When considering information and evidence, it’s vital to consider both the wider context and the specific perspective.
I recently attended a parents’ evening at my children’s school. I usually dread these evenings – the inevitable biting my tongue and counting to ten under my breath as my daughter’s teacher tells me with utmost earnestness that she is worried that my daughter does not have a good grasp of cuboids. (What are cuboids, you may wonder…) This time, however, was different. It helped to restore my faith in the education system and to think about how, as adults, we often forget the fundamental things we learnt in childhood.
My daughter’s history teacher showed us three pictures of Elisabeth I, taken at different times in her life, and two letters that were written by German and French dignitaries reporting back to their home countries about the Virgin Queen and whether she was holding on well to power. The teacher told us that she had asked my daughter and her nine-year-old classmates to explain the differences in the two letters’ accounts, and contrast these with the pictures. Why were the accounts different? What factors could have explained the different accounts of how powerful the Queen was?
The point of the exercise was to explain two things to the children:
- One: perspective matters. A French or German dignitary may have wanted to convey to his superiors that the Queen was powerful, or losing power, to serve his own national or personal interests. The personal ambitions of these dignitaries may also have coloured their reports, as whatever they reported may have swayed in their favour in some way. So perspective is crucial.
- Two: always think of confounding factors. The three portraits of Elisabeth I were taken at different periods of her life – and if her age (written in small text at the bottom of each picture) was not reported in the dignitaries’ accounts, then a very different portrayal of her physical beauty, health and wellbeing may have been given. Confounding factors are typically thought of in the case of clinical trials data: is the observed difference between treatment arms really due to the different treatments given to patients, or is this hiding a confounding effect of another factor, such as a different age profile or case mix of the two groups being treated?
Clarity in a character-limited culture
Confounding factors and perspective have huge relevance to health policy. In much of the work we do, gaps in individuals’ health literacy may account for misinterpretation of the benefits and risks of given interventions. Statistics – particularly economic statistics – are often reported out of context. They may hit the headlines, but there is little understanding as to where they came from or whether they can be extrapolated to other contexts.
At HPP, we pride ourselves on accuracy, concision and relevance – all of which depend on our ability to concisely convey clear facts, supported by indisputable evidence (which we have spent a long time turning upside down), in such a way that they will not be prone to misinterpretation or misunderstanding. So we would never say, ‘Cancer is more important to policymakers than heart disease’; rather, we may say, ‘A greater proportion of current health policies [precise fact] in the UK [specific context] are focused on cancer than heart disease.’
Why is this important? Because we are living in a culture of soundbites, character limits and skim‑reading – and as much as we might disparage the individuals or cultural norms that propagate this culture, we are all part of it. We measure the success of an event not by who attends it, but by the number of tweets it engenders. We measure the relevance of a campaign not by the meaningfulness of its cause, but by the comms value of its message. That is not necessarily wrong, and one would be foolish to refuse to tick the box against these metrics – but we mustn’t forget that every fact should be interrogated for its context, accuracy and relevance to other situations.
Getting some perspective
Peer-reviewed publications usually look on the use of ‘we’ with disfavour – and there is a reason for this, as it compromises objectivity. The problem in policy, of course, is that without saying ‘we’, there is a risk of floating in a world of abstract policy recommendations without thinking about who should be held accountable for translating laudable goals into concrete actions.
So I will continue to drum home to my nine-year-old – as well as to my extremely competent, well-educated and highly literate colleagues – that perspective and context matter, and we should never succumb to laziness in neglecting to add these notes of precision and accuracy to anything we write. This is what differentiates good research, and good writing, from that which isn’t up to scratch. If we want to provide useful insights to decision makers in the hope of changing policy, we owe it to ourselves, and to them, to report findings to the highest standard.
Context. Confounding factors. Perspective. Far more important lessons for life than cuboids.
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