Bridging Science and Public Policy for a Better BC

By Arundati Dandapani, CMRP 

The Science and Policy Integration Network (SPIN) hosted their annual BC Science and Policy Conference on May 11th this year. Sam Sullivan, Member of the Legislative Assembly of British Columbia for Vancouver False Creek, opened with the provocation that our assumptions about the world are usually wrong and that we require education and educational institutions to change our intuitive assumptions about reality. Conflict and division usually arise when there is too much information and when intelligence is misused to support an inherent identity for “cohesion”. Politics and electoral campaigns can often illustrate how information and intelligence are susceptible to abuse where scientific inquiry is divorced from public discourse in an age of the fast-moving internet with a prevailing self-confirmation bias.

Sullivan’s key achievements in bridging the gap between science and policy have included shaping public attitudes to deliver change on the ground in two inaugural initiatives he has led in Canada’s province of BC: eco-density or the use of density, design and land use to build a more environmentally sustainable BC, and the chronic addictions substitution treatment programs including methadone maintenance and heroin-assisted treatment, including initiating research in substitution and maintenance programs for stimulant users. Captured below are highlights from some of the conference sessions.

Death and Adverse Drug Reaction

The lightning talks were kickstarted by Amani Saini, President of Adverse Drug Reaction Canada, who spoke about “Using evidence to inform policy to prevent adverse drug reactions”. Close to 12% of Canadians enter the hospital because of an adverse drug reaction, the fourth leading cause of death in Canada (following cancer, heart disease, stroke and accidents—varies by sex), killing up to 22,000 Canadians annually. (The two leading causes of deaths for millennials and younger include accidents and suicide). Other countries tackle adverse drug reactions by tracking how gene variants interact with drugs and use it to steer health policy, according to Saini. Genomics and genetic testing can determine whether patients have gene variants that may cause adverse drug reactions.

In Thailand, Taiwan and Singapore, databases are established to document drugs that elicit adverse drug reactions. Saini’s own experience with adverse drug testing hit closer home when her sister suffered near-fatal consequences of adverse drug reactions. Her organization advocates for three key policies in this regard.

Public Policy is About the People

Dr. Maria Giammarco, Behavioural Scientist, Privy Council Office, Environment & Climate Change Canada, convened on the importance of “Putting People into Policy”. Context matters, she said. We respond differently to the same choice depending on how it is presented or framed, and our behaviour is shaped by our environment. Our thoughts, although governed by two cognitive systems—emotional, fast and automatic versus rational, slow and reflective—generate an “intention-action” gap, with policy often being designed not accounting for how humans really behave. For example, there’s a tendency to assume that humans are completely rational. Behavioural insights in policy are harnessed to create behavioural interventions (nudges) to improve policies, programs and services by encouraging positive behaviour and closing these intention-action gaps. Experimental approach methodology uses background (desk and end-user) research, generating behaviourally informed interventions that test how policy changes compare with existing policies. Interventions in the BC Public Service have aimed at reducing hiring times, encouraging charitable giving, improving tax compliance and timely income assistance submissions, and enabling environmental compliance. 

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The Best Measure of a Nudge

The best measure of nudge-effectiveness will revolve around the behaviour(s) a nudge is aiming to shift—i.e., being able to measure a statistically significant impact of a nudge or intervention or multiple interventions on behaviour compared to the status quo. For example, if you are trying to nudge more citizens into paying their taxes on time using a behaviourally informed reminder message, seeing a significantly higher number of on-time payments for citizens that received the reminder as against those who received the control, would be your measure of whether the nudge worked. Furthermore, to quantify the magnitude of that difference or just *how* effective the nudge is, you would look at other statistical measures such as effect size. Beyond quantitative measures of behaviour, you can look to secondary quantitative and qualitative measures to get a more holistic understanding of the effectiveness of nudges, for example, by surveying whether people are more satisfied with the new reminder system.

Nudges for Public Policy versus Nudges in Business

Behavioural insights for public policy don’t have to differ from those in business in terms of general methodologies, but the context of the types of nudges designed (eg for public services and programs vs. corporate goals or client needs) could be quite different, and the end goals and motivators might be quite different as well. For example, while a government may be concerned with saving taxpayer dollars and supporting social welfare through improved social services, a business might be focused on marketing or product strategies. Though it is also possible that businesses outside government, including both for-profit and non-profit organizations, are focused on similar concerns as government (social welfare) but simply have a different jurisdiction than the government. It’s all about the context of the organization and their mandate.

Further reading: The Last Mile, Nudge, Thinking Fast and Slow

Opioid Agonist Treatment

Dr. Conny Lin (CL), Director of Recruitment for SPIN and the government relations manager for Women in Tech, is a practicing neuroscientist whose career non-linearity lends to her versatility as an advocate for integrating science and policy. She talked about the importance of opioid agonist treatment and victims requiring psychosocial support and addiction is a manifestation of underlying problems including socioeconomic. Scientists can contribute to new and inventive ways of thinking that inform policy in deep and lasting ways, she said. Some questions she took are excerpted below:

Who qualifies as a practicing/professional scientist?

CL: In my mind, professional scientists are in academia (researchers in post-secondary or government agencies). Their primary objective is research to advance human knowledge. Scientists in industry have different objectives.

What can scientists do to understand or get with policy better?

CL: Academic scientists need to interact with policy makers more. Reading the news is not going to give them the tool to interact with the public policy world. Scientists also need to remember their “facts” (experimental results) are only one type of fact, and are still not free from biases and subjective opinions. When I look at one piece of my data, I can see one thing one day, and another on a different day. Therefore, who are we to say what we “conclude” from our data is the end all and be all “facts”? In addition, scientists need to remember the limitation of our experiments. Often conclusions are made from one small cohort, which is not representative of the whole population. What is “true” in a specific cohort may be completely false in another. Scientists can choose their population, but policy makers don’t have that choice. Further, policy makers need to weigh much more than facts (i.e. money, change management, harm to other populations, etc.). Scientific facts are a start, not the end, for policy makers.

What can professional non-scientists do to bridge the gap between science and policy?

CL: Non-scientists can demand the policy makers to consult scientists before they make a policy. Policy makers respond to and prioritize public demands.

Where do technology and business fall in this equation?  

CL: I saw many cases where businesses push for policy changes based on scientific facts. That’s good because policy makers respond to businesses more so than scientists (because there is a bigger stake—scientists often are on government’s “pay roll” (grants/scholarships/fellowships), but businesses are revenue source (taxes).

Regarding technology, I am a big data person so I am biased to say that governments really need to modernize their data technology. It’s a pain, looking at how they deal with their data now.

Giving as Part of Everyday Living

Dr. Ashley Whillans, Assistant Professor at Havard Business School, talked about the importance of increasing charitable giving programs for communities. What decision would make an individual happier: spending money on themselves or on others? Financial generosity can promote happiness, but the benefits are often overlooked. Furthermore, charitable giving is on the decline compared to previous decades. There is some research suggesting that people often do not plan their giving. Dr. Whillans is conducting research to foster an interest in charitable giving among North America’s youth.

What will cause the next generation to learn to give? Dr. Whillans is currently examining the efficacy of both school-based programs (10 elementary schools in BC) and sports-based programs (70 teams in the US and Canada) in collaboration with CHIMP, a Vancouver-based charitable foundation. In these programs, kids, teachers and parents are encouraged to have discussions with youth about charitable giving to trigger increased giving in both younger generations and in parents. Reaching new and younger demographics digitally is another targeted approach to achieve more giving.

In general, charitable giving can be increased when: people know exactly where their money is going (they can see the impact of their dollars), people see links between the cause and their personal experience, and people think about the charitable cause in terms of the specific people their aid will help.

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By working with a local charity and conducting research in schools and sports teams, Dr. Whillans’ research seeks to inform educational policy about the best ways to catalyze charitable giving for North America’s next generation. The research being conducted on philanthropy in academia can be used to help shape policies in both education and finance that encourage Canadians to enact their charitable giving aspirations.

From Evidence to Action: BC’s Response to the Fentanyl Crisis

Former BC Health Minister and current VP, Corporate Social Responsibility at the Hydropothecary Corporation, Dr. Terry Lake established at the outset that good policy leads to good politics. Illicit drug overdose deaths in BC are increasing drastically, and its sharp rise is primarily due to fentanyl use with over 80% of current overdose deaths in BC owed to fentanyl. Opioid overdoses do not discriminate—many “high-functioning members of society” use illicit drugs. A public health emergency was declared in the fentanyl crisis of April 2016, raising public outcry, improving real-time information sharing, strengthening interventions and enabling the identification of new actions to end the crisis. Pictured below is Dr. Terry Lake with Dr. Evan Wood from the BC Centre on Substance Use.

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What lessons can be learned from BC’s response to the Fentanyl Crisis that could be applied to the rest of Canada?

Numerous initiatives in BC took shape in response to the fentanyl crisis that are now being emulated across Canada, falling into three categories: harm reduction, awareness and prevention. Harm reduction includes the dramatic increase in the availability of naloxone, the life-saving opioid reversal agent. It no longer requires a prescription and is available free of charge through community organizations and pharmacies throughout BC. All first responders are carrying and using naloxone. Other harm reduction strategies include opening more supervised consumption sites and overdose prevention sites and services. This provides those who consume potentially harmful drugs to do so in an environment where trained personnel are closeby to monitor and respond to any overdoses—there have been no recorded overdosing deaths at these sites. Drug testing is becoming more prevalent so that users can determine if there is fentanyl in the drugs before using. Results reveal that an increasing proportion of injectable drugs contain fentanyl. These strategies are being replicated in other regions in Canada.

In BC, prescription injectable opioid programs like the use of prescription heroin and hydromorphone are being expanded along with consideration of hydromorphone tablets that would be distributed with the knowledge that users would likely crush them and either snort or inject them. These methods are all an effort to provide a clean drug supply when the current supply is highly toxic. The goal is to keep people alive until they may be ready for treatment. This approach is being considered in Alberta, but will likely take more time to be emulated elsewhere. There is also a pilot project in BC to look at the role cannabis can play in reducing opioid consumption and assisting in withdrawal for those who want to stop using opioids.

Many victims of overdose are lone users in their homes and the awareness campaigns have been trying to target people who may fall into this group. Prevention strategies include work by the BC Centre for Substance Use to update guidelines for treating substance use and training more physicians and nurse practitioners to treat substance use. The creation of a separate Ministry of Mental Health and Substance Use and increased funding through federal transfer payments would result in more treatment opportunities when people are ready for treatment. Through the federal funding agreement, Dr. Lake projected that most provinces will see more mental health and substance use services, but they may be addressing different needs in different parts of the country. He is pictured below with Leslie McBain, who lost a son to an opioid overdose and started the group Moms Stop the Harm.

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What can scientists do to improve grower-seller relations as cannabis enters the marketplace?

In the new cannabis industry, licensed producers and licensed processors (they can be the same company) will in most cases, sell products to a government distributor who will then sell them to a retailer that is either government run or privately run or a combination. Retailers will want to have an array of interesting products to ensure they can compete with the black market, which would mean that just selling dried flower will not be enough. Scientists will be needed to transform the plant (cannabis) into forms that consumers will seek—like oral sprays, capsules, topicals (lotions, balms, and oils) and transdermals (skin patches). When edibles are allowed within a year of legalization, there will be a demand for food-like products including drinks. The chemical nature of cannabis makes this challenging, and scientists will be needed to meet this challenge. Probably the biggest role for scientists, however, will be in medical cannabis where research and innovation will be needed to create specific cannabis compounds tailored to specific conditions. These will go through a drug approval process leading to a drug identification number and likely be dispensed through pharmacies.  

Science’s Failure to Inform Policy

When asked about the biggest gap where science has failed to inform policy, Dr. Sally Otto, Director of the Biodiversity Research Centre at the University of British Columbia talked about the muzzling of the scientist – highlighting the responsibility of scientists in ensuring science is properly communicated to the public. In how to properly communicate between scientists and policymakers, Dr. Otto suggested training young academics to be better at policy.  The creation of the Mitacs Canadian Science Policy Fellowship program, evidence in species conservation (collection of scientific data) and public interest in conservation are all good steps. But while scientists constantly advocate research, they must also assert themselves in uncomfortable situations in order to be effective and truthful in science advocacy.

Dr. Laurel Schafer, Canada Research Chair in Catalyst Development emphasized the opportunity to train graduate students in knowledge transfer/translation, and Dr. Lynn Raymond, Professor and Neurologist in the Departments of Psychiatry and Medicine at UBC, where she researches Huntington’s Disease, offered a two-pronged strategy of raising public awareness for fundamental/basic science, addressing the challenge faced by scientists to see research in its larger scope, given the current lack of public health awareness.

How Should Scientists Support Policymaking?

Dr. David Castle, Vice-President of Research at the University of Victoria offered that expectation management and other evidence (besides scientific) must be considered in policy-making. The Director of the Centre for the Study of Democratic Institutions at UBC and founder of the Summer Institute for Future Legislators, Dr. Maxwell Cameron, shared that understanding how to generate context in which politicians can make wise policy decisions is important. Dr. Schafer added that using evidence-based approaches to shift public opinion/perceptions is key, while Dr. Raymond stressed the importance of having a roadmap in bringing attention to issues. Dr. Otto added that science involves weighing different options and finding the best compromise when faced with conflicting options. Overall, the gap in communication between scientist and the public is always underestimated! We need to analyze the effectiveness of educating the general public in basic scientific processes. More articulate advocates across disciplines are crucial for building better science advocacy.

The tensions in advocating for science-backed policy will persist unless we hold scientists and policymakers accountable to benchmarks, publish the best work in peer-reviewed journals, and ensure that science is portrayed accurately and that scientists are in better positions to apply pressure on politicians where necessary to bridge the gap.

Closing Keynote: Building Reciprocal Advocacy

Closing Keynote Speaker, Kei Koizumi, Senior Advisor in Science Policy at AAAS (American Association for the Advancement of Science) spoke about the implementation of science for policy and policy for science in the US White House from his years of experience as a science policy advisor in the Obama Administration. His talk focused on strategies for scientists to work effectively in science for policy and policy for science.

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Policy for science encompasses government actions that govern the science enterprise, including government policies to fund scientific research (US $70B per year). But just as important as funding policies for science are other government policies that affect the science enterprise. As one example, Koizumi expanded on the scientific integrity policies implemented under the Obama administration to ensure that policymakers have access to and use sound and effective science. For all these policies for science, he explained that scientists have many tools at their disposal. The scientific integrity policy was actually inspired by the political suppression of government scientists under the previous Canadian government, and similar incidents in an earlier US administration. Upon entering office in 2009, the Obama Administration committed to ‘restoring science to its rightful place’ by ensuring that federal scientists were able to communicate freely about their work and that the science used in making decisions was free from political interference. Making that policy a reality required 8 years of effort in formulating policy documents, helping US science agencies implement the policy, conducting numerous workshops with both federal and nongovernment scientists, channeling the voices of US scientists represented by several nongovernment organizations, and consultations with Canadian lawmakers. Science policy includes events, tweets, personal interactions and any opportunities or tools to promote science and catalyze change in addition to the standard laws, regulations and government documents. Scientists can use these tools to leverage the federal government’s power to bring change.

Science for policy or science advice that informs policy decisions in non-science realms, requires effective translation between scientific and policy “languages”, entailing a “bilingual” effort. Science alone does not shape the right policy—it is further shaped by values, economics, and other factors. For science to shape policy, it requires the active engagement of scientists and the participation of scientists in the world of policymaking, using tools of personal engagement, research skills, collecting information through networks and effective distillation and communication of complex scientific information.

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Koizumi concluded that science policy is a contact sport, and that everyone can and should participate, including scientists who are members of non-government organizations like AAAS. Scientists can and should make the case for the importance of scientific integrity at all levels, stress the significant returns on investments in innovation and scientific research, but everyone should be aware that science policy requires patience because policies take a long time to implement. Conversely, they also take a long time to undo, an insight that has special relevance at this moment in US history. Although it was frustrating that it took 8 years to implement a scientific integrity policy and the US Trump Administration is very different in its priorities than the Obama Administration, many of the science policies from the Obama era endure. For example, scientific integrity policies are still in place at 20 different federal agencies. Although they are endangered in 2 or 3 agencies, they mostly endure because of a combination of factors: they are implemented by civil servants rather than political appointees; they are in 20 different agencies; they are low-profile enough to be “under the radar” of political appointees; US scientists vocally support these policies, especially when potential violations are made known; and bureaucratic inertia keeps past policies in place without active efforts to undermine them.

According to Koizumi, Canada is actively trying to improve science advice for policy, including the reinstatement of a Chief Science Advisor to the Prime Minister and to various provincial governments. The current Canadian government is implementing its own scientific integrity policy, which like the US policy, ensures that Canadian scientists are free to communicate about their work and have their work used in government decision-making without political interference. Overall, he thinks that Canada and the US are similar in terms of science policy challenges, opportunities and actions.

Bridging Science and Policy Means Business

SPIN’s BC Science and Policy Conference concluded with an audience discussion on possibilities and actionable steps. Can BC better support and strengthen the use of (for eg. behavioural) science for policy development? Is the acceptability of a given risk a political question to be determined in the political arena or largely determined by values, economics, and other factors? Scientists measure risk, and politicians weigh in and their estimation may not be scientific or objective. Objectivity is further compromised when there is a lack of dialogue between the scientific concern and the political concern.

Dr. Tony Phillips closed the conference with a call for more actionable items in the issues showcased and said that the sessions were an incubator for discussions of current affairs in British Columbia. Dr. Susan Porter remarked that the ability to see different perspectives to address today’s pressing issues demands a collective of great minds and hearts, reemphasizing the relevance of graduate and postdoctoral training to value and support the interface between science and policy, and integrate more policy in science programs and vice-versa.

SPIN’s conference revealed gaps between science and policy that spell opportunities for businesses, whether as people (expectation) managers, accountability-hacks, dialogue-facilitators or disruptors. Big corporates, start-ups, non-profits, retailers, marketing researchers and others look to dive deep in public opinion (local, provincial, national, international) and marketing metrics to offer integrated solutions to consumer-citizen problems on the scientific and social advancement curve.

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Arundati Dandapani, CMRP (@itadnura)