Beyond the sound of one hand clapping: experiences in six countries using health equity research in policy

In an attempt to better understand the complex and sometimes tenuous relationship between health equity research and health policy, we undertook a collaborative comparison of six case studies with researchers from the United States, the United Kingdom, the Netherlands, China, South Africa, and Chile. Patterns in factors contributing to governments' interest in research included the role of domestic advocacy, interest in their international standing, and the existence of internal government champions. Strategies used by researchers to promote their findings included carefully crafting messages and selecting messengers in accordance with their audience's concerns, delaying publication until interactions with policy makers had occurred, monitoring public opinion, and a host of ideas relating to the style and content of government-sponsored commission reports. Most of the similarities crossed the developing/developed country divide, although it did appear that in the three case studies from the north, greater attention was paid to the professional legitimacy of institutions, individuals, and journals, while in the three developing countries the existence of trusted personal messengers appeared essential. While there are no prescriptions for ensuring the use of health equity research in policy, the comparison across such different international settings stimulated participants to question their assumptions about what works, when, and why.