1. Is scientific knowledge useful for decision making? CRICS 5 La Habana, April 2001

2. Why this question? Because although decision makers are requesting more and more that researchers be their advisors, nevertheless this relation is complex, made of unsatisfied expectations on both sides and misundertsanding; This is particularly true in public health.

3. The right question How can we improve the effectiveness of the link between research and decision making?

4. Why public health? Because it has become a domain of increasing demand from decision makers; Because, by definition, public health research has a vocation to be applicable research. Public health research deals with the functionning of social systems and their impact on the health of populations: its outcomes are of interest only if they translate in policies

5. What is wrong between decision makers and researchers? The initial quid pro quo: –Decision making is about dealing with uncertainty. Decision makers’ secret hope is that research will bring certainty, whereas in most cases research brings plausible predictions. –On the other hand, researchers are enclined (it’s their job) to think that science is the only way to produce truth, but science only produces partial answers to specific questions.

6. Bounded rationality Researchers tend to think that they are rational, and decision makers caught in a web of intertwined interests; at the best, decision makers have the rationality of their constituencies. But scientists must not forget that they are also acting under bounded rationality; they have access to limited resources, and they choose their research issues according to competition with other scientists.

7. Prediction and action Research as said before will help make plausible predictions on the evolution of specific systems, according to different scenarios; But the role of the decision maker is to make some of those predictions come true.

8. The context of decision Often, the problem at study is one of many in the decision maker’s agenda. This may not be well perceived by the researcher, but will definitely have an influence on the way the decision maker will consider his/her work. The decision maker will consider a nexus of intertwined decisions, not only one.

9. The context of decision Decision makers have to anticipate the impact and the reaction of their different constituencies to the problem at study; The researcher oftent does not integrate this aspect both for ethical and methodological issues.

10. Deadlines Decision makers have their own agenda, and may not be able to wait for research results; Scientists are always asking for time… and money! The clocks are not the same….

11. The time to learn To be understood, research needs to convince: –Decision makers –But also, all the actors that are relevant to the issue of concern by the policy. It takes time, and persuasion: often it is not useful to be right to early, people are not ready to hear the message from research

12. Attitude towards risk and uncertainty Researchers think that rational decision making under uncertainty should lead to a Von Neuman Morgenstern decision rule of maximization of the expected benefits There is more and more empirical evidence suggesting that people are actually biasing probabilities of outcomes according to the value they give to each consequence.

13. Accountability The advisors are not the payors….Researchers should accept that since they are not responsible for decision making, they should allow decision makers not to follow their advice.

14. The remedies There is a need for special skills, or for a function to exist between research and decision makers, to mediate their interaction. What skills? What tasks?

15. Uncertainty When there is uncertainty, suggest decisions that allows to produce knowledge on the areas of uncertainty: –Assessment during implementation –Point out to areas of strong irreversibility

16. Translation From decision to research: –Translation means to explain the decision context, so as to adapt the research agenda and anticipate on the reactions of different constituencies. From research to decision: –Translation means to explicit to the decision maker the way his or her demand has been transformed.

17. Strategic thinking To help the decision maker, the researcher must become a strategist, understand the context of decision: –Identify the relevant actors, their motivations and their potential for action; –Identify the need for communication, to find support.

18. Deadlines Produce only synthesis of existing research; Accept the idea that there are favourable times to pass on messages; Learn how to diffuse knowledge so as to gain allies

19. Ethics Can a researcher become an actor in the decision process? Is it ethical? Yes, if the knowledge resource he/she represents is equitably distributed among actors Yes, if researchers remember that they also have their own prejudices when designing a research