Shifting the Health Care Debate

Insights from Science Policy Controversies to Inform Public Engagement

Along with climate change and social inequality, the struggle in the United States to contain rising health care costs stands out as among our most "wicked" and polarized problems. Not surprisingly then, many experts and organizations working within the health care services field are currently searching for new strategies that engage the public and policymakes in a manner that helps diffuse, rather than strengthen political disagreement.

This past year, in a project funded by the Robert Wood Johnson Foundation, I was commissioned by AcademyHealth to author a white paper summarizing key insights and recommendations from research on debates over science and environmental issues that could be applied to the public engagement efforts of those working in the health care services field. On Monday, April 28 at a workshop in Washington, D.C. I will be presenting the key recommendations from this paper. (Also embedded at the end of this post are the slides from my presentation.)

There are four broad conclusions from past research on science and environmental policy debates that are important for health services experts and their organizations to consider and that challenge the contemporary translation and dissemination paradigm in the field:

1. First, is that the traditional goal of dissemination and translation to boost technical knowledge is a relatively ineffective way to influence public judgments and decisions. In highly contested political environments, the impact of knowledge often varies by way of an individual's political identity, such that well-educated individuals from different social groups tend to be the most divided in their opinions. In this context, even carefully crafted efforts to influence those individuals holding factually incorrect beliefs; may only serve to reinforce those beliefs.

Other research suggests that when dissemination, translation and media outreach efforts intensify, it is often the best educated who benefit from the increased access to information as lower socio-economic, and/or minority populations remain inattentive and disengaged. In all, disseminating and translating expert knowledge via ever more sophisticated multimedia tools and online platforms may in fact only strengthen political disagreement among already highly informed partisans while simultaneously failing to engage historically under-served segments of the public.

2. Second, based on this research, social scientists recommend that effective communication focus on “framing” or conveying the social relevance of an issue while fitting information to the existing values, mental models, experience, and interests of an intended audience.

These strategies are enhanced if experts partner with everyday opinion-leaders who are trusted among a targeted group, who can pass on information by way of word of mouth and social media, and who thereby shape impressions within their social networks about what is socially desirable and acceptable.

3. Third, simply applying research to the formulation and design of a broader based communication strategy is not enough. Health services experts also need to carefully consider the role they play as policy advisors.

In overcoming the polarized perceptions that tend to derail substantive discussion of policy, health services experts and their organizations may be most effective if they adopt the role of “honest broker,” expanding and diversifying the policy choices available to decision-makers.

4. Finally, health services experts and their organizations can benefit by pooling their resources and investing in localized public and media forums where decision-makers, stakeholders and members of the public learn, debate, and participate by offering their own recommendations and solutions to health services problems.

This local and regional engagement at a time of gridlock at the Federal level can catalyze new ideas, leaders, and networks of political cooperation.


Nisbet, M.C. (2014). Rethinking the Translation and Dissemination Paradigm: Recommendations from Science Communication Research for Health Services Policy Debates. Discussion paper for AcademyHealth workshop on Dissemination and Translation Strategies for Health Services Experts, April 28 & 29, Washington DC.