what partnership means in this context. The aim is to include, in appropriate and effective ways, the people who have the necessary skills, knowledge, experience, values and vision to do the work. Partnership is a possible means to fulfill this aim but is not itself the goal. The Centres need to be clear on what the roles, duties and authority of the many participants are (e.g partners, members, representatives).
If the concept of partnership is to have any meaning, it is essential that the Centres know who it is they are talking about when referring to potential partners, which may include academic, community and policy groups.
Academics are usually researchers or teachers who are based in a university. However, the Centres will be involved also with non-academic researchers. Consideration needs to be given to where these researchers fit into the structure and work of the Centres and in the partnership context.
The definitions of policy and community partners are more difficult and need to be context specific. For the CEWHP, the definitional task requires a determination of what is being looked for in the partner. What makes the community and the policy group desirable or even essential as partners in this undertaking?
The skills and training that policy people bring to the work of the Centres is important, as is their situational knowledge and understanding. "Situation" may be an essential part of the definition of "policy people" for the CEWHP. From a situational perspective, anyone who has worked in policy for an agency or organization that is a potential target for the Centre's policy advice would fit within the definition of policy partner. These are the people with an understanding of the policy infrastructure and processes of the targeted policy-making site, and of the bigger policy picture from that site-specific perspective. With respect to community partnership, the Centres need to consider what interests, knowledge, experience, skills and understanding they need to have represented, in the Centre and on their projects. Having identified the communities, the next question is who the members of those communities are. Some communities will be clearly demarcated, but for others membership will not be as clear. Membership and representation questions raise important issues of territory, appropriation and who speaks for whom. These issues can create considerable conflict if they are not addressed directly. Centres need to be clear whom they are defining as community and why -- what they are looking to that community to contribute to the Centres or the project.
There can be a significant power differential between the three partner groups. Processes need to be developed that mitigate power differentials and facilitate full participation and mutual respect.
There is also considerable potential for overlap between the groups, and among individuals who could fit into more than one group in different aspects of their lives. Overlap raises the question of whether it is meaningful to compartmentalize people in such a fashion. If not, what does that mean in terms of partnerships and equality? Is partnership really the issue or is it more about ensuring that the appropriate people are involved. Here again, clarity in terms of role and expectations is crucial.
Centres need to ensure that the perspectives of non-dominant groups -- racialized, immigrant, Aboriginal, poor, disabled, lesbian -- are represented in and by all three partnership groups. Diversity needs to be reflected in the organizational structure of the Centres and the projects, and it needs to be addressed in the operational processes.
2.5.2 What are the partners, partners in?
Partnerships are referred to in two contexts -- in relation to the Centres themselves and to projects funded or sponsored by the Centres.
Partnership in a Centre would be reflected in its organizational structure. Partners would be equally involved in decision making for the Centre and management of the Centre. If academics, community representatives and policy workers share these responsibilities equally, it is appropriate to describe a Centre as a three-way partnership. If any of these groups is not represented or is underrepresented in a Centre's organizational structure, it would be misleading to refer to the Centre as a three-way partnership. It may be that a Centre chooses not to be a partnership, but instead establishes itself as an organization that promotes and funds partnership projects and works in alliance with academic, community and policy groups. Clarity and transparency in the Centres' organizational structures are essential to avoid misunderstandings and tensions relating to the control and direction of the Centre.
Similarly, the Centres need to assess if and why project-based partnerships between academics, community workers and/or policy workers might be important or beneficial. Key informants raised concerns about tokenism, partnerships being imposed as a requirement of funding, the funding of sham partnerships, the lack of resources and of opportunities to develop partnerships. Attempts to address these concerns do not appear to have been successful, and may call into question the desirability and effectiveness of project partnerships in the context of the CEWHP. If project partnerships are determined to be key to the research and work of the Centres, the Centres need to take a more active role in developing and facilitating these partnerships. For projects for which partnership is the preferred model, the Centres need to invest the resources required to germinate and nurture the partnership. This must be done as a preliminary matter, not as an add-on or support function. Except where an established and well-functioning partnership already exists, the project proposal process is not an appropriate model for this type of undertaking.
Given differences in status and privilege between partner groups, questions of ownership and who belongs are particularly sensitive. Any implication, for example, that academics are at the centre of the program will likely create tensions between partner groups. If these are to be true and effective partnerships, every effort needs to be made to ensure that all partners are recognized, portrayed and treated as equals.
2.5.3 Building a good partnership
Partnerships are hard work -- they take commitment, openness, flexibility, time and a willingness to be changed by the experience. Partners have to want to be in partnership with each other, be willing to do the hard work of partnership together, and have mechanisms and resources to enable them to do so. Clarity and accountability provide essential grounding for good partnerships. Each group and subgroup has its own particular culture, interests and perspectives. These differences need to be acknowledged and addressed to minimize the tensions, conflicting assumptions and ungrounded expectations that can arise and to facilitate disparate groups being able to work together and learn from each other.
Some community and academic key informants raised concerns that the Centres are just doing governments' work for them. For some, this perception is heightened by the participation of government policy workers directly in the work of the Centres. Some policy informants aired concerns that because funding for the Centres comes from the federal government, their research and policy advice will be directed to the federal policy agenda to the exclusion, and sometimes even at the cost, of other policy agendas. Some community informants resent funds being directed into research when the delivery of women's health services has been decimated by funding cuts. Unless these types of issues are confronted directly, they will continue to haunt the Centres.
The training of academics, the scholarly style of writing valued in academia and the university reward structure under which academics operate are not conducive to the production and promotion of policy-relevant research. If the Centres expect academic researchers working with them to produce policy-relevant research, analyse the policy implications and provide recommendations for policy direction, they will need to provide the training and support that these researchers may require in order to produce this type of work.
The focus of the full report on which this synopsis is based was on the Centres' work on policy-relevant research on women's health issues. This research is to be designed to provide the basis for policy advice that will be actively promoted, in the expectation of having a positive impact on women's health and women's health policy in this country.
There is no blueprint for the successful production and promotion of policy advice. The process is too complex; the factors and forces involved are too numerous, too intertwined and too unpredictable; and the power dynamics that influence the process at every stage and level are too dominant for there to be any easy answers on how best to influence the policy-making process. Nonetheless, there are basic components of a policy-directed research-to-advice process that would ensure that the advice is well grounded, appropriately directed and suitably promoted
In setting out the basic components, some background issues need to be addressed before the steps involved in producing the research, translating it into policy advice and advancing the advice can be articulated.
3.1 Background Issues
Thinking about the issues from a policy perspective has to be front and centre, from the beginning of the process to the final presentation. To provide the base for an integrated policy focus, preliminary decisions need to be made on the following issues:
- what constitutes policy-relevant research; and
- targeting policy sites.
3.1.1 What constitutes policy-relevant research
There are major debates and strong disagreements about what constitutes policy-relevant research. Centres need to determine what they mean by policy-relevant research:
- How direct and explicit do the policy implications and policy application need to be?
- How narrow does the focus have to be? Is it enough that the research contributes useful information or improves knowledge in relation to some aspect of women's health or do the policy implications need to be more precise and, if so, how much precision and specificity are required?
- Do the Centres favour problem-solving research or are they more interested in broader research and more general application?
- Can "pure research" be considered policy relevant, and under what circumstances or criteria?
- Are the Centres willing to fund research that falls outside their own definition of policy relevance? If so, on what basis?
One way to approach the definition of policy relevance is to determine what role the Centres see policy playing in relation to the research; that is, where does the Centres' policy focus lie. The following are some options to consider:
- policy as the research focus -- the research is directed to a specific policy question -- you start with the policy or the absence thereof;
- policy as an analytic tool -- the research focus is on a specific issue; policy is a way of analyzing the issue and applying the results but is not the research focus itself -- you start with the issue or problem; and
- participation in policy -- the research is designed to help and equip people to participate in policy development -- you start with the skills and knowledge needed to engage in policy debate.
The Centres need to decide where along the spectrum they wish to draw the line with respect to the types of research they will fund and how this relates to their goals, mandate and approach to policy research. This information needs to be communicated clearly and precisely in the form of criteria for assessing research project applications.
3.1.2 Targeting policy sites
Some of the discussion relevant to targeting policy sites is raised when exploring the macro-micro distinction in relation to policy-making levels. The conclusion reached is that, with respect to policy-relevant research, this is largely a false distinction. While implementation or application may be pursued at a local, micro level, the policy implications of the research will be of more macro, or general application. This flows from the definition of policy-relevant research. It is the job of the researchers or those drawing policy implications from the research to ensure that generalizable lessons are drawn from the findings, connections are made and policy potential explored. In the words of one key informant, "You've got to seek policy interventions and action research leading to policy interventions at any level you can and charge after the opportunities as they present themselves.... You can always translate these things. The hard job, the important job, is the translation. It is very interactive; to be exclusive is intellectually artificial and practically counter-productive." Centres should brainstorm about whom they think are key policy makers on matters relating to health. Thinking about the range of potential targets for the advice should help in setting parameters and providing focus for selecting research topics and directing the research. There are several ways in which the question of selecting target sites can be approached:
- Focus on the target -- all of the Centres' advice would be targeted to a single policy maker. Research topics would be chosen accordingly;
- Focus on the issues -- sites appropriate to the issues raised by the research would be targeted for the advice. Site might be only one of many factors in the selection of research topics;
- Combination approach -- the Centres' advice would be targeted to a limited number of policy sites. Site would be a significant factor in the selection of research topics; and
- Community uptake -- the community rather than the Centres would target the advice. Research topics would reflect the needs and interests of the community.
3.2 The Research-to-Policy Advice Process
In developing policy advice, the Centres are engaging in a policy-making process similar to that pursued with respect to any policy. The Centres' role as policy promoter ought to be informed by the lessons learned from their role as policy maker. The Centres will learn about timing and what interventions are effective and what are not from their responses to interventions by groups and individuals seeking to influence or participate in the development of policy advice by the Centres.
Good research is the foundation of good policy advice. But good research is not enough. A number of other pieces are needed to focus the policy advice and to present it effectively.
3.2.1 Generating the research topics
To do research that will have an impact on policy, the first critical question is "what to research." Virtually all of the key informants agreed that choosing what to research has to be a collaborative process and that the research topics need to be generated by the audience for whom the policy advice is being developed.
A general environmental scan should be the preliminary stage in the selection of research topics to provide the Centres with background information to guide their decisions. This scan should be an ongoing project of each Centre so that it is aware of new developments, shifts and changes in the environment.
A focused environmental scan should be the first stage in any research project in order to ground the research and ensure that it is policy relevant and policy directed from its inception. Each project should continue the environmental scan throughout its duration to ensure that it is continuing on target and is responsive to environmental changes.
An environmental scan involves checking on what is out there. It can and should be done using whatever tools and contacts are available. These include:
- researching current policy agendas and research projects -- finding out what research and what policy work are under way by whom, what is on the policy horizon and what is being predicted with respect to future policy items; and
- consultations (formal and informal, broad-based and issue-specific) -- talking to people who work on health issues and health policy and to those directly affected by the issues being explored.
3.2.2 Choosing the research projects
A completely open-ended request for proposal (RFP) for the selection of research projects is not the most appropriate model for producing policy-relevant research or for generating the support and awareness necessary to promote the resulting policy advice. In such cases, the research topics are generated from the interests of individual researchers or groups of researchers and as such tend to reflect a more individualistic and limited approach. Policy-oriented research needs a more specifically defined process for the generation of comprehensive and broadly based research questions, as well as a more collaborative and interactive research and policy advice development process.
An organization interested in having an impact on policy needs to be directive about the research it funds. To set the research agenda, determine what research is needed and to reach decisions as to what research projects they will sponsor, the Centres need to make decisions on the following issues:
Audience focus
To focus their projects appropriately and to ensure that the essential people are involved, the Centres need to determine whether their audience focus is directed primarily to the community or to policy developers and policy makers.
Project types
There are a variety of different types of projects on which Centres could choose to focus their resources, including:
- seed money projects -- funding and working with groups to develop proposals for major research projects;
- major Centre projects -- a Centre itself funding and directing one or two major research projects;
- synthesis projects -- funding projects that infuse a gender analysis into existing synthesis work and ones that pull together, analyse and draw implications from existing research in a specific area or areas; and
- small research projects -- funding a variety of specific research projects.
While some combinations of project types may be possible, Centres will be doing themselves and the CEWHP a disservice if they try to do too many things and spread themselves and their limited resources too thinly. Centres need to determine what type of project might best suit their mandate, goals, vision and the parameters within which they are operating. And they need to commit themselves to funding only those projects.
Some key informants raised the concern that the Centres need to have some ability to respond to unexpected and short-term opportunities for policy interventions or to sudden major events or crises that are having a deleterious effect on women's health. Process and budget mechanisms need to be established to provide for some of these quick turn-around projects.
Selection processes
Whatever model the Centres adopt for the generation of research topics, they need to develop a clear and transparent process for determining what research projects will be developed and funded. The decision makers who choose the projects need to be drawn equally from all the partners in the Centre and the criteria they use need to be as precise as possible. The Centres have to be accountable to their partners and be able to explain the project decisions that are made in relation to the Centres' goals and objectives and the CEWHP.
Once research projects have been chosen, the Centres need to find the people with the skills, knowledge and experience to conduct the research and the policy analysis. The process, criteria and decisions in this area need to be clear, transparent and accountable.
3.2.3 The research process
The more people who are involved throughout the research project, the greater the potential for policy impact. In the words of one key informant, "If it works out well, the process has created a group of ambassadors for the research results." The strategic question that Centres need to consider is whether to include people with different or opposing views from those informing the project and, if so, for what purpose.
The research questions are critical for ensuring that the research will be policy relevant and that it is responsive to audience needs. It is the Centres' role to bring together the people, particularly the intended audience, who can contribute to the development of the questions to be addressed in the research project.
Research uptake
The research is the background to, and support for, the policy advice. It is important that the research itself be widely disseminated, easily understood and used. The Centres need to promulgate their research widely and visibly. They need to develop and build on their research reputation.
3.2.4 Policy implications and policy advice
Distilling the policy implications from the research and offering advice or direction is the goal of policy-directed research. This process involves analysis, application and projection. The advice needs to be firmly grounded in the research and presented briefly and decisively. If the research produced through the Centres is to be used in a policy context, the distillation process and the advice dissemination process are the most important components. To be done well, these processes are extremely time, labour and resource intensive. This aspect should be considered a major portion of the Centres' work and resources.
The research and advice need to be produced in multiple forms, each designed for a specific audience. These would generally include a key point summary, a longer synopsis and a full report. The researchers or communications experts who produce these documents need to be trained and skilled in culling the pertinent information and presenting it clearly and accessibly.
The following are some characteristics of good policy advice:
- brevity;
- clear, logical presentation;
- positive, constructive tone;
- pared-down style;
- presentation and assessment of options; and
- justification for recommended course.
3.2.5 Policy advice promotion
Effective promotion of policy advice requires a well thought-out and serious marketing strategy. This involves all of the strategies traditionally associated with marketing -- market/audience research, packaging and promotion. Substantial amounts of time and money need to be devoted to this work. The more the process can be transformed into one of helping rather than selling, the more likely it is to be successful.
Policy making is often described as a push-pull process. At one end are the advocates, stakeholders, lobbyists, researchers who are trying to "push" their policy advice forward to get their item on the agenda or to have input into an item already on the agenda. At the other end are the policy makers trying to "pull up" the information, analysis, advice and support they need to make a decision.
The Centres need to decide how involved they will be in promoting the policy advice they develop and how they can develop that involvement from both ends of the spectrum. They need to decide whether their involvement will be directly with the policy developers and policy makers, or indirectly through community and advocacy groups. The strategies for policy advice promotion differ depending on whether the Centres are communicating with policy developers and policy makers directly or indirectly.
Indirect community-based promotion
From a bottom-up perspective of social change, it is the role of the community and advocacy groups to pursue and promote the policy advice. One of the key ways to get the attention of policy makers is through large-scale public support, high public visibility and sustained public pressure. This aspect of policy advice work is about numbers, vocal support and persistence. The Centres' dissemination/uptake role in this context would be to facilitate the work of communities and to work with them in building alliances and coalitions to promote the policy advice. These relationships must be cultivated and developed. Public education is extremely important. Other groups have to understand your perspective and issues, and vice versa, before any alliance can occur. With the decimation of community groups and services, the Centre's role in doing this work will be critical.
Direct promotion
Direct promotion involves the researchers and/or Centre staff promoting the policy advice directly to policy developers and policy makers.
Policy key informants strongly advised Centres not to step over the line from researchers to advocates when dealing with policy developers. The distinction between advocacy and advice promotion was described as relating to both content and style -- what you voice and how you voice it. Advocacy was described as ideologically based and full of rhetoric. The independence of advocacy-based research was seen as suspect due to the belief that the outcome of the research would be predetermined. Advocates were described as speaking for a specific constituency; and advocacy as a role appropriate for community groups. Advocacy was seen as part of the political process which should be directed exclusively to the decision makers. Researchers were advised to limit their advice to what flows directly from the research. Academic and community key informants were skeptical about this advocacy/advice distinction, believing it to be based on ideological and value differences. The advocacy label is pejoratively attached to those promoting social change, while those advocating variations on the status quo are seen as objective researchers.
Whatever one thinks of the advocacy/neutral advice distinction, the Centres are at some risk of being perceived as advocates for women's health rather than researchers of women's health. Perhaps the advocacy designation is inevitable and the Centres should adopt it with pride. However, it is a strategic question for the Centres to consider when deciding how they want to position themselves in relation to the community and advocacy groups they work with and to the policy developers whom they are trying to influence.
The key to direct promotion is to know your target. This involves knowing:
- which are the appropriate targets for your advice and how best to approach them;
- the infrastructure of your target bureaucracy: the decision-making processes, leverage points, horizontal and vertical interactions;
- the culture of the bureaucracy you are dealing with: protocols, secrets, values;
- the constraints, problems and tensions under which they operate.
The emissaries who promote the advice to the policy developers and policy makers need to be trained. It can be an intimidating and alienating environment which policy promoters need to be prepared to handle.
A major component of policy promotion is finding and working with allies within the targeted bureaucracies. Allies can provide inside information, assist in mapping a strategy, make introductions and connections and smooth the way. Senior allies can become champions of the advice and promote it themselves.
Direct promotion of policy advice can be initiated either by the Centres or at the invitation of policy developers or policy makers. The more power -- related to reputation, credibility, personal contacts, status, resources -- the promoter has, the more likely it is that the promoter will be invited to participate in the process. If this kind of individual power is not available, more reliance must be placed on the power that comes from public support, numbers, visibility and audibility.
A person is more likely to have an impact on the process and the decision if invited or "pulled" into the process by the policy maker than if the person "pushes" in from the bottom. Different kinds of invitations offer differing degrees of potential impact:
- As one of the inner circle -- a person whom the decision maker relies upon for assistance in sorting through policy issues and making decisions. These are people who are recognized as experts in their fields and are seen to be good thinkers and analysts on a range of issues and to have political and strategic acumen.
- As an expert on a specific issue -- a person called in to give advice, in the form of contracted research, a presentation, round-table discussion or response to a discussion paper, because he or she is recognized as an expert on a particular issue or in a specialized field.
- As general contract researchers -- to provide research that policy developers are not able to produce in-house.
- As participants in a broad-based consultation.
People in these invited positions can be highly influential in developing specific policies and general policy direction. The earlier they are involved, the greater their ability to shape the direction of policy and to contribute to the development of the policy at different points along the process. The Centres should be positioning themselves, their researchers, and their community and academic partners to be invited to fill these roles in order to provide a gendered analysis of health issues and expertise on women's health.
Media
The media can be important players in the uptake of both research and policy advice. Having a story published on the front page of The Globe and Mail, for example, would be one way for Centres to get government attention. Front page news is also an avenue for finding out what the government is reacting to or having to respond to. A Centre able to seize the opportunity to assist a policy maker with information and/or advice relating to a headline story would gain immediate attention from that policy maker.
Getting media coverage requires relationship building and maintenance. The easier you make it for the media -- providing information and telling a story -- the more likely it is that coverage will result. The Centres need to brainstorm creative ideas for media coverage.
The media can be used as well for information/dissemination purposes. They can also be used to turn up the heat on issues and put pressure on the policy maker. But this needs to be done cautiously and rarely.
3.2.6 Models
There are many different models for an organization committed to influencing public policy through research and the promotion of policy advice. Three examples of such models are outlined to indicate the range of options and the differences in vision and approach that can inform such work:
- Community development model -- focused on capacity building within the community to develop skills, knowledge and experience to enable community members to become informed and active participants in the policy development/ advice process;
- Research arm of the community model -- focused on providing community activists and advocates with the best research and policy analysis possible on which to base their advice for policy change; and
- Direct policy model -- focused on developing research-based policy advice about issues on the policy makers' agenda, with a heavy emphasis on policy uptake.
These models are examples only. The Centres will create their own models, drawing upon the experience and ideas of other organizations that share the CEWHP's vision or that offer interesting or effective approaches to the development of research-based policy advice. The shape, structure and organization will depend very much on how the Centres view the social change process and how they see their relationship with the communities with which they work, the policy developers and policy makers they seek to influence and the researchers whose work they fund.
There are, in this country, a multitude of immediate and pressing needs relating to women's health, in addition to the multitude of long-term, deeply entrenched, chronic problems. Research on women's health and research applying a gender analysis to health issues have been underfunded and underresourced in the extreme. The women's health research that has been done is not widely known and has not had much impact on health policy. Some of the research has been greeted with skepticism or dismissed as biased. Good, solid research on women's health issues and research applying a gender analysis to health issues more generally are urgently needed. There is also an urgent need for that research to be used as the basis for refocusing and redirecting health policy in this country so that it is more responsive to the needs and experiences of women.
The CEWHP provides a wonderful opportunity for those who work in the area of women's health -- as researchers, community workers, activists or policy developers -- to have a significant impact on health policy in Canada. The Centres need to decide what contribution they can make through the CEWHP that will best lay the groundwork for ongoing policy influence to promote women's health and to foster a gendered analysis of health issues. If the Centres are to be anything more than short-term, mini-funding agencies, they need to seize the opportunity that the CEWHP represents to develop and start to implement a long-term strategy for changing health policy in this country. The Centres need to take leadership in defining themselves, their role and their goals. This self-definition will depend very much on how the Centres view the process of social change and on the relationships they set up with the grass-roots, academic and policy communities with whom they are engaged through this CEWHP. Working within a limited time frame and with limited resources, the Centres need to decide how they can most effectively set in motion a process and vision that can be carried on, so as to ensure an ongoing and long-term impact on Canadian health policy and on the health and well-being of Canadian women.
