1、Global Commission on Evidenceto Address Societal ChallengesThe Evidence Commission reportA wake-up call and path forward for decision-makers,evidence intermediaries,and impact-oriented evidence producersGlobal Commission on Evidence to Address Societal ChallengesCopyright 2022 McMaster University.Al

2、l rights reserved.This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.No part of this report may be adapted in any way without the prior written permission of the publisher.This report and the information contained herein are for informative,public inte

3、rest purposes only.While the secretariat and commissioners have attempted to ensure that the information was up-to-date and accurate at the time of writing,the information is distributed on an as-is basis,without warranty express or implied.The information contained in this report is not meant to su

4、bstitute for financial,legal or medical advice.McMaster University,the Evidence Commission secretariat,the commissioners and the publisher assume no responsibility or liability for loss or damage caused or allegedly caused,directly or indirectly,by the use of the information contained in this report

5、.McMaster University,the secretariat,the commissioners and the publisher specifically disclaim any liability incurred from the use or application of the information contained in this report.The publisher of this report is the McMaster Health Forum,1280 Main St.West,MML-417,Hamilton,ON,Canada L8S 4L6

6、.Acting on behalf of the Evidence Commission,the McMaster Health Forum welcomes feedback about the report,as well as suggestions about pathways to influence for the reports recommendations.Please send your comments to evidencecommissionmcmaster.ca.The appropriate citation for this report is:Global C

7、ommission on Evidence to Address Societal Challenges.The Evidence Commission report:A wake-up call and path forward for decision-makers,evidence intermediaries,and impact-oriented evidence producers.Hamilton:McMaster Health Forum,2022.ISBN 978-1-927565-31-51.Introduction1.1 Desirable attributes of c

8、ommissions 61.2 Commissioners 81.3 Commissioner terms of reference 101.4 How the commission builds on and complements past work 111.5 Connection to COVID-END 121.6 Timeline of key developments in using evidence to address societal challenges 131.7 Equity considerations 151.8 What success looks like

9、171.9 References 182.Nature of societal challenges2.1 Ways of looking at challenges202.2 Example of a transition in how a societal challenge is seen 222.3 Ways of addressing challenges232.4 Examples of approaches to prioritizing challenges to address 242.5 Global-commission reports by challenge type

10、 252.6 References 273.Decisions and decision-makers:Demand for evidence3.1 Steps in deciding whether and how to take action 303.2 Four types of decision-makers and how each may approach decisions 313.3 Government policymakers and the context for their use of evidence 323.4 Organizational leaders and

11、 the context for their use of evidence 343.5 Professionals and the context for their use of evidence 353.6 Citizens and the context for their use of evidence 363.7 Ways that evidence can be used in decision-making 383.8 Global-commission reports by decision-maker type 403.9 References 414.Studies,sy

12、nthesesand guidelines:Supply of evidence4.1 Forms in which evidence is typically encountered in decision-making 444.2 Definitions of forms in which evidence is typically encountered 454.3 Matching decision-related questions to forms of evidence 474.4 Interplay of local and global evidence 484.5 Dist

13、inguishing high-from low-quality evidence 504.6 Coverage,quality and recency of evidence syntheses 524.7 Living evidence products 554.8 Best evidence versus other things(and how to get the most from other things)574.9 Contexts that shape how evidence is viewed 594.10 Indigenous rights and ways of kn

14、owing 604.11 Misinformation and infodemics 624.12 Weaknesses in a health-research system 654.13 Weaknesses in many COVID-19 evidence-support systems 674.14 Features of an ideal national evidence infrastructure 694.15 Global-commission reports by form of evidence 724.16 Annex to section 4.5 Examples

15、of quality-assessment tools 734.17 References 755.Role of evidence intermediaries5.1 Types of evidence intermediaries 785.2 Characteristics of evidence intermediaries 805.3 Strategies used by evidence intermediaries 815.4 Conditions that can help and hinder evidence intermediaries 835.5 UN-system en

16、tities use of evidence synthesis in their work 865.6 References 886.Need for global public goods and equitably distributed capacities6.1 Global public goods needed to support evidence use 906.2 Equitably distributed capacities needed to support evidence use 936.3 References 967.Recommendations7.1 In

17、sights from an analysis of global-commission recommendations 987.2 Evidence Commission recommendations 1017.3 Annex to section 7.1 Detailed findings from the analysis of global-commission recommendations 1107.4 References 114ContentsGovernment policymakers David Halpern Trusted policy advisor bringi

18、ng formal experimentation and behavioural insights into governments,first in the United Kingdom and now in many countries16 Fitsum Assefa Adela Committed policymaker striving to bring a whole-of-government perspective to cabinet-level planning and development27 Andrew Leigh Seasoned politician bring

19、ing economics and legal training to public-policy writing and debate109 Soledad Quiroz Valenzuela Government science advisor contributing her national experiences to regional and global efforts to improve the quality of government scientific advice21Organizational leaders Asma Al Mannaei Experienced

20、 public servant leading quality improvement and stewarding research and innovation across a health system33 Modupe Adefeso-Olateju Non-governmental organization leader pioneering the use of citizen-led assessments and public-private partnerships to improve educational outcomes for children37Professi

21、onal Julian Elliott Clinician researcher leveraging technology for efficiently preparing and maintaining living evidence syntheses and guidelines to inform decision-making39Citizens Maureen Smith Citizen leader championing the meaningful engagement of patients and citizens in conducting research and

22、 using it in their decision-making96 Hadiqa Bashir Young leader advocating for girls rights and gender equality in male-dominated environments96Evidence intermediaries Julia Belluz Respected journalist bringing rigour to reporting about what the best available science does and doesnt tell us about t

23、he major challenges of our time14 Kerry Albright Eternally curious international public servant bringing passion about evidence-informed decision-making,systems thinking,and help in understanding the value of evidence to international development85Evidence intermediary and producer Gillian Leng Expe

24、rienced executive leading a technology-assessment and guideline agency that supports health and social care decision-making by governments,service providers and patients51Evidence producer Jan Minx Impact-oriented scholar bringing innovative evidence-synthesis approaches to domestic policy advice an

25、d global scientific assessments about climate change and sustainability568.Appendices8.1 Methods used to inform commissioner deliberations and recommendations 1168.2 Commissioner biographies 1188.3 Secretariat 1248.4 Funders 1258.5 Commissioner and secretariat affiliations and interests 1268.6 Advis

26、ors and other acknowledgements 1298.7 Timeline 1308.8 Annex to appendix 8.1 List of global-commission reports 1318.9 Annex to appendix 8.5 Conflict-of-interest policy 1348.10 References 137Commissioner comments1The Evidence Commission report1.1 Desirable attributes of commissions 61.2 Commissioners

27、81.3 Commissioner terms of reference 101.4 How the commission builds on and complements past work 111.5 Connection to COVID-END 121.6 Timeline of key developments in using evidence to address societal challenges 131.7 Equity considerations 151.8 What success looks like 171.9 References 18Chapter 1.I

28、ntroduction The Evidence Commission report2COVID-19 has created a once-in-a-generation focus on evidence among governments,businesses and non-governmental organizations,many types of professionals,and citizens.There has been an unparalleled demand for evidence to address rapidly evolving challenges,

29、as well as remarkable efforts to meet this demand with the best evidence under very tight timelines.Not all went well,of course.Some decision-makers wilfully ignored best evidence,while others trafficked in mis-and dis-information.As we describe in section 4.13,many things other than best evidence w

30、ere relied upon,and some forms of evidence were relied upon more than others.And as we describe in section 4.6,there was uneven topic coverage,variable quality and updating failures among the syntheses of the best evidence globally,as well as tremendous research waste arising from a lack of coordina

31、tion.But many parts of the COVID-19 evidence response did go well,as we describe later in this section,in section 4.7(living evidence products),and in the final column of section 4.12(such as rapid multi-country randomized-controlled trials and rapid contextualized evidence support for government po

32、licymakers).Other societal challenges from educational achievement to health-system performance to climate change need a similarly renewed focus on best evidence.The pandemic more clearly revealed some deeply rooted challenges,such as inequalities in exposure to risks and in access to ways to mitiga

33、te those risks.Other slow-burn challenges were temporarily put aside,and now need to be returned to.Plus we have learned about the need to better prepare for unpredictable future crises,including but certainly not limited to future health emergencies.Now is the time to systematize the aspects of usi

34、ng evidence that are going well and address the many shortfalls,which means creating the capacities,opportunities and motivation to use evidence to address societal challenges,(1)and putting in place the structures and processes to sustain them.Now is also the time to balance the use of evidence wit

35、h judgement,humility and empathy.(2)For those seeking to use evidence to address societal challenges,legitimacy needs to be earned and then actively maintained.The Global Commission on Evidence to Address Societal Challenges was convened to support people in this vital work.The Nobel prize in econom

36、ics has recently been awarded to two trios of economists using very different approaches to build the evidence needed to inform one type of decision-maker,government policymakers.Less than half a year before the COVID-19 pandemic began,the prize went to three economists using randomized-controlled t

37、rials to evaluate what works.One-and-a-half years into the pandemic,the prize went to three economists using natural experiments to evaluate what works.As an example of the humility needed by those supporting the use of evidence by decision-makers,one of these economists Esther Duflo has been quoted

38、 as saying:One of my great assets is I dont have many opinions to start with.I have one opinion one should evaluate things which is strongly held.Im never unhappy with the results.I havent yet seen a result I didnt like.(3)Evaluations are just one of the forms of evidence we discuss in this report.W

39、e use the word evidence in this report to mean research evidence.Researchers like Esther Duflo do research.Decision-makers may use the resulting evidence.Ideally they will use the forms of evidence that are the best match to the specific questions that need to be answered,as we return to in section

40、4.3,and do so recognizing that there is typically not a straight line between evidence and action in most circumstances(e.g.,the evidence may address some but not all questions,it may be of low quality or of limited applicability to their context,and there may be significant uncertainty).They may al

41、so use other types of evidence,such as experiential evidence derived from their own lived experiences and the judicial evidence considered in a court of law.Decision-makers may also consider many other factors in making a decision.Government policymakers,for example,need to give attention to institu

42、tional constraints(including resource constraints),interest-group pressure,their own personal values,and the values of their constituents,among other factors.Our focus is supporting four types of decision-makers government policymakers,organizational leaders,professionals and citizens to better use

43、evidence,research evidence specifically,alongside other factors in addressing societal challenges.Introduction“Chapter 1.Introduction3Four stories drawn from the weekly magazine,The New Yorker,illustrate how these four types of decision-makers can use evidence to learn and improve,and how they may b

44、e able to learn better and improve faster.First,we have Mohamed Nasheed,the former president of the Maldives and the current speaker of its legislature,who faces a very strong motivation to address climate change:his country an archipelago in the Indian Sea will one day be fully underwater.An interv

45、iew with him,conducted by Bill McKibben,describes his efforts to put in place climate-adaptation strategies in the Maldives while also advocating on behalf of the 48 Climate Vulnerable Forum countries to re-structure their countries debts to free up the funds needed to implement these strategies.(4)

46、Nasheed is keenly aware of the findings of the Intergovernmental Panel on Climate Change and the evidence it has generated about the dire future or what some call the existential risk his country faces.He needs to bring great judgement to his simultaneous pursuit of three goals:1)convincing high-inc

47、ome countries to take dramatic action to slow down the rate of increase in man-made contributions to climate change and to allow his proposed debt re-structuring;2)building climate resilience in his own country;and 3)preparing for the possibility that he will fail in his first two goals and his fell

48、ow citizens will one day have to leave a submerged archipelago.What is less clear from the story is where he can turn for evidence about,say,the climate-adaptation strategies he should be considering.Government policymaker,Mohamed Nasheed Organizational leader,Alvaro Salas Chaves Second,we have Alva

49、ro Salas Chaves,the former head of several Costa Rican health organizations,who created many opportunities to improve the health of his fellow citizens,starting with his work in a very small clinic and culminating in his leadership of the countrys social-security agency in the early 1990s.The author

50、 of this story,Atul Gawande,describes how Salas progressively shifted the health system from one where health workers reacted to the patients who walked through the doors of clinics and hospitals by treating whatever problem brought them in to one where a team of health workers assumed responsibilit

51、y for the health of all patients in their local area.Each team organized themselves to proactively reach out to their patients(with more frequent contact among those with the greatest health and social needs)and to provide a range of effective services in each encounter.(5)Costa Ricas health outcome

52、s improved dramatically as a result.Salas brought tremendous capacity for persuasion and an intense motivation to creating opportunities to institutionalize this new approach.He seems to have combined this with judgement,humility and empathy.What is less clear from the story is where he drew insight

53、s about the effective services that teams need to deliver,but one can surmise that he would have been exposed to many guidelines from the World Health Organization(WHO)and its regional office,the Pan American Health Organization.Today he could search Health Systems Evidence to find the evidence for

54、his population-health management approach,the Cochrane Library to find evidence about effective services,and the WHO database of guidelines.Third,we have Denny Gioa,a former engineer with Ford,who drew on his professional capacity as an engineer to address automotive safety.He routinely drew on data

55、 analytics to decide when to propose that his company invest millions of dollars on the recall of cars of a particular model and year of manufacture.The author of this story,Malcolm Gladwell,begins with a joke about a priest,a doctor and an engineer,the moral of which is that the engineer was the on

56、ly one to use his judgement to solve the problem,although he could have done so as well as display some of the empathy shown by the priest and doctor.(6)Gioas experiences were somewhat similar.He had the capacity,opportunity and motivation to use data analytics and the judgement to apply them in sol

57、ving the problem of which types of cars to recommend for recall.However,his rigour didnt stop public opinion from turning against large car companies when the public found out that the companies knew about rare events,like Pinto cars bursting into flame in a rear-end collision,and chose to do nothin

58、g.If we really wanted to improve automotive safety,one approach would be to ensure that engineers and other professionals have the capacity,opportunity and motivation to use both data analytics about the problem and syntheses of the best evidence about the full range of approaches to addressing the

59、problem(including seat belts and speed limits),as well as the judgement,humility and empathy to convince others about the need to try new approaches,evaluate them,and make adjustments as need be.Professional,Denny GioaThe Evidence Commission report4Fourth,we have Paula Kahumbu,a citizen leader,who d

60、raws on both her capacities as an ecologist and storyteller,and her motivation to get her fellow citizens to see themselves as stakeholders in conservation efforts.The author of this story,Jon Lee Anderson,describes how Kahumbu created the opportunity to put Kenyans at the centre of the action by de

61、veloping and hosting a popular Kenyan television show Wildlife Warriors where she meets fellow citizens working to save endangered animals.(7)(As we explain in section 3.6,we use the term citizen to keep the focus on the individual,and not to imply formal citizenship status as determined by a govern

62、ment.)Kahumbu speaks of her fellow citizens as heroes,campaign supporters,tree planters,park and forest defenders,and voters.To inform her choices about what stories to tell and what conservation strategies to pursue,she uses data analytics about endangered species and about court rulings on poachin

63、g.She also“looked at what was working and what wasnt working in Kenyan conversation.”Ideally she could complement such local evidence with syntheses of the best evidence globally about what strategies and combination of strategies offer the greatest promise.These might range from very upstream strat

64、egies like human-population planning to mid-stream strategies like natural-resource management(e.g.,maintaining parks,limiting logging,restricting sprawl,and limiting fencing),infrastructure planning(e.g.,carefully locating new power lines,rail lines and roads),Indigenous communities support(e.g.,en

65、abling win-win leasehold agreements with conservation groups and private safari companies),and wildlife support(e.g.,enforcing bans on poaching and ivory sales).Citizen,Paula KahumbuAs these stories illustrate,our current approach to societal challenges and ways to address them relies on learning in

66、 ad hoc ways over long periods of time.We need to transition to a new approach that involves using evidence systematically and transparently to rapidly learn and improve.The COVID-19 pandemic showed us that we can do this:we learned that elimination could be pursued as a goal as was done in Australi

67、a and China,among other countries if the political,geographic and pandemic conditions were right(and that this could change,as it did with the Delta variant)we learned that aerosols are a key mode of transmission,and that masks and ventilation can help to prevent transmission(see bit.ly/3HiGuIT)we l

68、earned that the risk of transmission from children to children and from children to adults in primary school and daycare settings is low when infection prevention and control procedures are in place(for a living rapid review on the topic,see bit.ly/3c7BOr1)we learned that steroids can reduce deaths

69、in hospitalized patients(for a living guideline about drug treatments,see bit.ly/3DehxMf)we learned that vaccines can prevent transmission,infection,severe disease and death,including for new variants(for COVID-END living evidence synthesis#6,which is updated every two weeks,see bit.ly/3FfPOeX)we le

70、arned that inequities were made worse within and across countries,and that we need to pay particular attention to the most vulnerable,such as those living in long-term care homes and those facing financial and housing insecurity.Emerging guidance(e.g.,we dont yet know enough,but wash your hands well

71、 in the meantime)was superseded by replacement guidance(e.g.,we now have a lot of evidence indicating that masks reduce transmission),as it should.The above list may also change,as it too should.As one of our commissioners suggested in a call,picture a 2*2 table created by a Y axis denoting using(or

72、 not using)best evidence and an X axis denoting being able(or not able)to rely on self-correcting systems that ensure that effective practices emerge.The commissioner argued that many doctors are typically in the top right quadrant of this 2*2 table.They use rigorously developed clinical-practice gu

73、idelines(best evidence)and they also observe whether their patients are responding to the treatment recommended by the guideline.The latter may often be wrong,but it powerfully complements the former.Soldiers are more commonly off to the right along the X axis.They cannot use rigorous evaluations in

74、 the way doctors do,but sadly they observe very quickly whether they are accomplishing their objectives.Many types of decision-makers can neither draw on best evidence in their area of work nor rely on self-correcting systems.Beliefs about effective approaches may be held,sometimes very strongly,but

75、 these beliefs are neither subjected to rigorous testing nor subjected to self-correcting systems that have proven themselves to be highly reliable.y xChapter 1.Introduction5The first six chapters of the Evidence Commission report provide the context,concepts,and shared vocabulary that underpin the

76、Evidence Commissions recommendations.These six chapters can be used by many people,not just those positioned to make the changes necessary to ensure that evidence is consistently used to address societal challenges.The seventh chapter provides the Evidence Commissions recommendations about how we ca

77、n and must improve the use of evidence,both in routine times and in future global crises.The report includes 52 sections that can be separately downloaded from the Evidence Commission website.Drafts of these sections were shared publicly at key junctures in the work of the Evidence Commission,both t

78、o elicit feedback about how to strengthen them and to begin building momentum for action.These sections often include one or more infographics.They have been designed to be easily used in presentations,reports,and other formats.The Evidence Commission encourages you to share freely,give credit,adapt

79、 with permission.The commissioners and secretariat hope that this report is the start of a serious set of conversations about what is going well and where we can do better.We have undertaken this work very rapidly and with limited financial support,and we have inevitably made some mistakes and misse

80、d key evidence syntheses and other documents.We have covered a lot of ground and spoken about a great diversity of societal challenges,and we have inevitably over-generalized and missed some important nuances.We have tried to avoid reference lists that run to dozens of pages per chapter,and we have

81、inevitably failed to honour all of those whose ideas we have built upon.Again,we welcome feedback so that we can make corrections in the additional products that we and we hope many others will create based on this report.The remainder of this chapter comprises eight sections:1.1 Desirable attribute

82、s of commissions 1.2 Commissioners 1.3 Commissioner terms of reference 1.4 How the commission builds on and complements past work 1.5 Connection to COVID-END 1.6 Timeline of key developments in using evidence to address societal challenges 1.7 Equity considerations 1.8 What success looks likeThe equ

83、ity section is particularly key because equity is a thread that runs through the entire report.The seven appendices to this report complement these sections in important ways:8.1 Methods used to inform commissioner deliberations and recommendations(relates to section 1.1)8.2 Commissioner biographies

84、(relates to section 1.2)8.3 Secretariat(complements section 1.2)8.4 Funders 8.5 Commissioner and secretariat affiliations and interests (relates to section 1.2)8.6 Advisors and other acknowledgements(complements section 1.2)8.7 Timeline(expands upon section 1.6)The Evidence Commission report6Global

85、commissions are frequently convened to address societal challenges.Yet there is no agreed list of desirable attributes of commissions,let alone tools to support their development,reporting and evaluation.The convenors of global commissions can likely learn a lot from the health-related field of clin

86、ical-practice guidelines,which was in a similar position three decades ago.Since then a steady stream of methodological developments led to a list of desirable attributes of clinical-practice guidelines,(8)first-and second-generation tools to support guideline development,reporting and evaluation(AG

87、REE I and II),and complementary tools to assess the quality and implementability of guideline recommendations(AGREE-REX),and to support the development,reporting and evaluation of health-systems guidance(AGREE-HS).For additional details,see the AGREE Enterprise website.To support its own work and to

88、 lay the groundwork for future methodological developments related to global commissions,the Evidence Commission drafted a set of desirable criteria for global commissions,using as prompts the five elements of the AGREE-HS tool(which is closer to the system focus for most global commissions than cli

89、nical-practice guideline related tools).1.1 Desirable attributes of commissionsConvened and/or funded by a formal body with the authority to act on the recommendations and/or justified by a strong rationale for the topics priority and timeliness for decision makers who can act on the recommendations

90、Comprised of commissioners who have been explicitly chosen to capture many elements of the diversity required to ensure that the recommendations speak to and are likely to be used by the types of decision-makers who could take action based on the recommendations,such as by:types of challenge(includi

91、ng sector),decision-maker,and evidence spectrum of experience and seniority gender balance mix of ethno-racial backgrounds location by region and country languages spokenSupported by a conflict-of-interest policy that requires commissioners and secretariat staff to publicly report their potential co

92、nflicts of interest,an independent panel(if needed)to manage these conflicts in a way that is proportionate to their risks,and secretariat staff to ensure that the influence of funders is avoided or minimizedTopicParticipantsEnabled by the use of systematic and transparent methods to:review the evid

93、ence(e.g.,data analytics and evidence syntheses)that informed deliberations about sections(e.g.,infographics,tables and text boxes)and recommendations engage a broader group of stakeholders to build momentum for action and to inform deliberations(e.g.,through website,social media,and direct outreach

94、 to umbrella groups)agree upon the final recommendations(e.g.,formal consensus)Culminated in recommendations that are actionable and likely acceptable to decision-makers,and that promote equityIncluded plans for dissemination to ensure decision-makers are reached(e.g.,translation into multiple langu

95、ages,open-access publications,engagement of intermediaries,and participation in decision-maker-targeted events),and for monitoring and evaluation to ensure continuity of the work and the accountability of players involved.MethodsRecommendationsImplementabilityChapter 1.Introduction7The Evidence Comm

96、ission adhered to these attributes as diligently as possible and used them to analyze global commissions whose reports were published from 1 January 2016 onwards,or were being drafted.We selected this start date because it coincided with the start of the Sustainable Development Goals era(2016 to 203

97、0).Our assessment of global-commission reports against these attributes found that:50 of 70 reports explicitly addressed the recommendations attribute,namely that the commissions work culminated in recommendations that are actionable and likely acceptable to decision-makers,and that promote equity5

98、of 70 reports explicitly addressed the methods attribute,namely that the commissions work was enabled by the use of systematic and transparent methods in each step of the process32 of 70 reports explicitly addressed the first of two participant attributes,namely that commissioners are chosen to capt

99、ure many elements of diversity21 of 70 reports explicitly addressed the second of two participant attributes,namely that commissioners and secretariat staff are required to publicly report their potential conflicts of interest and to adhere to other elements of a conflict-of-interest policy as well6

100、5 of 70 reports explicitly addressed one or both parts of the topic attribute,namely that the funder or convenor had the authority to act or that a strong rationale was provided for creating the commission36 of 70 reports explicitly addressed the implementability attribute,namely that the commission

101、 report included plans for dissemination and for monitoring and evaluationTopic Participants Methods Recommendations ImplementabilityThe same global commissions also formed the basis of our analysis of:global-commission reports by challenge type(section 2.5)global-commission reports by decision-make

102、r type(section 3.8)global-commission reports by form of evidence(section 4.15)For this section(1.1),as well as sections 2.4,3.8 and 4.14,we focused on what was reported(which may be less than what was actually done).We did not conduct interviews or review websites.Similar work could be done for the

103、many regional,national and sub-national commissions,which sometimes go by other names,such as:1)advisory group;2)advisory or review committee;3)assessment or high-level panel;4)national or royal commission;5)monitoring board;6)science academy;or 7)task force.More extensive analyses could be done usi

104、ng some of the methods used in an analysis of global commissions,albeit with a different focus,by Gertz and colleagues.(9)A thematic analysis of recommendations from these global commissions also helped to:understand the gap between where we are and where we need to be in using evidence to address s

105、ocietal challenges,at least from the point of view of the high-profile members of global commissions(see section 7.1)improve the framing of the Evidence Commissions draft recommendations,and identify new ideas for Evidence Commission recommendations,that would help to bridge this gap(see section 7.2

106、)identify the Evidence Commissions recommendations that align with the recommendations from other global commissions(see the aligned reports column in section 7.2).The methods underpinning these analyses are described in appendix 8.1.The Evidence Commission report8Daniel Iber Alves da SilvaYoung Ind

107、igenous leader educating students and others about Indigenous ways of knowingThe 25 commissioners were carefully selected to bring diverse points of view to creating a report that speaks to the many different types of people who make or can influence decisions about whether and how evidence is used

108、to address societal challenges.This diversity is reflected in many ways:Amanda Katili Niode Talented policy advisor and non-governmental organization director advancing dialogue about environmental action,including climate action Andrew LeighSeasoned politician bringing economics and legal training

109、to public-policy writing and debateAsma Al MannaeiExperienced public servant leading quality improvement and stewarding research and innovation across a health systemDavid Halpern Trusted policy advisor bringing formal experimentation and behavioural insights into governments,first in the United Kin

110、gdom and now in many countriesFitsum Assefa AdelaCommitted policymaker striving to bring a whole-of-government perspective to cabinet-level planning and development Gonzalo Hernndez LiconaDistinguished economist bringing rigorous evaluation methods to the fields of poverty measurement and economic d

111、evelopment *Ranging across most types of societal challenges(and Sustainable Development Goals),all types of decision-makers(government policymakers,organizational leaders,professionals and citizens),and all major forms of evidence *China,India,United States,Indonesia,Pakistan,Brazil,Nigeria,Mexico,

112、Japan and Ethiopia,as well as Australia,Austria,Canada,Chile,Germany,Trinidad and Tobago,United Arab Emirates,and United Kingdom*English,Chinese,Hindi,Spanish,French and Arabic,as well as Portuguese,Indonesian and Urdu,among othersAntaryami Dash Non-governmental organization leader bringing nutritio

113、n expertise to the development and humanitarian sectorDonna-Mae KnightsCareer public servant,specialized in poverty reduction and development,driving policy change towards building sustainable communitiesGillian LengExperienced executive leading a technology-assessment and guideline agency that supp

114、orts health and social care decision-making by governments,service providers and patientsPowerfully complementary perspectives*Spectrum of experience and seniorityGenderbalanceMix of ethno-racial backgroundsAll six world regions and 10 of the 12 most populous countries*Speaking the six most widely s

115、poken languages*Speakingthe six mostwidely spokenlanguages*1.2 CommissionersChapter 1.Introduction9Julia BelluzRespected journalist bringing rigour to reporting about what the best available science does and doesnt tell us about the major challenges of our timeKenichi TsukaharaEngineering leader sup

116、porting disaster risk management in government,a development bank,and international agencyMaureen SmithCitizen leader championing the meaningful engagement of patients and citizens in conducting research and using it in their decision-makingHadiqa BashirYoung leader advocating for girls rights and g

117、ender equality in male-dominated environmentsHoward WhiteResearch leader supporting the use of robust evaluation and evidence synthesis in decision-making in international development and across sectorsJinglin HeNon-governmental organization leader engaging policymakers and stakeholders,as well as U

118、N agencies,in advancing social-development initiativesJulian ElliottClinician researcher leveraging technology for efficiently preparing and maintaining living evidence syntheses and guidelines to inform decision-makingJan MinxImpact-oriented scholar bringing innovative evidence-synthesis approaches

119、 to domestic policy advice and global scientific assessments about climate change and sustainabilityNeil VoraInterdisciplinary professional bringing planetary-health thinking to the interface between conservation efforts(such as preventing deforestation)and pandemic preventionSoledad Quiroz Valenzue

120、laGovernment science advisor contributing her national experiences to regional and global efforts to improve the quality of government scientific adviceLarry HedgesApplied statistician driving the use of evidence synthesis in educational policy and practiceModupe Adefeso-OlatejuNon-governmental orga

121、nization leader pioneering the use of citizen-led assessments and public-private partnerships to improve educational outcomes for childrenPetrarca KaretjiEntrepreneurial policy advisor innovating in the use of data analytics to support evidence-informed policymaking about sustainable developmentStev

122、e Kern Foundation leader using data analytics and other forms of evidence to fight poverty,disease and inequity around the worldKerry AlbrightEternally curious international public servant bringing passion about evidence-informed decision-making,systems thinking,and help in understanding the value o

123、f evidence to international developmentThe Evidence Commission report10Drawing on their expertise and experiences in addressing(or informing efforts to address)societal challenges from the vantage point of one or more categories of decision-makers and using one or more forms of evidence,commissioner

124、s supported the Evidence Commission in four(or five)main ways:Participating in virtual deliberations to shape the report structure and content,sections,and proposed pathways to influence(e.g.,advisors and events)Providing input on select draft sections(e.g.,infographics and tables)that will be disse

125、minated widely both to elicit input to improve them and to begin to build the case for actionIdentifying key gaps in the sections,the analyses needed to underpin sections,and the interviews and other communications with partners needed to ensure the sections are fit for purpose(Optional)Contributing

126、 to virtual events where the published report has the potential to achieve significant influence.Reviewing the draft final report,endorsing the final recommendations about how to better meet the evidence needs of decision-makers as they address societal challenges,both in routine times and in future

127、 global crises,and reviewing the prioritized pathways to influence1.3 Commissioner terms of referenceChapter 1.Introduction111.4 How the commission builds on and complements past workWhy now?COVID-19 has created a once-in-a-generation focus on evidence among government policymakers,business and non-

128、governmental organization leaders,many types of professionals,and citizens.Their decisions have shaped the pandemic response and will shape responses to future societal challenges.The pandemic has fast-tracked collaboration among decision-makers and evidence producers,but decision-making that draws

129、from a range of forms of evidence is not yet routine.Our independent panel of commissioners has produced this report with recommendations for ways to better meet the evidence needs of decision-makers in routine times and in future global crises.In doing so,they have built on and complemented past wo

130、rk,such as the examples below.VSPrepare for different types of societal challenges Focusing on single categories of challenges like pandemics(as did the Independent Panel on Pandemic Preparedness and Response)(10)VSRecognize distinct needs ofdifferent types of decision-makersTargeting single types o

131、f decision-makers like government policymakers(as did the Commission on Evidence-based Policymaking)(11)VSConsidercomplementaritiesof different formsof evidencePrioritizing single evidence sources like data analytics(as did the G7 Science Academies)(12)ChallengesDecisionsEvidenceThe Evidence Commiss

132、ion report121.5 Connection to COVID-ENDThe COVID-19 Evidence Network to support Decision-making(COVID-END)first identified the need for the Evidence Commission and helped shape the report contents,and it is committed to pursuing pathways to influence for the Evidence Commissions recommendations.COVI

133、D-ENDs 55 partners are drawn from diverse evidence-synthesis,technology-assessment and guideline-development communities,as well as key intermediary organizations.(For a listing of partners,see bit.ly/3wGw012.)The partners have long track records of supporting decision-makers locally,nationally,inte

134、rnationally and across sectors.They are among the most respected organizations in their respective fields.They came together to provide a more coordinated evidence response to the once-in-a-generation global challenge of COVID-19.Their evidence-related activities have spanned the full spectrum of th

135、e pandemic response,from public-health measures and clinical management to health-system arrangements and economic and social responses.Their activities also covered the full spectrum of contexts where the pandemic response has been playing out,including low-,middle-and high-income countries.As the

136、world begins to return to addressing both slow-burn societal challenges and encounters new crises,COVID-ENDs partners want to see us build on what went well with the evidence response to COVID-19 and ensure that we address what could have gone better.COVID-END acts as umbrella for these partners in

137、the time-limited evidence response to COVID-19,and many of them in turn act as an umbrella for many other partners in addressing a broad range of societal challenges.Examples of these umbrella organizations include:The Evidence Commission welcomes expressions of interest from other umbrella organiza

138、tions that can commit to pursuing pathways to influence for the Evidence Commissions recommendations.Africa Centre for Evidence,which supports the Africa Evidence Network in bringing together more than 3,000 people from across Africa to support evidence-informed decision-makingCampbell Collaboration

139、,which supports teams around the world to prepare and support the use of evidence syntheses in areas like business and management,climate solutions,crime and justice,disability,education,international development,and social welfareCochrane,which includes review groups around the world that prepare e

140、vidence syntheses,and geographic groups in 45 countries and thematic networks in 13 domains that support evidence-informed decision-making on health-related topicsEvidence Synthesis International,which supports evidence-synthesis organizations around the world that produce,support,and use evidence s

141、ynthesesGuidelines International Network,which supports 130 organizations around the world that develop and implement evidence-based guidelines.Chapter 1.Introduction131.6 Timeline of key developments in using evidence to address societal challengesKey developments in.how societal challenges are vie

142、wed in multilateral organizations First global mechanism to periodically achieve agreement among leading climate scientists(with the sixth global assessment being released in 2021-22)and consensus from participating governments:Intergovernmental Panel on Climate Change(1988)First OECD-level commitme

143、nt to time-bound targets to achieve key goals:International development targets(1996-2015)*First global commitment to time-bound targets to achieve key goals:Millennium Development Goals(2000-15)First multi-sectoral and transdisciplinary framework to focus on the animal-human-ecosystems interface to

144、 improve health:One Health(2008)*Second global commitment to time-bound targets to achieve key goals:Sustainable Development Goals(2016-30)how using evidence to support decision-making is viewed in multilateral organizations First World Bank report dedicated to the topic:World development report:Kno

145、wledge for development(1998-99)First UN body to transition from relying on expert opinion to using more rigorous approaches in developing recommendations:WHOs guidelines for guidelines(2003)First WHO report dedicated to the topic:World report on knowledge for better health(2004)First call to base de

146、velopment efforts on what works and enhance country ownership of development agendas:Paris declaration on aid effectiveness(2005)First UN strategy to nurture the capabilities and foster the enablers for data-driven action:UN Secretary-Generals data strategy(2020)First UN report that prioritized evid

147、ence syntheses as part of a research response to a societal challenge:UN research roadmap for the COVID-19 recovery(2020)First World Bank report dedicated to using data to advance development objectives:World development report:Data for better lives(2021)Multilateral organizations such as the UN sys

148、tem and the Organisation for Economic Co-operation and Development(OECD)are key players in determining whether and how decision-makers use evidence to address societal challenges,as well as being users of evidence in their own right.The UN system is comprised of a secretariat,many departments(e.g.,D

149、epartment of Economic and Social Affairs),funds(e.g.,UNICEF),programs(e.g.,UNDP),and specialized agencies(e.g.,World Bank and WHO).How such multilateral organizations view societal challenges profoundly shapes evidence needs for decision-making,especially among government policymakers in their membe

150、r states,but also among organizational leaders,professionals and citizens.Similarly,how they view using evidence to support decision-making profoundly shapes the evidence-support system that they and their member states put in place.Select examples of key developments in both these domains are provi

151、ded in the first two lists below.The many forms in which evidence is now typically encountered by decision-makers emerged over the past 80 years,first with randomized-controlled trials(an approach to evaluating what works)in the 1940s and moving on to technology assessments,evidence syntheses,guidel

152、ines,and behavioural/implementation research.More recently,big data and artificial intelligence have spurred rapid developments in data analytics and modeling.Select examples of these developments are provided in the third list below.ChallengesDecisions *oecd.org/dac/2508761.pdf *fao.org/3/aj137e/aj

153、137e00.pdfThe Evidence Commission report14*psycnet.apa.org/record/1978-10341-001 how best evidence is produced to support decision-making Early double-blind randomized-controlled trials Patulin for the common cold(1943)and streptomycin for pulmonary tuberculosis(1948)Notion of participant-driven(ver

154、sus only investigator-driven)evidence emerges through work by Lewin and Freire on participatory-action research(1946-70)Early social-science use of trials:Perry Preschool Project(1962-67)and RAND Health Insurance Experiment(1971-86)US Office of Technology Assessment established(1974)First evidence s

155、ynthesis yielding an effect estimate:Psychotherapy(1977)*Landmark book on quasi-experimentation by Cook and Campbell(1979)Landmark book on data visualization(1983):Tuftes The Visual Display of Quantitative Information(first edition)First field-wide overview of the safety and effectiveness of care:Ef

156、fective Care in Pregnancy and Childbirth(1989)Cochrane Collaboration and International Network of Agencies for Health Technology Assessment established(1993)Campbell Collaboration established(2000)First Campbell evidence synthesis yielding an effect estimate:Scared Straight program(2002)Guidelines I

157、nternational Network established(2002)Implementation Science journal established(2006)First widely read book on using behavioural insights:Nudge Improving decisions about health,wealth and happiness(2008)Evidence“The COVID-19 pandemic has been a challenging and disorienting time in many ways,includi

158、ng for all of us who are trying to make sense of,and communicate,what the latest evidence can tell us about the virus and how to keep our families,communities,and countries safe.In a fast-moving information environment,where were constantly challenging and updating assumptions,understanding the impl

159、ications of new studies or policies has been more difficult than ever.But the good news is that COVID-19 has also accelerated a global push to develop and refine tools that can help people think critically about evidence and contextualize it.Im thinking in particular of evidence synthesis,and living

160、 evidence products,which the report addresses in sections 4.4 and 4.7.Their very raison detre is bringing together the latest and best evidence on important social,policy,and clinical questions to come to more fully supported conclusions.For example,the COVID-END inventory collates high-quality evid

161、ence on everything from how the various vaccines stack up against new coronavirus variants,to what impact school closures have on minimizing the risk of outbreaks(see section 4.12 for additional examples).These tools should be an essential resource for journalists reporting on this pandemic,the next

162、 pandemic,and the many other societal challenges to come.For those on the receiving end of decisions by clinicians,public servants,and elected officials,these tools are also potentially life-saving.I just hope this pandemic will finally help more people appreciate,and make use of,them.Evidence inter

163、mediary,Julia BelluzRespected journalist bringing rigour to reporting about what the best available science does and doesnt tell us about the major challenges of our timeChapter 1.Introduction15Socio-economic status(e.g.,economically disadvantaged populations)Race,ethnicity,culture and language(e.g.

164、,Indigenous peoples and minority ethnic,cultural and linguistic groups within a country)1.7 Equity considerationsA challenge often disproportionately affects some groups in society.The benefits,harms and costs of options to address the challenge may vary across groups.Implementation considerations m

165、ay also vary across groups.Evaluations may ask what worked for which groups under what conditions.How evidence about a challenge is viewed may also vary across groups based on their historical,social and cultural contexts.One way to identify groups warranting particular attention is to use the PROGR

166、ESS-Plus framework.(13)PROGRESS is an acronym formed by the first letters of the following eight ways that can be used to describe groups:EEducational level(e.g.,numeric literacy)SSSocial capital/social exclusion.Place of residence(e.g.,rural and remote populations)PGGender and sexRORReligion(e.g.,C

167、hristianity,Islam and their respective denominations)Occupation and labour-market experiences more generally(e.g.,those in informal or precarious work arrangements)Personal characteristics associated with discrimination(e.g.,age,disability)Features of relationships(e.g.,parents who smoke,school expu

168、lsions)Time-dependent relationships(e.g.,leaving the hospital,other instances where a person may be temporarily at a disadvantage).Plus refers to:Access to trustworthy information,immigration status and sexual orientation are examples of other descriptors.As we return to in chapter 4,an evidence syn

169、thesis uses a systematic and transparent process to identify,select,appraise and synthesize the findings from all studies that have addressed the same question.An evidence synthesis aims to come to an overall understanding of what is known on that question,including how this may vary by groups(e.g.,

170、racialized communities living in low socio-economic neighbourhoods or socially isolated seniors living in rural communities).The Evidence Commission report16“For me the key take-aways are:1)the sheer scale of the catch-up needed for other sectors if they are to ever get to where the health sector is

171、 in all aspects of the production,sharing and use of evidence;2)the need for a global mechanism for governments to jointly commission evidence syntheses not least to avoid duplication and for a set of global public-good producers to respond with high-quality and timely evidence products;and 3)the ne

172、ed to build absorptive capacity in governments and professional bodies.Im both passionate and impatient on these points.On the first point,we need to lay bare the fragility of our evidence base in so many areas,but more positively whats possible when we do build it.COVID-19 illustrates both sides of

173、 this incredible and rapid advance in some domains,but also some serious lacuna.This sets up our recommendation 2 all of us should pay attention when a claim is being made and ask about the quality and applicability of the evidence on which the claim is based.Demand better!Turning to the second poin

174、t,we need to flush out the questions that government departments should know the answers to but dont or said another way,we need to identify the areas of policy and practice that are built on sand.Weve had some success with this in the UK with what we call areas of research interest.These questions

175、posed by government departments now help shape the research funding agenda of UK Research and Innovation(8 billion per annum).This connects to our recommendation 5 about making government evidence-support systems more fit-for-purpose.We also need a global coordination mechanism to respond to these q

176、uestions by generating,synthesizing and sharing evidence.We would call them a global network of What Work Centres(extending what we have already in the UK),but other countries may want to use a different name for the network.The global network can help to address the uneven coverage and quality of t

177、he available evidence,and the unnecessary duplication that we see now with each country doing its own thing(or free riding on the investments of others).This connects to our recommendation 24 directed at funders.The last point brings me to the weakness of the institutions that people think of as off

178、ering definitive policy advice.The shocking truth is that,across large swathes of policy and practice,were stumbling in the dark.Robust evaluations are rare.At the same time,policymakers are prone to over-confidence.Technical guides such as the UKs Magenta Book on designing evaluations and the Green

179、 Book on how to appraise and evaluate policies,programs and projects are a good starting point.We need more fit-for-purpose evidence-support staff and partnerships,science advisors,and advisory bodies in government(recommendations 6-8),and corresponding improvements in professional bodies(recommenda

180、tion 12).Building evaluation capacity,such as the UKs new Evaluation Task Force,is especially important as pump-primes for evidence building alongside the capacity to utilize it.One day Id like to see us select,periodically test and internationally compare senior policy advisors on their ability to

181、understand and use evidence.The Evidence Commission report brings such ideas together,along with a lot of how to guidance.Government policymaker,David HalpernTrusted policy advisor bringing formal experimentation and behavioural insights into governments,first in the United Kingdom and now in many c

182、ountriesWith the COVID-19 pandemic response,the distribution of benefits,harms and costs fell very differently across countries and across groups within countries.For example,in some high-income countries,essential workers(who could not stay home during lockdowns)were often women working in low-inco

183、me jobs with no paid sick leave,from racialized communities suffering from stigma and discrimination,living in small homes with both children and grandparents and where isolating was not possible,and living in urban neighbourhoods with crowded public transportation and overwhelmed hospitals.In some

184、low-income countries,many migrant workers lost their jobs during lockdowns and could not safely return to their villages when public-transportation systems were simultaneously shut down.Other migrant workers had to choose often without access to trustworthy information between staying on the job in

185、cities and returning to their villages based on where they would have the lower risk of becoming infected,and greater prospect of receiving healthcare if they became severely ill.Vaccine availability in low-income countries lagged very substantially behind vaccine availability in high-income countri

186、es.As we also return to in chapter 4,context can shape how evidence is viewed by racialized communities and by women,among others(see section 4.9).Contexts,as well as Indigenous peoples distinct rights and ways of knowing,can also shape how evidence is viewed by Indigenous peoples(see section 4.10).

187、Chapter 1.Introduction17What will change if the Evidence Commissions work has the impact we hope for?We provide below some examples of what success looks like,both generally and specifically.Examples marked with an asterisk(*)are drawn from the actual experiences of commissioners and COVID-END partn

188、ers.Decision-makersare provided in a timely way with local(national or sub-national)evidence and with syntheses of what has been learned around the world,including how it varies by groups andcontexts they can moreeffectively respond tosocietal challenges they can work in their respective areasof str

189、ength and build on one anothers workIntermediaries are positioned optimally and have the right capacities,opportunities and motivation they can package the right evidence on the right issues at the right time in the right context A national government regularly adjusts its decision-making about lock

190、downs and travel restrictions based on co-designed modeling (of the likely consequences of available policy options)and its decision-making about vaccination distribution based on weekly updates to a living evidence synthesis about vaccine effectiveness against variants*A citizen group relies on evi

191、dence syntheses to fact check statements made by government and to advocate for change A research unit maintains a living evidence map about human settlements(showing the likely consequences of available policy options)that informs the preparation of a national commission report,its implementation,a

192、nd the monitoring of its implementation and evaluation of its impact*A research unit prepares timely,demand-driven evidence syntheses that directly inform policymaking and feed into other units modeling,behavioural insights,technology assessments,guidelines and evaluations that in turn inform policy

193、making in complementary ways A non-governmental organization establishes an integrated evidence-support unit that commissions data analytics,evidence syntheses and behavioural insights,and integrates them into briefing notes*The UN Secretary-General supports the design,implementation and monitoring

194、of the global evidence architecture needed to ensure that evidence is at the heart of the UNs efforts to deliver the SDGs,including the work of any global commissions that it sponsors.1.8 What success looks likeEvidence producers are supported by improved prioritization and coordination processesand

195、 other supportsIf.(key players have theright supports in place).then(they can achievegreater impacts)ExamplesThe Evidence Commission report181.Michie S,van Stralen MM,West R.The behaviour change wheel:A new method for characterising and designing behaviour change interventions.Implementation Science

196、 2011;6(1):42.2.Brooks R.Competence is critical for democracy:Lets redefine it.The New York Times,2021;15 August.3.Parker I.The poverty lab.The New Yorker 2010;17 May.4.McKibben B.The answer to climate change is organizing.The New Yorker 2021;1 September.5.Gawande A.Costa Ricans live longer than us:

197、Whats the secret?The New Yorker 2021;30 August.6.Gladwell M.The engineers lament.The New Yorker 2015;4 May.7.Anderson J.A Kenyan ecologists crusade to save her countrys wildlife.The New Yorker 2021;1 February.8.Grimshaw J,Russell I.Achieving health gain through clinical guidelines:1.Developing scien

198、tifically valid guidelines.Quality and Safety in Health Care 1993;2:243-248.9.Gertz G,Zoubek S,Daly J,Hlavaty H.High level commissions and global policymaking:Prospects for accelerating progress toward SDG2.Washington:Duke Sanford World Food Policy Center and Global Economy and Development at Brooki

199、ngs;2020.10.The Independent Panel for Pandemic Preparedness and Response.COVID-19:Make it the last pandemic.Geneva:World Health Organization;2021.11.Commission on Evidence-Based Policymaking.The promise of evidence-based policymaking.Washington:United States Government Printing Office;2017.12.The Ro

200、yal Society.Data for international health emergencies:Governance,operations and skills.London:The Royal Society;2021.13.Cochrane Methods Equity.PROGRESS-Plus.London:Cochrane;2021.https:/methods.cochrane.org/equity/projects/evidence-equity/progress-plus(accessed 27 October 2021).1.9 References19The E

201、vidence Commission report2.1 Ways of looking at challenges 202.2 Example of a transition in how a societal challenge is seen 222.3 Ways of addressing challenges 232.4 Examples of approaches to prioritizing challenges to address 242.5 Global-commission reports by challenge type 252.6 References 27Cha

202、pter 2.Nature of societal challengesThis chapter is the first of three chapters exploring the issue at the heart of this report:what is involved in systematizing the use of evidence,by the full range of decision-makers,in addressing societal challenges?Here we focus on the nature of societal challen

203、ges.Chapter 3 focuses on decisions and decision-makers,or the demand for evidence.Chapter 4 focuses on studies,syntheses and guidelines,or the supply of evidence.The Evidence Commission report20A challenge can be looked at by the level at which it is typically addressed,by the reason to label it a p

204、roblem worth paying attention to,(1)or by the complexity of the underlying problem.Additional dimensions of a challenge can include the time horizon(e.g.,effects of health and social services on experiences and outcomes can often be evaluated over weeks and months,whereas the effects of climate acti

205、on are modeled over decades and centuries)and stakeholder complexity(e.g.,some challenges can be discussed with a well-organized peak association of stakeholders,while others require engaging with a large number of differently sized and resourced groups,including civil-society groups).A challenge ca

206、n also be expressed negatively(as a problem)or positively(as a goal or strength to be built upon).The Sustainable Development Goals and the strengths-based approaches often advocated by Indigenous peoples are examples of the latter.The label used to describe a challenge can appear neutral to some an

207、d politicized by others.For example,words like sustainable have been used in countries like Brazil both by those seeking to preserve the Amazon rainforest and by those seeking to open it up for logging(under the label of sustainable forestry).2.1 Ways of looking at challengesLevel(and sector)at whic

208、h a challenge is typically addressedDomestic sectoral Health systems failing to improve health outcomes and care experiences Schools struggling with virtual instruction Declining living standardsDomestic cross-sectoral Antimicrobial resistance Gender-based violence Growing levels of inequality Lack

209、of trust in institutions Missed targets for the Sustainable Development GoalsGlobal(or regional)coordination Inequitable patterns in COVID-19 vaccination Climate changeReason to label a challenge a problem worth paying attention toValues“This problem does not reflect who we are as a society”Past“Thi

210、s problem is getting much worse”Other groups within jurisdiction“This group is doing much worse than any other”Other jurisdictions“This country is doing much worse than others like it”Other framing“This is not an issue of insufficient numbers or an inequitable distribution of workers,but a problem o

211、f mis-aligned financial incentives”Chapter 2.Nature of societal challenges21Complexity of the underlying problemSimpleCause and effect can be easily identified and the solution can involve a single actionComplicatedCauses can be identified and the solution can involve rules and processesComplexSome

212、causes can be identified,others are hidden,and some may be consequences of other causes,and the solution is multifaceted and may need to be adjusted as it is implementedComplexity cubed(or wicked)*Causes are even more complex because symptoms can become causes and because feedback loops operate,so s

213、olutions are highly context specific,and wrong or mistimed solutions can make the problem worse*Some commissioners questioned the value of distinguishing degrees of complexity and using the label wicked that has sometimes been attached to problems of significant complexity.Here we use the term compl

214、exity cubed to capture the greater degree of complexity and note that some refer to such problems as wicked.One commissioner observed that complexity often manifests itself as a balancing of trade-offs in outcomes across sectors(e.g.,an intervention may improve educational outcomes and worsen health

215、 outcomes)and a need for appropriate sequencing of interventions.A second commissioner observed that others have called such challenges chaotic,and that the chaotic nature of these challenges can mean that what you learned from solutions tried yesterday may not work today.(2)“Some of my fellow commi

216、ssioners are focused on improving on whats already in place,but in many countries in Latin America,we dont yet have the key building blocks in place to use evidence to address societal challenges.Some governments dont have advisory bodies,so we need to start by setting them up.Most governments dont

217、have staff whove been trained in how to use evidence routinely in their work.I dont think Latin America is alone in this regard.In my role as the vice-president for policy with the International Network for Government Science Advice(INGSA),I hear similar descriptions from colleagues in other regions

218、.Networks like INGSA can play a key role in showing the relevance of an evidence-support system that works for their context.Government policymaker,Soledad Quiroz ValenzuelaGovernment science advisor contributing her national experiences to regional and global efforts to improve the quality of gover

219、nment scientific adviceThe Evidence Commission report222.2 Example of a transition in how a societal challenge is seenUnsustainable fishing practices provide an interesting example of how the way we look at a societal challenge can change over time.Once seen as a complicated,domestic sectoral proble

220、m,unsustainable fishing practices are increasingly understood as part of a more complex or complexity cubed problem,and as both a domestic cross-sectoral and global(or at least regional)coordination problem.(3)LevelDomains where challenges need to be understoodManagement frameworkSingle-species fish

221、eries management FisherymanagementplanEcosystem approach to single-species fisheries managementFisherymanagementplanEcosystem-based broad fisheries management FisheriesmanagementplanEcosystem-based whole-ocean managementRegionaloceanplansAquaculture Conservation Development Ecotourism Energy Fisheri

222、es Marine Oil and gas Sanctuaries OtherClimate Ecology HabitatSingle speciesSingle speciesClimate Ecology HabitatMulti-speciesChapter 2.Nature of societal challenges232.3 Ways of addressing challengesSocietal challenges can be addressed in many ways.Here we describe three ways,some of which can be c

223、ombined.For example,a team of research and innovation professionals may partner with community leaders to co-design a single intervention to address a societal challenge.Alternatively,a group of researchers may use a combination of data analytics,cost-effectiveness analysis and modeling to identify

224、what combination of evidence-based interventions will have the greatest impacts in jurisdictions with a given profile,as was done with Disease Control Priorities 3,a periodic review to address the burden of disease in low-resource settings.(4)Ways of addressing challengesDescriptionsWhat is being of

225、feredSingle interventionAn intervention(e.g.,a policy,program,service or product)is selected based on the certainty of the evidence that benefits outweigh harms,and that the intervention is affordable to those who will pay for it and acceptable to those who will receive itPackage(or bundle)of interv

226、entionsAn optimal package of interventions is selected based on the interventions that will give the greatest improvement in outcomes within a fixed budgetSynergistic combination of interventionsAn optimal combination of interventions is selected based on the likelihood that some interventions will

227、interact with other interventions in ways that the whole is greater than the sum of the parts,or that they simultaneously achieve multiple targetsHow it is selected or developedEvidence-based intervention selectedAn intervention is selected from among interventions that have been shown to work for t

228、he same problem being experienced locallyNew intervention developedAn intervention is designed by researchers,innovators and othersCo-designed interventionAn intervention is co-developed by those who will receive it and/or those who will offer it,as well as researchers,innovators and othersCommunity

229、-led actionAn intervention is developed by representatives of the community who recognized the need for the intervention and who will receive itHow it is managed over timePortfolio managementAn optimal portfolio is selected that achieves strategic objectives,reflects capacity to deliver,and balances

230、 the implementation of change initiatives and the maintenance of business-as-usual while optimizing return on investmentSystems thinking(5)Interventions are combined,adapted and replaced based on an understanding of patterns in their interrelationships and interactions within complex adaptive system

231、s that are themselves constantly changing in unpredictable waysThe Evidence Commission report242.4 Examples of approaches to prioritizing challenges to addressMany approaches can be used to prioritize societal challenges.They can vary by the breadth of challenges and the time frame they address,and

232、by the degree to which they can inform priority setting.Priority setting may be for evidence-related global public goods(which we return to in chapter 6)or for the strategies used by evidence intermediaries(which we return to in chapter 5 and again in chapter 6).Below we outline five of the general

233、approaches that can be used to prioritize action on societal challenges.The first considers all possible sectors and the remaining four are drawn from the health sector.For each example,we suggest some of the pros and cons of the approach.FocusExamplesProsConsBroad societal challenges operating over

234、 the long termGlobal Priorities Institute approachto setting a research agenda(6)Attention to the very long term,including the many generations that will come after us,and to existential risk,such as the extinction of the human speciesFocus on the buckets where evidence is needed,without also focusi

235、ng on the specific questions to be answered or the forms of evidence to answer them within each bucketMid-range challenges operating overthe short termApproaches to allocating resources,such as program budgeting and marginal analysis,technology assessment,and multiple-criteria value assessment*(7)At

236、tention to how financial and human resources can best be allocated within a sector to achieve the greatest value for moneySame as for the rows above and below,as well as the tendency to do these episodically and not as living processesSpecific research questions where new primary research is needed

237、nowJames Lind Alliance approach to engaging patients,caregivers and professionals in prioritizing the top 10 unanswered questions(or evidence uncertainties)on a specific topicResearch priorities being set by those who need to use the resulting evidence and with a check that best evidence doesnt alre

238、ady exist for each potential priorityTendency to focus on products and services,without also focusing on how to get the right mix of many different products and services to those who need themSpecific research questions where a synthesis of the best evidence globally is needed nowSPARK tool for enga

239、ging government policymakers and stakeholders in prioritizing questions for evidence syntheses about the health-system arrangements and implementation strategies needed to get the right mix of products and services to those who need them(8)Same as for the row above,as well as the focus on evidence s

240、ynthesis to complement primary researchLack of anticipation of future needs,which can include both issues that tend to recur with political and economic cycles and issues for which preparedness will be essentialSpecific decisions where locally contextualized evidence is needed now,typically on very

241、short timelinesCOVID-END approach to prioritizing urgent requests from national and sub-national policymakers for rapid evidence syntheses to be prepared in one-to-10 days and funded out of a common pool over a one-year periodUse of proxy indicators for likelihood of impact(high-level request and in

242、terest from multiple jurisdictions),a check that best evidence doesnt already exist or isnt already being synthesized,and checks that the work can be completed in the timeline requested and within bi-monthly spending targetsPotential for duplication in the production of new global public goods and f

243、or such goods to be of lower quality than if a living evidence synthesis had been prepared by methodologically strong teams that anticipated a future need and made available updates in ways that can be easily contextualized*An alternative to MCVA is the incremental cost-effectiveness ratio based on

244、quality-adjusted life years,which is a single-criterion value assessmentChapter 2.Nature of societal challenges252.5 Global-commission reports by challenge typeGlobal-commission reports provide an interesting window into how challenges are viewed by the eminent persons who often fill the ranks of co

245、mmissioners.Our analysis of the 70 commission reports published since January 2016 found that:most commission reports(46)address both domestic and global levels only three sectors have been the focus of more than seven commission reports,namely health,public safety and justice,and food safety and se

246、curity,with 22,17 and 12 reports,respectively only four Sustainable Development Goals(SDGs)have been the focus of more than six commission reports,Good health and well-being(SDG 3),Peace,justice and strong institutions(SDG 16),Zero hunger(SDG 2),and Decent work and economic growth(SDG 8)with 25,16,1

247、0 and seven reports,respectively nearly half of the commission reports(33)labeled the problem they were addressing as complex and none used the labels simple,complicated or wicked the most common reasons used to justify calling a challenge a problem worth paying attention to were values(59)and compa

248、risons to the past(52)most challenges were framed positively as goals or targets(39)rather than negatively as problems(31)most commission reports(43)propose a package(or bundle)of interventions,albeit not with the rigour of a report like Disease Control Priorities 3,but dont speak to how the interve

249、ntions were developed or how they should be managed over time.Note that a commission report can address more than one sector and SDG so the numbers do not always add up to the total number of reports we analyzed.Challenge typesNumber of commission reportsWays of looking at challengesLevel at which a

250、 challenge is typically addressedBoth domestic and global 47Domestic(e.g.,national or sub-national)17Global coordination6Sector addressedHealth23Public safety and justice17Food safety and security12Economic development and growth7Natural resources5Infrastructure4Climate action4Culture and gender3Edu

251、cation3Employment2Energy supply2Environmental conservation1Government services1Children and youth services1Community and social services1Housing1Recreation0Transportation0Citizenship0The Evidence Commission report26SDG addressed3 3 Good health and well-being261616 Peace,justice and strong institutio

252、ns162 2 Zero hunger108 8 Decent work and economic growth76 6 Clean water and sanitation51010 Reduced inequalities51212 Responsible consumption and production54 4 Quality education49 9 Industry,innovation and infrastructure41717 Partnerships for the goals45 5 Gender equality31 1 No poverty31313 Clima

253、te action37 7 Affordable and clean energy21414 Life below water21111 Sustainable cities and communities11515 Life on land1Not stated explicitly1Complexity of the underlying problemComplex33Simple0Complicated0Complex cubed(or wicked)0Not stated explicitly 37Reason to label achallenge a problem worth

254、paying attention toValues60Past52Other groups within jurisdiction12Other jurisdictions7Other framing3Not stated explicitly 1FramingPositive39Negative31Ways of addressing challengesWhat is being offeredPackage(or bundle)of interventions43Synergistic combination of interventions20Single intervention1N

255、ot stated explicitly6How it is developedCo-designed intervention14Evidence-based intervention selected4New intervention developed1Community-led action1Not stated explicitly50How it is managed over timeSystems thinking12Portfolio management5Not stated explicitly53Chapter 2.Nature of societal challeng

256、es271.Kingdon JW.Agendas,alternatives,and public policies.Boston:Longman;2011.2.Snowden D,Boone M.A leaders framework for decision making.Harvard Business Review 2007;85(11):68-76.3.National Marine Fisheries Service.Ecosystem-based fisheries management policy.Silver Spring:National Oceanic and Atmos

257、pheric Administration;2016.4.Jamison D,Nugent R,Gelband H,et al.Disease control priorities:Third edition(nine volumes).Washington:World Bank;2015-2018.5.Adam T.Advancing the application of systems thinking in health.Health Research Policy and Systems 2014;12(1):50.6.Global Priorities Institute.A res

258、earch agenda for the Global Priorities Institute.Oxford:University of Oxford;2020.7.Seixas BV,Dionne F,Mitton C.Practices of decision making in priority setting and resource allocation:A scoping review and narrative synthesis of existing frameworks.Health Economics Review 2021;11(1):2.8.Akl EA,Fadla

259、llah R,Ghandour L,et al.The SPARK Tool to prioritise questions for systematic reviews in health policy and systems research:Development and initial validation.Health Research Policy and Systems 2017;15(1):77.2.6 References“As a cabinet member and a key player in my countrys macroeconomic team,I and

260、my team bear the huge responsibility of offering the best recommendations for effective development plans and policy designs aimed at solving societal challenges.This makes the office I lead one of the key users of evidence,both to provide a foundation on which plans and policies are based,as well a

261、s for alternative policy recommendations.My participation in the Evidence Commission,as well as my engagement over the last three years at the apex of policymaking where we strive to make policies in a complex environment,have given me an ideal opportunity to re-emphasize the need for synthesizing t

262、he many forms of evidence pertinent to the issue at hand.To support the use of evidence in policymaking and monitor our impacts,my team has been developing a new monitoring and evaluation metrics to better track progress in achieving the Sustainable Development Goals.Furthermore,we have been working

263、 with stakeholders to develop a national multidimensional poverty index(MPI)to complement existing measures of poverty.While global MPIs can set the stage for global comparisons,national MPIs can provide the sensitivity to local contexts that we need.Thus,I strongly support the insights provided in

264、chapter 3 about decisions and decision-makers,particularly those provided in section 3.3 about the demand for evidence among government policymakers and the context for their use of evidence.I also wholeheartedly support the insights provided about the evidence-support system in section 6.2,where th

265、e need for basing it on local(national or sub-national)contexts has been emphasized.The insights about the need for global public goods and equitably distributed capacities in section 6.1 are also important,given the lack of global equity in this regard.This report will be instrumental in guiding us

266、 in the best ways for using evidence to properly understand and effectively solve societal challenges.Government policymaker,Fitsum Assefa AdelaCommitted policymaker striving to bring a whole-of-government perspective to cabinet-level planning and developmentThe Evidence Commission report2829The Evi

267、dence Commission reportChapter 3.Decisions and decision-makers:Demand for evidence This chapter is the second of three chapters exploring the issue at the heart of this report:what is involved in systematizing the use of evidence,by the full range of decision-makers,in addressing societal challenges

268、?Here we focus on decisions and decision-makers,or the demand for evidence.Chapter 2 focuses on the nature of societal challenges.Chapter 4 focuses on studies,syntheses and guidelines,or the supply of evidence.3.1 Steps in deciding whether and how to take action 303.2 Four types of decision-maker an

269、d how each may approach decisions 313.3 Government policymakers and the context for their use of evidence 323.4 Organizational leaders and the context for their use of evidence 343.5 Professionals and the context for their use of evidence 353.6 Citizens and the context for their use of evidence 363.

270、7 Ways that evidence can be used in decision-making 383.8 Global-commission reports by decision-maker type 403.9 References 41The Evidence Commission report303.1 Steps in deciding whether and how to take actionPeople can decide whether and how to take action on impulse(often as part of a habit-drive

271、n,non-conscious process)or after reflection(as part of a deliberative,conscious process that can include finding and using evidence).(1)For the latter,approaching decision-making as a series of steps can help to make explicit the questions that may be asked and the nature of the decisions,even if ma

272、ny people dont follow steps at all or dont follow them in order.Here we introduce two of the four types of decision-makers who are the focus of this chapter(government policymakers and citizens,in this case those acting as community leaders),and we foreshadow the types of questions that can be answe

273、red with the evidence that is the focus of the next chapter(see sections 4.2 and 4.3).For decision-makers like government policymakers,section 2.4 can also help in step 1.*or ensuring the chosen option makes an optimal impact at acceptable costUnderstanding a problem and its causesMonitoring impleme

274、ntation and evaluating impactsSelecting an option for addressing the problemIdentifying implementation considerations*1243StepsRelated questionsDecisions for a government policymakerDecisions for a citizen or community leaderHow big is the problem?Should we pay attention to this problem given all th

275、e others we face as a government?Should I pay attention to this problem given all the others that the people and community I care about face?Is the problem getting worse or is it bigger here than elsewhere?How do different people describe or experience the problem and its causes?What good might come

276、 of it?Should we take any action to address this problem and,if yes,which option should we select?Should I take any action to address this problem and,if yes,what action(e.g.,talk to others about changing their behaviour,work with fellow community members on local solutions,or contact elected offici

277、als)?What could go wrong?Does one option achieve more for the same investment?Can we adapt something that worked elsewhere while still getting the benefits?Which groups support which option?What will get in the way or help us in reaching and achieving desired impacts among the right people?Should we

278、 take any additional steps to increase the chance that the selected option does what we intend it to do?Should I work with fellow community members and encourage elected officials to take steps to ensure the selected option reaches the people and community I care about?What strategies should we use

279、to reach and achieve desired impacts among the right people?Is the chosen option reaching those who can benefit from it?Should we take any additional steps to give us the numbers we need to tell a success story or to correct our course if need be?As above to ensure we have the numbers we need to kno

280、w whether were succeeding or failing?Is the chosen option achieving desired impacts?1243Chapter 3.Decisions and decision-makers313.2 Four types of decision-maker and how each may approach decisionsGovernment policymakersNeed to be convinced theres a compelling problem,a viable policy and conducive p

281、oliticsOrganizational leaders(e.g.,business and non-governmental organization leaders)Need a business case to offer goods and servicesProfessionals(e.g.,doctors,engineers,police officers,social workers and teachers)Need the opportunity,motivation and capability to make a professional decision or to

282、work with individual clients to make shared decisionsCitizens(e.g.,patients,service users,voters and community leaders)Need the opportunity,motivation and capability to make a personal decision,take local action or build a social movementThe Evidence Commission focuses on four types of decision-make

283、rs.Each type of decision-maker may approach decisions in different ways.Here we provide an example of an approach used by each type,recognizing that this approach may be complemented by others(e.g.,government policymakers also play a role in supporting decision-making by others,including by funding

284、or building the evidence used by them).People wear multiple hats and may have experience in multiple roles.For example,a government policymaker is also a citizen,may have trained in the past as a doctor or teacher,and may have led a non-governmental organization before being elected or appointed to

285、government.As well come to in chapter 4,using evidence is not rocket science.Two randomized-controlled trials in Uganda showed that school children(ages 10 to 12 years)and their parents can be taught to assess the reliability of health-treatment claims and make well-informed decisions.(2;3)The Evide

286、nce Commission report323.3 Government policymakers and the context for their use of evidenceGovernment policymakers are one of four key types of decision-makers.They also shape the scope and supports for decision-making by organizational leaders,professionals and citizens,just as organizational lead

287、ers can do this for professionals and citizens,and professionals can do it for citizens.Citizen leaders,like the young Swedish environmental activist Greta Thunberg,can seemingly also shape the scope for decision-making by government policymakers,organizational leaders and others.Here we provide con

288、text for how government policymakers make decisions,using questions likely to elicit factors that could support(or discourage)their use of evidence.Given the array of policy,system and political analysis skills required to answer these questions,some evidence intermediaries focus exclusively on gove

289、rnment policymakers.QuestionsPromptsWhat types of decisions do they make?Domestic sectoral,domestic cross-sectoral or global(e.g.,as a member state in the UN system)One-off versus on-going process with defined re-assessment points Routinized versus ad hoc(e.g.,adding a product or service to an exist

290、ing benefits package using established procedures versus creating a new benefits package)Products and services versus the governance,financial and delivery arrangements that determine whether the right mix of products and services get to those who need them One policy instrument versus another(see s

291、ection 7.1 for examples of information/education,voluntary,economic and legal policy instruments)Where and how are decisions made?National,provincial/state or local level of government Executive,legislative or judicial*branch of government If executive:cabinet or other cross-government entity,minist

292、er or secretary(and their political staff),and public servants in central agencies,ministries or departments,government agencies,and regulatory bodies Personal decision(command),consult,consensus or vote Time constraintWhat factors may influence decision-making?Need a compelling problem,a viable pol

293、icy and conducive politics to get an issue onto the decision agenda Make decisions within institutional constraints(e.g.,veto points and legacies of past policies),contending with interest-group pressure(e.g.,support or opposition from those who will gain or lose a lot),considering both what is(e.g.

294、,data analytics)and what should be(values),and in light of external events(e.g.,economic crisis)What structures may provide a way in for evidence(and for institutionalizing evidence support)?*Internal evidence-support coordination unit and contributing data-analytics,evaluation,behavioural-insights,

295、and other units Internal government science advisor units External evidence support from advisory groups,assessment panels,independent commissions,monitoring boards,review committees,and technical task forces Internal units for budgeting and planning,monitoring,auditing,and complaints investigation(

296、e.g.,ombudsperson)External support from management-consulting firms External support from normative-guidance and technical-assistance units in the UN system and other multilateral organizations External support from global public-good producersWhat processes may provide a way in for evidence?*Budget

297、ing,planning and monitoring Policies,procedures,handbooks and other tools to support workflows Hiring criteria,performance-review criteria,promotion criteria,turn-over rate,and professional development for policy,program,technical and library staff Stakeholder,public and media engagement,as well as

298、public-opinion polling Legislative debate and committee meetings Elections and political-party platforms Global and regional programs of action and accountability frameworks The judicial branch of government considers evidence as conceived in this report as something introduced by expert witnesses a

299、nd as something to be considered alongside other testimonial evidence as well as physical evidence(e.g.,fingerprints and DNA),demonstrative evidence(e.g.,maps and photos),and documentary evidence(e.g.,contracts and diary entries).Some of these structures and processes are explicitly evidence-related

300、 while others can be considered mainstream structures and processes where evidence can be a helpful input.*Chapter 3.Decisions and decision-makers33Many evidence syntheses address the factors that influence the use of evidence in government and the strategies that increase the appropriate use of evi

301、dence in government,while others examine similar issues for decision-making in governments and organizations without explicitly differentiating the two.Many of the evidence syntheses addressing the factors that influence the use of evidence are of medium quality and focus on the health sector,althou

302、gh some address many sectors.(4;5)The evidence syntheses addressing strategies tend to be of higher quality and focused on the health sector.(6-9)The studies included in these evidence syntheses are challenging to conduct for many reasons,including the difficulty of identifying the individuals invol

303、ved in high-level behind-the-scenes decision-making,the difficulty of securing their participation given the confidentiality and time constraints that many work under,the complexity of the competing political forces at play,and the lack of simple measures of evidence use that reflect an understandin

304、g of political environments and can be applied at scale.Randomized-controlled trials are very infrequent,with only a few notable exceptions like the SPIRIT trial,(10)and natural experiments are very difficult to evaluate in ways that make causal statements possible.Medium-quality evidence syntheses

305、also address complementary issues,such as evidence intermediaries use of a range of strategies to support evidence use in policymaking in the health sector,technical-advisory groups support for policymaking and program decision-making specifically about immunization,and cultures of evidence use in a

306、 range of non-health sectors.(11-14)More operationally,many governments have developed handbooks to assist their staff in using evidence,(15-17)some audits of government documents have provided a window into at least the citation practices of many departments,(18)and some rich descriptions of eviden

307、ce use in a single government have shed light on what this can look like on the ground.(19)“I work in a very fast-paced environment where decisions must be made based on the best available evidence,ideally presented in formats appropriate to busy executives.So the parts of the Evidence Commission re

308、port that are most important for me are the ones that could help our authorities develop the types of ultra-rapid evidence-support system that we need in Abu Dhabi.Some examples include section 2.4(examples of approaches to prioritizing challenges to address,especially the final column about COVID-E

309、NDs approaches),section 4.7(living evidence products,especially living evidence syntheses that we can keep returning to),section 5.3(strategies used by evidence intermediaries,especially rapid-evidence services),and section 6.2(equitably distributed capacities,especially how our own internal process

310、es can better intersect with the norms and guidance,technical assistance and global public goods).If we can create wins that meet our current needs better,then Im hopeful we can introduce the need to be working on multiple time horizons.No doubt we can better anticipate challenges in advance and hel

311、p to build a local evidence base while we also look at what has been learned in the Gulf Cooperation Council countries,in our region and globally.Organizational leader,Asma Al MannaeiExperienced public servant leading quality improvement and stewarding research and innovation across a health systemT

312、he Evidence Commission report34Organizational leaders include both business and non-governmental organizational leaders.They make decisions in their own right,and can shape the scope and supports for decision-making by the professionals who work for them and the citizens they serve.Here we provide c

313、ontext for how organizational leaders make decisions using questions likely to elicit factors that could support(or discourage)their use of evidence.QuestionsPromptsWhat types of decisions do they make?Strategic,tactical and operational If operational:programmed(routine)versus non-programmedWhere an

314、d how are decisions made?Head office,country office or local office Chief executive,other C-suite leader,manager,employee or volunteer Personal decision(command),consult,consensus or vote Time constraintWhat factors may influence decision-making?Need a business case to offer goods and services Make

315、decisions within regulatory and organizational constraints and market opportunities,contending with shareholder or stakeholder pressure,considering both what is(e.g.,data analytics)and what should be(e.g.,corporate values and sales targets),and in light of external events(e.g.,economic crisis)What s

316、tructures may provide a way in for evidence(and for institutionalizing evidence support)?Internal evidence-support units,including data-analytics and evaluation(e.g.,A/B testing where commercial pressures encourage the use of randomized-controlled trials)Internal units for knowledge management,resea

317、rch and development(R&D),budgeting and planning,marketing,monitoring,auditing,and risk management External support from advisory groups,management-consulting firms,and the financial-services sector(e.g.,financing)and authorities(e.g.,externality pricing)External support from global technical-standar

318、d settersWhat processes may provide a way in for evidence?Budgeting,planning and monitoring Workplace policies,procedures,handbooks and other tools to support workflows Hiring criteria,performance-review criteria,promotion criteria,turn-over rate,and professional development for staff Organizational

319、 accreditation Quality assurance Government,stakeholder relations,public and media relations Philanthropic giving Environmental,social and corporate governance(ESG)principles UN Global Compact principles and UN Guiding Principles on Business and Human Rights3.4 Organizational leaders and the context

320、 for their use of evidenceEvidence syntheses that address the factors that influence the use of evidence in organizations and the strategies that increase the appropriate use of evidence in organizations are harder to come by(than those focused on governments),usually focused on the health sector,an

321、d typically of low-and medium-quality.(20-22)Many evidence syntheses will likely be needed in future given the heterogeneity of this category,which comprises both the full array of businesses and the full array of non-governmental organizations.Ideally these evidence syntheses will be undertaken usi

322、ng a common framework,such as one proposed in the Effective Altruism Forum,to permit comparisons across types of organizations.(23)One of the commissioners regularly reminds us that many successful businesses from the credit card company Capital One and the supermarket chain Coles,to Amazon,Google a

323、nd Netflix do randomized-controlled trials all the time.(24)Chapter 3.Decisions and decision-makers35Professionals include doctors,engineers,police officers,social workers and teachers,among others.What typically unites members of some professions is that they have acquired formal qualifications thr

324、ough specialized training,have been admitted and are subject to discipline by a regulatory body,provide objective counsel and service in the interest of their client and the public,and have been given some degree of monopoly rights to do so.Membership in other professions may be much less formalized

325、.Countries differ significantly in which categories of workers are considered professionals.Here we provide context for how professionals make decisions using questions likely to elicit factors that could support(or discourage)their use of evidence.QuestionsPromptsWhat types of decisions do they mak

326、e?Provide counsel or serviceWhere and how are decisions made?Can decide whether and how to take action independently on impulse,often as part of a learned,non-conscious process,or after reflection,as part of a deliberative,conscious process that can include finding and using evidence(1)versus in a w

327、orkplace with policies and procedures set by others What factors may influence decision-making?Need the capability,opportunity and motivation to make a professional decision or to work with individual clients to make shared decisions Some profession-specific frameworks exist,such as the evidence-bas

328、ed medicine triangle of clinical context(patients condition and clinicians expertise),patient values and preferences,and evidenceWhat structures may provide a way in for evidence(and for institutionalizing evidence support)?Workplace units providing decision support,knowledge management,research and

329、 development(R&D),budgeting and planning,marketing,monitoring,auditing,and risk management External workplace support from evidence-support initiatives(e.g.,Education Endowment Foundation for teachers)External workplace support from management-consulting firms,financial-services sector(e.g.,financin

330、g)and financial authorities(e.g.,externality pricing),and global technical-standard settersWhat processes may provide a way in for evidence?Code of professional conduct Continuing professional development Maintenance of licensure(e.g.,minimum amount continuing professional development in a defined p

331、eriod;periodic peer and practice assessment)Other regulatory requirements Practice-based research opportunities Workplace processes such as budgeting,planning and monitoring as well as policies,procedures,handbooks and other tools to support workflows(see section 3.4 for the full list)3.5 Profession

332、als and the context for their use of evidenceWell over 1,000 evidence syntheses address the effectiveness of strategies to support the use of evidence by health professionals,especially physicians,and many of these syntheses are of high quality.Overviews of such syntheses exist,including one focused

333、 on low-and middle-income countries.(25)Some evidence syntheses address the factors the influence the use of evidence by other professionals,such as teachers and school principals.(26)More operationally,select governments have invested in evidence syntheses,guidelines and toolkits to support evidence use by professionals.For example,the UK government has invested in a set of What Works Centres,suc