Welcome to the Voices of Evidence Users interview series, offering firsthand insights from the people who use evidence in decision-making.
In this conversation, OTT talks to Cristian Mansilla, formerly based at the Ministry of Health (MoH) in Chile, where he supported health policy-making processes using the best available research evidence.
He also founded and led the Evidence-Informed Policy-making Unit at the MoH.
1. Can you tell us about your former role? What did you do there? How did your department work?
I was a Chilean government official for a number of years at the MoH, in which I led a unit that provides evidence advice for decision-making in public health and health systems issues.
A big disclosure is that this was my role up to 2019, where I left the MoH to start my PhD at McMaster University. This means that what I can tell is mostly what I lived over those years, but many things have happened since then, including the Covid-19 pandemic.
The unit worked mostly in a demand-driven way, where we would normally receive requests from high- and low-level decision makers and programme implementers on a variety of issues and was meaning to bring evidence as close as possible to the decision-making process.
More details about this unit can be found in this paper that we published while I was in office: The Evidence-Informed Policy Network (EVIPNet) in Chile: lessons learned from a year of coordinated efforts – PMC (nih.gov)
2. Can you give an example of a recent key policy debate in your sector? Was there any opposition to this policy? What role did evidence play in that debate? What type of evidence was used and who provided it? Can you tell us about the impact of this policy?
While I was at the MoH, one key policy that was implemented was the food front-of-package labelling scheme that is currently used in Chile (many foreign nationals find this very surprising once they arrive to Chile, because it is very notorious).
While this law was approved since 2014, the government in place between 2014 and 2018 needed to implement this law, which entailed the selection of the specific signs and symbols that will be used, and what food will be receiving signs.
In this example, there was a lot of interest groups that were advocating for a less stringent regulation that would allow their food to not be labelled as ‘unhealthy’.
A number of evidence syntheses were asked to our unit, and we provided critical experiences and evaluations of different alternatives and facilitated some discussions with a number of stakeholders around the evidence base.
This whole process can be seen in a paper that we published during this time, including a sample of the final scheme that was used for labelling food.
This is more of a personal note, but I have lived outside of Chile for more than four years now, and what I can see is that the Chilean regulation in this respect is truly pioneer. We truly have a law that is directly targeting asymmetry of information when buying food, that was made following an evidence-informed approach.
Issues that I commonly see abroad are parents buying granola bars thinking they are ‘healthy’, or people buying cereals that are advertised as ‘good for your heart’ but, in reality, they contain more sugar than what you are supposed to intake.
In Chile, these foods will be flagged by using this labelling scheme, truly informing the consumer of what he/she is buying.
3. What are the main challenges and opportunities you see for embedding evidence systematically into the policy-making process?
I strongly believe in the role of evidence intermediaries. These are key actors that sit between evidence producers and decision-makers. They are able to navigate local politics, and they are truly listened to by decision-makers. In my opinion, they have a key role to strengthen evidence-support systems.
Furthermore, they understand that they would not compete with political factors when facing a policy-
making process, but rather, they would understand the full picture of having evidence as one of the insights that could compete with multiple other factors, such as the institutions in place, the interest groups around a given topic, or external factors that could influence a given decision.
Despite the importance that I see around evidence intermediaries, I don’t see a lot of efforts among the international community on investing in training and learning from evidence intermediaries.
Several efforts are conducted to bridge the gap between evidence production and decision-making, including having plain language summaries, translating systematic reviews, etc.
However, I personally believe that what truly has impact is having an evidence intermediary that could provide evidence-informed advice for decision-making.
4. Are there any current/recent crises or transitions that you feel have affected/changed the discussion around how research and evidence feeds into policy, both globally and in your country?
I feel the Covid-19 pandemic opened a window of opportunity for people like us, working on how to promote evidence use in decision-making processes.
While I have been working on this for a decade, the importance of using science, knowledge and information when making a Covid-19-related decision increased a lot during the last couple of years.
During these times, we heard a lot of researchers complaining that there is evidence saying something different from what government officials were doing, or we even saw citizens and media criticizing politicians for not following science. From my perspective, we had never seen something like that before.
That’s why I personally believe that we are in a crucial moment to take what we learn during the pandemic and use this momentum to build stronger evidence-support systems.
In my country, we have gone through a lot in the last couple of years. From having deep social unrest in 2019, we have gone through two different drafts of a new constitutions (the last one of them is about to be voted in a referendum).
What I missed of these two huge processes was the role that science and evidence could play in writing these constitutional drafts and, most of all, that I didn’t see a clear effort for institutionalising evidence-support systems across the different levels of decision-making at government level.
5. What advice do you have for researchers hoping to see their work inform policy?
For researchers, look for evidence intermediaries that could bring your research forward. I’m sure evidence intermediaries are eager to know research centres that don’t consider a publication in a high-impact journal their only single output of their work, but that are looking for a deeper impact in decision-making processes.
6. Can you tell us about the obstacles to evidence-informed policymaking in your country? What advice do you have for policymakers wanting to improve the use of evidence?
For policy-makers, we conducted a rapid-evidence support system assessment in 12 countries around the world (more of this work can be found here RESSA Country Leads Group (mcmasterforum.org)).
In Chile, we searched for intersectoral agencies and government bodies in three sectors – health, education and climate action – and found more than 50 (not a typo, 50!) groups inside government that their role was either producing, but most of the time ensuring that at least one form of evidence was considered by decision-makers.
However, they barely know each other, which is mainly due to the big challenge that evidence-support systems face now (from my perspectives): they work in silos.
We have two critical silos.
First, sectoral silos: people working in health barely know what people working in education does, and vice versa.
Second, silos across forms of evidence: people producing evaluations don’t know that an evidence synthesis can also answer different types of questions, and people working with data analytics barely know what behavioural research is.
These two silos make it very difficult to further strengthen evidence-support systems.
Then, for policy-makers I would advise that we strongly need institutions that could act in an intersectoral way and could leverage different types or forms of evidence, depending on the specific question or need that a given decision-making process has.