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Where is the Evidence-base for Health Policy and Health System Management?

There is a need for a One Health Knowledge Management System that addresses the need for evidence in health policy and health system management in the U.S. as well as overseas. The article below rightly claims that evidence-based medicine is growing and is positively impacting clinical practice. That said, there needs to be a One Health Knowledge Management System that can inform policy makers, planners, and health systems managers about the cascading health issues and impacts within their domains and jurisdictions. See below. The engagement of the Human Security Index within the One Health Knowledge Management System may be a good start. xxxxxxxxxxx Policy-Making as a Struggle for Meaning: Disentangling Knowledge Translation across International Health Contexts Aris Komporozos-Athanasiou, Eivor Oborn, Michael Barrett and Yolande Chan School of Management, Royal Holloway University of London Working Paper Series SoMWP–1005 -June 2010 Available online PDF [27p.] at: “……While evidence-based medicine has increasingly sought to transform decision making in clinical practice, this trend has not been followed by a similar logic in health management and policy-making. This has ultimately led to significant discrepancies between policy and practice (Walshe and Rundall 2001, van der Schee et al 2007). In this paper, we argue the need to step back and analyze the development of policy discourse in different institutional and national contexts as an important starting point in further understanding how this policy-practice „gap‟ develops over time. We consider this discourse not only regarding its role in directing healthcare policy, but moreover vis-à-vis its ability to render visible concurrent political structures and mechanisms (Moon and Brown 2000). Moreover, we explore the linkages between the rise of a public sector discourse and its varied manifestations with the different notions of citizen, user and, in our case, patient in co-designing best practice and transferring knowledge during service restructuring (Löffler 2009), which has emerged as an important area of debate in healthcare policy (Dawson and Morris 2009). Rather than being viewed as a passive recipient, the patient as service user may be central in re-structuring care, especially through making “informed choices” and as well as participating in the service design and thereby acquiring more control over the process of care delivery (Fotaki 2005; Le Grand 2004; Löffler 2009). Our approach is to unearth how different underlying meanings of best practices - deemed as gold standards by medical science - are discursively enacted in health policies across different institutional and political contexts. To this end, we analyzed stroke care related policies in the UK and Canada. In the UK, we examined both the general “umbrella” healthcare strategies that informed and influenced the re-organizing of stroke care services as well as the various reviews and policy guidelines that were generated after the launch of the National Stroke Strategy….”

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