It’s not enough for scientists to clearly communicate their findings to policy makers; they need to be politically smart, too. This means highlighting evidence and options that can appeal to opposing ideologies.
One evening more than 30 years ago, when working as a legislative assistant in the U.S. House of Representatives, I attended a dinner at which I was the target of an onslaught of attacks from scientists who believed Congress was clueless about the value of the National Institutes of Health and the need for more appropriations. I made my rebuttal in a commentary in The Journal of the American Medical Association (JAMA), saying: “Government and the scientific community must work together because two constants exist that are unlikely to change in the years ahead. First, government rightfully continues to demand accountability for the taxpayers’ money. Second, research will go on, if for no other reason than mysteries remain unanswered.”
Those constants still hold. And as one way to help reconcile these two very different worlds, I have collaborated with hundreds of researchers to help them tell their stories so that policymakers might listen. They have been experts on many subjects—malaria vaccines, teen sex, stem cell research, crop science, college drinking, homelessness, health in jails, community college reform, violence reduction, land rights in the Amazon, and many more.
Since then, there has been a seemingly endless chorus of concern that doesn’t seem to be dying down, calling for scientists to be better communicators. I am a member of that chorus. The theory is that better communication will lead to public support for needed scientific research, greater acceptance of validated scientific findings, and greater funding for research across the scientific spectrum. The “science of science communication” has itself become a subject for research championed by the National Academies. Programs such as The Aldo Leopold Leadership Program (started in 1998 by Oregon State University ecologist and former National Oceanic and Atmospheric Administration director Jane Lubchenco) have been created to train scientists to communicate more effectively to decisions makers. Duke and SUNY-Stony Brook offer workshops to train faculty and students, and scientific societies sponsor countless “Hill visit days” to bring scientists to Washington to speak to legislators.
But, by and large, scientists don’t appear much further along as a “cohort” (a word they would use) than they were three decades ago. Bitter disagreements over climate change, stem cell research, health care policy, education policy, and regulating air pollution and toxic chemicals often seem remarkably insensitive to scientific voices, however articulate and compelling. Meanwhile, social science research has revealed that attitudes about such issues are more a matter of whom one trusts and what core values are at stake than what “the evidence” says.
So, could it be that those of us who are proponents of science communication might be asking the wrong question this many years later? I suspect we’re focusing disproportionately on the imperative to communicate as an end in itself and neglecting the underlying political stakes. In these hyper-partisan times, a more strategic and effective approach might instead focus on identifying research findings that can actually help to skirt politics, seeking opportunities when effective communication of science might draw bipartisan support that actually leads to policy change.
It turns out that there is a history of successes, even recent ones, where science actually informed and even inspired policy agreements across the political aisles. These are successes where, without the science, government or institutional policies in the public interest would never have been enacted. We should pay close attention to these, because learning why some science communication translates to policy change would move us beyond communication for its own sake to a more strategic purpose.
Enabling strange bedfellows
In 2007, Randall Brown and colleagues at Mathematica Policy Research published results of a highly technical evaluation of a Medicaid program for people who needed help with basic activities of daily living. Rather than having a state agency decide which services participants would receive, who would provide them, and how and when, the agency provided them with a monthly allowance and let them decide how best to use it. Brown’s research found that under this “consumer-directed care” approach, more participant needs were met and quality of life improved dramatically compared to the traditional approach of having state-hired aides provide the care. And this happened for the same amount of money an agency would have spent.
But Brown, working with Kevin Mahoney, a long-term care innovator from Boston College, didn’t stop there. Together they engaged in a significant effort to communicate these findings not only to health professionals who read the policy journals, but also to the news media and to policymakers. Their research-based advocacy changed thinking of state officials across the country. Three states took the lead in trying out this “Cash and Counseling” approach—blue state New Jersey, purple state Florida, and red state Arkansas. There was, at most, token political opposition in these demonstration states, and the most vocal (and effective) proponent of the research-driven policy was former Arkansas Governor Mike Huckabee. The federal government now encourages state Medicaid programs to adopt this approach. Four different versions of this Medicaid program are now available in 49 states, and 23 states now offer this benefit through non-Medicaid programs, with 33 states expanding the program to veterans. Self-direction programs for life insurance policyholders are now also available nationwide.
Exhibit Two: Oxford University Professor Peter Tufano has also been interested in how state and federal policy can affect financing for the public good, specifically in what might motivate low-income Americans to save for their futures. This is not a new problem, but one that is becoming more acute in the United States. Between a quarter and a third of Americans have no retirement savings, and baby boomers are aging.
Asked by researchers whether they would be more likely to accumulate $500,000 by saving or by playing the lottery, more low-income Americans believe in the lottery. And Americans of all income levels spent some $78 billion in 2012 on lottery tickets. Research reports from the Harvard Business School, the University of Maryland, and the National Bureau of Economic Research have shown that a new savings model can appeal to current non-savers in the way lotteries do. And the research was promoted to policymaker audiences.
The research contributed to state credit union reforms, enabling people in a handful of states to play out their desire to gamble by opening prize-linked savings accounts through a program called Save-to-Win. Participants experience the thrill of playing the lottery but don’t have to incur the associated risks. They receive one raffle ticket just for opening a special Save-to-Win account and another for every $25 deposited. These raffle tickets each count as a chance to win a cash prize. Prizes can range from a $25 monthly prize for 150 winners to an annual Grand Prize of $10,000 for three winners. However, those not lucky enough to win are not losers; the money they deposited is still theirs for their savings accounts and will be eligible for entering in subsequent drawings. The amazing finding is that although participants are free to “cash out” at any time, winners often choose to deposit their winnings back into that same account, earning more raffle tickets for the next drawing. More important, they are increasing their savings and making saving a habit.
Media coverage of this counterintuitive innovation attracted congressional attention, and bipartisan legislation was introduced by Reps. Derek Kilmer (D-WA) and Tom Cotton (R-AK) in the House, and by Sens. Jerry Moran (R-KS), Sherrod Brown (D-OH), and Elizabeth Warren (D-MA) in the Senate. This coalition of strange bedfellows sought to expand Save-to-Win programs in state- and federally-regulated financial institutions—credit unions and banks alike. Previous racketeering, insurance, and gambling federal laws had prevented the unique program from moving forward. And to the amazement of Congress-watchers who know paralysis as the norm, President Obama signed the American Savings Promotion Act into law last December.
Exhibit Three: Sometimes research can lead to policy changes without requiring legislative action. Columbia University researcher David Rothman has compiled reams of previous research on physician conflict of interest. One piece of his work, a 2006 JAMA article co-authored with nine other experts in the medical field, focused on the modest swag pressed on physicians by representatives from pharmaceutical companies—the pads, pens, paperweights and other tchotchkes that seemed too insignificant to influence medical decisions. Few of us freely admit, even to ourselves, that we can “be bought,” but Rothman’s compendium of research showed that doctors’ prescribing behavior is indeed influenced by gifts of all kinds.
Then Rothman did something only the rare academic does: he made the effort to communicate clearly to the media and others influencing medical education and medical practice, such as physician associations, leaders of academic health centers, and reform-minded foundations, so that policymakers could learn, take notice, and act. Media attention for the research captured the attention (and subsequent support) of the Pew Charitable Trusts, and university administrators followed up as well. Some, such as Stanford’s Phil Pizzo, then dean of the School of Medicine, quickly realized patients should worry when their doctors scribble orders for a specific drug not because it’s best for the patient, but because they’ve been subtly nudged in that direction by the logo on their pen. Although the American Medical Association guidelines already prohibited doctors from accepting “substantial” gifts valued at $100 or more, Pizzo took it one step further and enacted a policy that disallowed physicians and scientists from accepting any and all gifts from companies, however small. Many other academic medical institutions have since followed Stanford’s lead and developed similar policies.
Tchotchkes were the tip of the iceberg. Republican Senator Charles Grassley undertook an investigation that uncovered the sinews of pharmaceutical gifting and its impact on physician conflict of interest. The result was the passage of the Physician Payments Sunshine Act in 2010, which required drug and medical device companies to disclose any payments made to doctors, ranging from research grants to any item worth at least $10. This law put pressure on pharma and its reps to stop the giveaways, and, in turn, for doctors to forgo paid gifts, vacations, and speaking engagements—all a lot more costly than writing pads.
The upshot was a decline in “gifting” to doctors, which has the important benefit of giving patients increased confidence that doctors are prescribing the right medication, free of bias planted by product salesmen. Rothman has directly affected the practice of medicine, drug company marketing practices, and inadvertently, the livelihoods of advertising specialties salespeople. And the solution had bipartisan appeal: to liberals, it helped limit the power of the pharmaceutical industry, and for conservatives, it improved the public’s health without resorting to a highly regulated government-financed program.
None of the specific policy solutions spotlighted here have fallen prey to divisive political warfare. The Cash and Counseling initiatives had near-unanimous support in state legislatures. And, Save-to-Win had polar opposites Elizabeth Warren and Jerry Moran as Senate co-sponsors. “Politicians from opposite ends of the ideological spectrum may come to support this idea for different reasons, but, in the end, that’s beside the point,” U.S. Rep. Derek Kilmer told me. He’s the former Washington state senator who pushed Save-to-Win in the state legislature and was essential to its recent passage in the House. “A message that really appealed to Democrats is that it helps people build assets. But, when I approached one of my Republican colleagues about becoming a co-sponsor, his response was: ‘So what we’re talking about is eliminating an unnecessary regulation to allow private financial institutions to offer an innovative product?’ I said, ‘Absolutely!’”
Kilmer is on to something. It doesn’t matter why political opponents arrive at the same conclusion. All that matters is that, in the end, they agree for whatever reason. Ideological purity is not the goal here. Rather, consensus is the end game—regardless of the reasoning that led to it.
This principle can help identify opportunities for research that can help build political consensus on important social policies. Public concern about the deaths of black men at the hands of local police in North Charleston, Ferguson, New York, and Baltimore has accelerated a national conversation about their excessive incarceration in this country, but it has also spotlighted urban violence more generally. One research-based initiative that is capturing media and policymaker interest is the Chicago-based Cure Violence model that is premised on a public health solution to gun violence. Cure Violence approaches gun violence as an epidemic, where violence begets violence, as opposed to a criminal justice problem that can be solved by incarcerating more offenders. The approach involves placing former felons back on the street as “credible messengers” who are uniquely qualified to interrupt the cycles of shootings before they occur.
The model is working. The Chicago and Baltimore programs have been rigorously evaluated by the U.S. Department of Justice and Johns Hopkins University, respectively, with glowing results. Gun-related activity is markedly less in neighborhoods where Cure Violence is being implemented when compared to those without this intervention. And the U.S. Conference of Mayors has taken notice, endorsing this approach that has spread to Kansas City, New York City, and New Orleans, along with other cities that are considering how to implement the model. Support has been bipartisan, often involving law enforcement officials, because policymakers are exasperated at the scope of the problem, and solid research has given them an alternative that works.
A related aim to reduce the prison population seems to trump the means for getting there at this particular moment in our history. The conservative Right on Crime initiative had been partnering with the American Civil Liberties Union and other politically progressive groups before the recent spate of shootings. Now, we see that most of the presidential candidates are calling for reducing the number of incarcerated adults in the United States, albeit for different reasons.
John Malcolm, the director of the Edwin Meese III Center for Legal and Judicial Studies at the Heritage Foundation, was quoted in an April New York Times article saying that Republican support comes from different perspectives. He notes that fiscal conservatives see an easing of the drain on public resources, social conservatives are focused on faith-based-redemption where sinners are given a second chance, and others see policy reform as part of scaling back the reach of government. And on the Democratic side, Hillary Clinton frames the issue as one of social justice and has said that we must avoid another “incarceration generation.” All seem to agree that “we need a true national debate about how to reduce our current prison population while keeping our communities safe,” and that a reevaluation of “current draconian mandatory minimum sentences” is necessary to ensure people are not sentenced to prison terms that they don’t deserve, as Clinton and Ted Cruz have said, respectively. When else have Cruz and Clinton agreed on anything? The growing bipartisan concern about the safety of black men in this country as well as an over-populated prison system creates an important opportunity for researchers to contribute knowledge and ideas that hasten a political convergence around solutions that are evidence-based.
Even today, there are areas about which left and right can agree, and it’s in these areas that conducting and communicating research is especially crucial.
And there appears to be promising new evidence that peer-based solutions might have a greater impact on childhood aggression than treating children under the traditional psychotherapeutic model wholly managed by clinical professionals. Marc Atkins, a research psychologist at the University of Illinois-Chicago and director of the Institute for Juvenile Research, is working with kids as young as grade-schoolers. His research makes the case for “context-based peer mentoring”—a model that integrates youth mentoring into wherever children learn, live, and play. Such a broad expansion of the mentoring concept could have huge implications for the mental health of low-income children in urban settings, and if expanded, could provide the potential for low-cost, community-based approaches that can appeal to left and right alike.
In these polarized times, research that has the best chance of attaining significance in the policy world is research on a topic that can somehow sidestep politics or point toward solutions that can appeal to competing ideologies. Even today, there are areas about which left and right can agree, and it’s in these areas that conducting and communicating research is especially crucial: improving patient safety, increasing clinically responsible care choices in our dying days, promoting personal savings for emergencies and retirement, incentivizing safe sex, reducing jail populations, ensuring economic competitiveness in the growing renewable energy market, and mitigating the risks of natural disasters are some examples.
More examples are on the horizon. An emerging national movement, spurred, in part, by the Federal Reserve Bank as an extremely nontraditional partner, argues that poverty is a principal driver of poor health and that improving the health of the U.S. population depends as much or more on combating unemployment, substandard housing, and poorly planned communities as it does on doctor visits. In 2013, then Federal Reserve Board Chair Ben Bernanke named the health care sector as “one of the most promising new partners” in the Fed’s poverty-focused community development work. When the San Francisco Fed’s David Erickson wrote this in 2009, it was groundbreaking:
“The reality is that people who live in supportive, connected, and economically-thriving communities tend to be healthier. Therefore, perhaps the most important contribution that community development finance provides—more than the affordable apartments, more than the startup capital for small businesses, more than the funding for a grocery store, charter school, or day care center—is the larger contribution of a more vibrant and healthier community. In the end, the most important contribution of community development finance may be something we don’t focus on or measure: the billions of dollars of social savings from fewer visits to the emergency room, fewer chronic diseases, and a population more capable of making a contribution as healthy productive citizens.”
Six years later, Erickson is no longer a lone voice or pioneer. A mountain of social science research on this topic informed the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, led not by doctors and health experts, but by economists from both political parties. Commissioners from a range of political backgrounds, co-chaired by Republican Mark McClellan and Democrat Alice Rivlin, noted that “despite our differences” we must create a seismic shift in how we approach health to address how to stay healthy in the first place. Bipartisan support for social impact bonds and high-quality early childhood education are examples of bipartisan convergence on Commission-backed policy initiatives that can improve health.
The New York Times reflected this growing consensus in a December 2014 editorial, citing social determinants of health as a “big idea” for social change: “Health is undercut by substandard housing, air pollution, food deserts, dangerous streets, trauma and toxic stress. Being poor can make you sick, and doctors can’t always help.”
Perhaps research is needed to flag those policy areas most amenable to research. But the common ground appears to be linked in some way to existing momentum in the political world, the salience of the issue, the avoidance of locked-in issues such as abortion and gun rights, a focus on common goals over common rationale, and a conscious effort to use research results to help identify and explain counterintuitive interventions such as encouraging retirement savings with lotteries and improving doctors’ judgment by taking product logos off of pens and pads.
But the focus on communicating life-altering research that holds the greatest promise for skirting politics does not absolve most researchers from the basic sin of communicating too infrequently with the media, advocates, policymakers, nongovernmental policy experts, and a variety of vested interests. They represent where the action happens. Whether the research proves the profound risks associated with complacency around climate change or the merits of vaccination or the most promising alternatives to over-incarceration, the imperative of basic communication is as valid today as it has ever been.
“I used to have this argument with our provost,” said Kevin Mahoney, the Boston College professor who was a lead architect of the Cash and Counseling model. “He believed a researcher is never an advocate and would say ‘You’re always supposed to be finding flaws with our own work and moving on to the next iteration.’ And, I would say, ‘When you have really strong research results, it’s basically an obligation to get them out. It’s an obligation!’”
The “obligation” here is not only to communicate research, but to do so effectively by understanding the political contexts of the work and learning how to navigate them. Otherwise, really, really important research is destined for the proverbial shelf—or worse, to be captured by partisan politics. Social scientists need to realize that their conclusive findings might have implications great and small on policy, and ultimately on the people whom the research is intended to benefit in the first place.
In today’s world, failure to communicate online, with the commercial media, with those positioned to influence the policy process, and with policymakers themselves—in and out of government—is research malpractice. There is now plenty of evidence that well-communicated social science and clinical research, on issues that are ripe for action, can dissolve partisanship to the great benefit of our individual and collective lives.