Evidence-based policy making in Aboriginal and Torres Strait Islander health

Evidence-based policy making in health is of great importance when addressing issues of Aboriginal and Torres Strait Islander health inequalities. I explore the role of evidence in influencing the decisions of policy makers, and question the relevance and accuracy of current evidence to the life experiences, social and cultural environments, and aspirations of Aboriginal and Torres Strait Islander persons. I examine the concept of evidence and Lin’s (2003) competing rationalities within the context of Aboriginal and Torres Strait Islander health. Lin describes three competing rationalities: cultural, political and technical. A social rationality can also be included, one that relates to how we see and know the world. Social rationalities may differ according to gender, class, age, ethnicity and place. White middle-class persons and politically marginalised Aboriginal and Torres Strait Islander peoples do not think and interpret realities in the same way because of divergent structural positions, histories and cultures. Cultural rationality informs and shapes social, political and technical rationalities because the latter are grounded in and developed by the former. Evidence-based medicine is the conscientious and explicit use of current research findings in clinical practice. It involves integrating the best available clinical evidence derived from systematic research with clinical expertise (Sackett et al. 1996; Straus & Sackett 1998). Evidence-based practice is central to health-care interventions and treatment in Australia, as it is in many developed countries of the world. The idea of using evidence as a basis for policy making in health is a more recent phenomenon that has arisen from the older and more established area of evidencebased medicine, and the development over the past 20 years of greater accountability in public sector management. The philosophical origins of evidence-based medicine extend back to the nineteenth century and earlier (Sackett et al. 1996). Seminal books such as Effectiveness and efficiency: random reflections on health services (Cochrane 1972) and Evidence-based medicine (Sackett et al. 1997), and international organisations such as the Cochrane Collaboration (Anon. 2006a), have stimulated and supported the concept and practice of evidence-based medicine worldwide. Evidencebased approaches now extend beyond medicine to include population health (Brownson et al. 2002; Heller & Page 2002; Rychetnik et al. 2002), health promotion (Rychetnik & Wise 2004), health policy making (Lin & Gibson 2003), Aboriginal primary health care (Anderson 2003a; Couzos & Murray 2003), and humanitarian work (Banatvala & Zwi 2000; Robertson et al. 2002). In recent years, evidence-based practice has become more central to public policy making. The Campbell Collaboration (Anon. 2006b), an international organisation, inspired by the Cochrane Collaboration, provides systematic reviews of the effectiveness of social and behavioural interventions in education, crime and justice, and social welfare (Davies & Boruch 2001). There has also been discussion about evidencebased policy making for Aboriginal and Torres Strait Islander peoples (Webster 2002). The practice of evidence-based policy making in health is much less developed than evidence-based Evidence-based policy making in Aboriginal and Torres Strait Islander health