Edited by Gabriele Bammer with Annette Michaux and Ann Sanson , Published by ANU E Press Canberra , August 2010 , Paperback , 163 Pages , ISBN 9781921666407 RRP $19.95
Reviewed by Louise A. Baur
Discipline of Paediatrics and Child Health, and Sydney School of Public Health, University of Sydney
As a paediatrician and academic working on such problems as poor nutrition, physical inactivity and obesity, I often reflect on why interventions to promote healthy eating and active living, and which have a good evidence base, are not immediately implemented across the country. After all, from my admittedly naïve and very medical vantage point, the policy and practice response can seem obvious! However, if I take the time to enquire, I find that my colleagues working in health promotion units are meantime juggling the diverse expectations of local service delivery on a tight budget, with a workforce that may feel overwhelmed with how to respond to the ever-expanding body of research knowledge. And, when I speak with policymakers at State and Federal level, they, too, are dealing with a range of very different constraints and political imperatives. Understandably, for them the latest research findings are not yet on their radar. All of us are concerned about the same broad issue, but we can see the response, and the time-frame to respond, very differently. The result can be that effective policy implementation is limited or delayed.
As described eloquently in one chapter in this book: “The shared frustrations over ‘wicked problems’ such as poverty, child abuse, substance abuse and Aboriginal disadvantage … are matched by widespread frustration at the failure of much policy and practice to reflect the evidence base.” This book addresses such issues by bringing together viewpoints from three groups working in the broad area of child health and welfare – researchers, service providers, and former policymakers. The authors of individual chapters reflect on how these different groups of people can be helped to work together more effectively. The editors ask the question: “How can research knowledge be brokered to achieve effective decision-making and action that improve child well-being?” The different chapters together provide a rich understanding of strategies for improving the education of, and the communication between, all parties.
I found the different case studies of particular interest. One example, from the Spastic Centre, describes a range of strategies to improve the uptake of research-supported practice by staff, to evaluate new services for families with children with cerebral palsy (through partnership with academics and obtaining a research grant from the Australia Research Council), and to provide more useful information for patients and families alike through innovative Web 2.0 applications. Another chapter describes KnowledgExchange, a broad-based knowledge-brokering initiative in Victoria, facilitated by the Alfred-Fenton Chair in Social Work at the University of Melbourne. The strategic role of an appointed knowledge broker in bringing together a range of people to discuss ways in which data systems can be used to develop evidence-informed practice is highlighted. Sounds important, but dry, right? Surprisingly, there has been real engagement, and the reasons for this are explored. Yet another chapter is by a Victorian paediatrician, Sharon Goldfeld, who works in both a policy setting and a clinical/academic setting. Her role has been strategic in helping establish several state-based initiatives around child health and development. Goldfeld highlights three elements, adapted from Gladwell's The Tipping Point, that are needed for knowledge brokering: leaders or champions who can transmit the message, being clear about the central message (the “stickiness” of the message), and understanding the various environmental opportunities. Not surprisingly, such themes are common to many of the chapters within the book.
The final section of this book presents some big-picture approaches to the issue of knowledge-sharing and influencing policy. The importance of having formal – rather than only casual – networks of practitioners, researchers and policy-makers is highlighted. This is one of the reasons behind the establishment of the Australian Research Alliance for Children and Youth (ARACY); its strategies for promoting collaboration are described. And there is an honest and open chapter by Michael Moore, former Minister within the ACT Legislative Assembly, and now CEO of the PHAA, reminding us all of the challenges of working within a political system, and describing how knowledge can sometimes be restricted to a select but powerful few.
This book has helped me better understand the different cultures and languages of practitioners, researchers and policy-makers, and I recommend it to all who are interested in these issues. Most importantly, there are many practical examples of strategies for how the knowledge-practice-policy divide can be bridged – the diverse views presented are real strengths of the book. Importantly, while the focus of this book is on child well-being, I believe it will be useful to all who are attempting to bridge these divisions in many other areas of health or welfare.