Economists are from Mars, policymakers are from Venus: Translating the language of science

While many scientists applaud former Vice President Al Gore and his documentary, "An Inconvenient Truth," some scientists have said that the film exaggerates the nature of environmental problems and/or makes conclusions that the science doesn't uphold. Part of the problem may be that scientists and policymakers don't speak the same language. The controversy highlights an enduring problem: how to translate the highly specialized language of science. The 18th Annual Health Economics Conference hosted by the School of Health Management and Policy at the W. P. Carey School of Business recently tackled this problem in the context of health policy.

Translating from one language to another is a notoriously perilous endeavor. A quick web search yields many tales of companies that have translated their marketing taglines literally without considering the local connotations. These often hilarious bloopers illustrate the importance of translating the meaning behind the words rather than just the words themselves.

Focusing on communicating in the audience's language is important in translating between technical fields and public policy, too. That job is particularly important for researchers who want their work to have an impact on public policy as well as those who need funding from government agencies. But Michael Hagan, a senior economist at the Agency for Healthcare Research and Quality (AHRQ) said that bridging the gap between health economics and public policy can be difficult.

"To paraphrase Keynes," Hagan said, "I think that the ideas of health economists are powerful but there is difficulty in understanding, facilitating, and documenting how such ideas influence public and private decision-making." Hagan presented his views recently at the 18th Annual Health Economics Conference hosted by the School of Health Management and Policy at the W. P. Carey School of Business.

Hagan and his co-presenter, Health Affairs Deputy Editor Robert Cunningham, talked to a room full of health economists and policymakers about the difficulty — and importance — of translating health economics research into a format that can be understood and used by policymakers.

The challenge of translation

"I don't want to convey the impression that I think the economics discipline is out of sync with health policy," Cunningham said. "But translating methodologically complex microeconomic work into terms that are intelligible to non-specialists is challenging."

Sometimes, keeping health economics research in health economics terms is appropriate, Cunningham said — such as when "scholars are working on problems that are not necessarily ready for discussion in the policy sphere — or the policy sphere is not ready for them." But, "when the intent is to bring an idea or a finding to the policy community, that's when we try to engage scholars around the challenge of translation," he said.

For those economists who care only about the intra-disciplinary impact of their work, effective translation of research into policy-appropriate language is a non-issue. But for those economists who want their work to have an impact on public policy — or those who need the policy impact to justify public funding for their research — then the issue is a crucial one. Cunningham agreed.

"The health economic viewpoint is critical to an understanding of the issues," he said. Forty percent of the papers published by Health Affairs — a health policy journal that speaks to a wide audience of policymakers, business leaders, and researchers — are written by health economists. "That fact shows how relevant economics is to public policy," Cunningham said.

SENSATION! gets attention

Sometimes, those tasked with bringing science to the policy community use sensationalism to get policymakers' attention. Former Vice President Al Gore, for example, has touched off a bit of controversy with his documentary "An Inconvenient Truth" as well as his recent Capitol Hill testimony on global warming. Some scientists take issue with the claims Gore makes — suggesting that they exaggerate the nature of the problem and/or make conclusions that the science doesn't uphold.

In a recent Morning Edition segment on National Public Radio, NPR's science correspondent Richard Harris was asked if the scientists challenging Gore's claims may simply be more focused on the details than Gore and his followers. Harris said that Gore "has realized that if you want to get attention, you really have to focus on the crisis.

You have to make people worry about things maybe a little bit more than scientists would say." So should health economists take their cue from Al Gore and add a little spice to their work to better get the attention of policymakers — as well as those agencies that fund research?Cunningham doesn't think that sensationalizing an issue or sounding more alarmist than the situation warrants is wise.

"In the long run, alarmism muddies the waters," he said. "It's the responsibility of the health economists and other researchers to avoid over-interpreting evidence. Because over-interpreting the evidence blows smoke into the environment and makes it difficult for subsequent researchers to add clearly to the issue debate."

So how can health economists better talk to policymakers?

One solution that Hagan suggests to help economists talk to policymakers without compromising the intellectual integrity of their work is the creation of a Federal infrastructure to handle the knowledge translation, acting as the bridge between economists and policymakers. The problem, Hagan said, is that "over time, health economics has become lost within the field of health services research."

Because health economics research is hidden behind general health services research, generating the will to create an infrastructure dedicated to bridging the translational gap is difficult. Difficult, but — Hagan believes — possible. Another solution that Cunningham engages in every day is helping health economists to contextualize their research so that it speaks to the real world as policymakers know it.

As deputy editor of a policy journal that regularly accepts contributions from health economists, Cunningham sees firsthand the difficulty in translating health economics research to policy-appropriate language. The second layer of the journal's rigorous editorial process (after traditional peer-review), Cunningham said, is about "contextualizing and translating the economic research into a format that's accessible for our policy audience." The key is couching economic research in real-world terms.

"Heavy technical discussions about models are for economic journals," Cunningham said.

"What policymakers need is a balanced view of the implications of the research — in real-world terms." Cunningham cites as an example a paper that was presented at the conference by University of Virginia Assistant Economics Professor Amalia Miller. The paper examines the effects of privacy laws on hospitals' adoption of Electronic Medical Records (EMR). The authors' conclusion is that privacy laws inhibit network effects (where one hospital's EMR adoption decision may rest on the adoption decisions of other hospitals).

The paper's authors, Cunningham said, "boil everything down and control for possible confounding factors — but that abstracts from the real-world context of the problem." The lessons learned in that kind of ideal model setting may be problematic to apply in a real-world setting, he said. Miller's paper considers what might be the effect of the hospital network on IT adoption.

"But the bigger question," Cunningham said, "is about network effects between doctors, labs, hospitals, specialists — medical providers across different settings. That's where information accessibility will lead to efficiency gains." The bottom line, for Cunningham, is that policymakers know what's going on in the real world. If economic research doesn't take real-world context into account, then the work could feel irrelevant to policymakers.

Convincing agencies to fund projects

Many health economists — especially those involved in applied research — rely on Federal grant money to conduct their research. But they're finding that research funding for health economics is harder and harder to come by. "In the next fiscal year, our budget for health economic research funding is less than one percent of our entire budget," Hagan said. The solution Hagan proposes is to make a better case for the value of health economics research in public policy.

To do that, he's launched a project to shed light on how health economic research translates into policy in the real world by evaluating and documenting the public policy impact of health economics research. He'll be looking at between 150 and 200 grants made in the health economics field to find the impact that those grants — and the research they funded — have had on public policy.

Part of the study, he said, is to conduct structured interviews with researchers to get at the nature of the policy impact of their work, based in part on where they publish their work, who they talk to, and where they testify. Anecdotal evidence of the impact of health economics research on public policy certainly exists — but it hasn't been synthesized and made easily accessible to policymakers and those who make funding decisions.

"Policymakers such as the Department of Veterans Affairs (VA), Medicare, and Medicaid over the past 20 years have relied upon leading-edge health economics literature as a foundation for many key policy innovations," said School of Health Management and Policy Assistant Professor Jonathan Ketcham.

Ketcham cited public policies including Medicare's implementation of the Prospective Payment System for hospital services to achieve budgetary control and improved economic efficiency; Medicaid's pursuit of specialty care "carve outs" to ensure access and quality; and the VA's development of pricing mechanisms to allocate resources to fund patient care activities and various incentive and measurement systems as all emanating from health economics research.

"The connection to public policy is the hallmark of good economics," Hagan said. The challenge is making that connection. The key to bridging the gap between health economics research and public policy is translating the work of economists into policy-appropriate language; couching the research in real-world context; and highlighting the cases where health economics has had a public policy impact.

Bottom line

• The ideas of health economists are powerful, but translating those ideas into policy-relevant terms is difficult.
• For those economists who want their work to have an impact on public policy — or those who need the policy impact to justify public funding for their research — the effective translation of research into policy-appropriate language is crucial.
• Sensationalizing policy issues to make them more likely to be heard in the end only harms the policy debate.
• A federal infrastructure to handle the knowledge translation could act as the bridge between economists and policymakers.
• Economists should contextualize their research so that it speaks to the real world as policymakers know it.
• An evaluation and documentation of the public policy impact of health economics research would help health economists convince funding agencies that their work is worth funding.
• Anecdotal evidence does reveal the importance of health economics research in public policymaking.