TIE-U, Fall 2012: Mortensen’s Introduction to Health Systems

This semester I’ll be blogging along with Karoline Mortensen’s Introduction to Health Systems (UMD’s  HLSA 601). The syllabus is here (PDF). This first post will serve as an index to all subsequent ones. Below the following index are a few comments about one of the first week’s readings.

Post Index for UMD’s HSLA 601 (Mortensen)

Comments on How Public Health Policy is Created, by Alfred Sommer (American Journal of Epidemiology, 2001)

The paper by Sommer is both short and ungated. I recommend you read it. Though there’s plenty to agree with, I want to push back on this sentence in the third paragraph:

In an ideal world, health policy would be formulated in a rational, linear process, moving from data collection, to interpretation, to scientific consensus.

This is a popular sentiment among researchers. I may have expressed the same some time ago. But I now think it’s wrong.

In a TIE guest post, Keith Humphreys commented on his paper Scientific evidence alone is not sufficient basis for health policy, coauthored by Peter Piot (BMJ, 2012). Keith wrote,

What we do with scientific evidence is always a political and moral judgment. We don’t provide health care to the sick because the evidence forces us to. We provide health care to the sick because such activity is in keeping with our values. Likewise, we might choose to morally oppose certain policies (e.g., capital punishment) even if there is solid scientific evidence of benefit (e.g., if it is ever shown conclusively that capital punishment reduces crime). It would be dishonest to hide behind the evidence and say, for example, that science made us put a helpless human being to death; that moral judgment falls on all of our heads.

Since his BMJ paper is ungated and but his post brief post is not.

Despite where it starts, Sommer’s paper seems to wind up agreeing with Humphreys and Piot. The final sentence is,

Health policy involves far more issues than epidemiologists and other scientists know or care about.

Agreed. So it is not clear in what sense a rational, data-driven world guided by scientific consensus would be ideal. More than that, it is not so clear how such a world could exist. Decisions are informed by data but not made by them.

Postscript: The other paper assigned this week is a summary of the IoM’s Crossing the Quality Chasm (2001). TIE has at least one  post about that report.


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