After the Candles Were Extinguished

This chapter covers several issues South Korea has dealt with following President Park’s removal from office: the election of Moon Jae-in as president in May 2017, pro-Park groups’ anti-government rallies, and a public divide on potentially pardoning Park in 2021. In addition, it considers citizens’ evaluations of the impeachment candlelight vigils three years after Park’s impeachment. There is now a growing sense that the momentum for change ignited by the vigils may have been lost and that real systemic change has not been achieved. This chapter looks at how some actors within society are striving to sustain momentum for social change. While political parties and civic organizations in South Korea are experimenting with different strategies to engage citizens, some people are already demanding new forms of participatory democracy. Grass-roots organizations such as WAGL and Parti Co-op have emerged to design and implement alternative ways of incorporating citizens’ direct participation in policy decision-making processes.

Registration of health and medical research

Registration of health and medical research is an effective way of improving the transparency and credibility of evidence. Registration involves pre-specifying the research objectives, design, methods and analytic plan on a publicly accessible repository before conducting the study. Registration can reduce bias and improve the transparency and credibility of research findings. Registration is mandated for clinical trials, but it is also relevant to systematic reviews, observational and preclinical experimental research. This paper describes how researchers can register their research and outlines possible barriers and challenges in doing so. Widespread adoption of research registration can reduce research waste and improve evidence-informed clinical and policy decision making.

Evidence-Based Public Policy Decision-Making in Smart Cities: Does Extant Theory Support Achievement of City Sustainability Objectives?

Evidence-based decision making is promoted as offering efficiency and effectiveness; however, its uptake has faced barriers such as underdeveloped supporting culture, limited access to evidence, and evidence that is not fully relevant. Smart city conceptualizations offer economic and environmental sustainability and better quality of life through evidence-based policy decision-making. We wondered whether smart city theory and practice has advanced the knowledge of evidence-based decision-making. We searched major databases for literature containing a mention of smart cities, decision-making, and policy. We identified relevant literature from a range of disciplines and supplemented these by following backwards and forwards citations. Evidence-based decision-making was found mostly in literature regarding the theory and practice of smart city operations, and, to lesser extents, the articles regarding policy decisions and tactical decisions. Better decision-making which supported the achievement of city sustainability objectives was reported in some articles; however, we found significant obstacles to the further achievement of city objectives in the areas of underachievement in collaborative decision-making, privileging of big data evidence, and artificial intelligence agents as decision-makers. We assembled a definition of smart city decision-making and developed an agenda of research which will support city governments, theorists, and practitioners in better achieving sustainability through improved decision-making.

Germany’s coalition faces division on several fronts

Significance The three parties successfully negotiated a coalition agreement with a strong emphasis on modernising Germany’s economy. Throughout the negotiations, the parties presented a public image of stability and harmony, yet several divisive issues will test the new government's stability and effectiveness. Impacts The composition of the new government will make it harder for Berlin to win approval for the EU-China Comprehensive Investment Agreement. Chancellor Olaf Scholz will seek to prioritise more unity at the EU level when it comes to foreign policy decision-making. The spread of the Omicron variant will slow economic recovery and potentially delay the transition to a greener economy.

OP179 Quantitative Evidence Synthesis Methods For Assessing The Effectiveness Of Treatment Sequences For Clinical And Economic Decision-Making: Methodology Review

IntroductionThe sequential use of alternative treatments for chronic conditions represents a complex, dynamic intervention pathway; previous treatment and patient characteristics affect both choice and effectiveness of subsequent treatments. Evidence synthesis methods that produce the least biased estimates of treatment-sequencing effects are required to inform reliable clinical and policy decision-making. A comprehensive review was conducted to establish what existing methods are available, outline the assumptions they make, and identify their shortcomings.MethodsThe review encompassed both meta-analytic techniques and decision-analytic modelling, any disease condition, and any type of treatment sequence, but not diagnostic tests, screening, or treatment monitoring. It focused on the estimation of clinical effectiveness and did not consider the impact of treatment sequencing on the estimation of costs or utility values.ResultsThe review included ninety-one studies. Treatment-sequencing is usually dealt with at the decision-modelling stage and is rarely addressed using evidence synthesis methodology for clinical effectiveness. Most meta-analyses are of discrete treatments, sometimes stratified by line of therapy. Prospective sequencing trials are scarce. In their absence, there is no single best way to evaluate treatment sequences, rather there is a range of approaches, each of which has advantages and disadvantages and is influenced by the evidence available and the decision problem. Due to the scarcity of data on sequential treatments, modelling studies generally apply simplifying assumptions to data on discrete treatments. A taxonomy for all possible assumptions was developed, providing a unique resource to aid the critique of decision-analytic models.ConclusionsThe evolution of network meta-analysis in HTA demonstrates that clinical and policy decision-making should account for the multiple treatments available for many chronic conditions. However, treatment-sequencing has yet to be accounted for within clinical evaluations. Economic modelling is often based on the simplifying assumption of treatment independence. This can lead to misrepresentation of the true level of uncertainty, potential bias in estimating the effectiveness and cost effectiveness of treatments and, eventually, the wrong decision.

Challenges of Water Policy Involvement of the Community in the East Coast River Basin of Thailand

Water policy-making requires the dedicated involvement of all stakeholders, but difficulties remain for the community sector. This study aims to examine the critical challenges of community involvement in water policy decision-making in Thailand. Both qualitative and quantitative methods used in this research project consisted of 39 interviews with informants from a variety of interested parties and 403 community members from around the East Coast River Basin in Thailand completing a survey questionnaire. The results have shown that although mechanisms to enable community involvement in decision-making, such as public consultation and water-related committees, exist, problems remain within the community sector. The critical challenges lie in the opportunities of being consulted and the sharing of power in water policy-making. Although the networks are important, at the same time, they are also obstructing the community sectors in linking their requirements to a final decision, as well as dealing with politics, policy-makers, and staff who organized the process. Therefore, the government should further develop water committee mechanisms by setting up a comprehensive yet practically easy consultation process so that new or inexperienced community members get an opportunity to practice and learn the vital elements necessary in water policy-making. Further research should be conducted in order to compare the opportunities in water decision-making between communities in rural and urban areas. Studies at the local government level should be carried out, with results used as a mechanism to enable community involvement at higher levels of water policy decision-making.

"Research ends with publication": A qualitative study on the use of health policy and systems research in Ethiopia

Background Decision-making about the design and implementation of health care policies should be supported by research evidence. This article reports on a qualitative study on the experiences of both research institutes and policymakers in Ethiopia in generating and using research evidence to inform health policy decision-making. Methods Semi-structured interviews were conducted from January through March 2020, with representatives of research institutes and with policymakers in Ethiopia. The data collected during the interviews were analyzed thematically. Results Half of the institutions represented had engaged in health policy and systems research (HPSR). These institutes’ capacities were limited by multiple factors, including unsupportive research environments; the limited number of researchers with extensive experience; high turnover among senior researchers; lack of staff motivation mechanisms; underdeveloped research culture; limited technical and analytical capacity among researchers; lack of core funding for HPSR; ineffective financial management; and, lack of connections with health policy platforms. Research institutes also lacked the capacity in strategic packaging of findings to influence policy decision-making, although some programs have recently improved in this area. Meanwhile, there lacked a culture of using evidence in policymaking settings. In general, we found that policymakers had poor attitudes towards the quality or value of the evidence, and had little capacity to interpret evidence and apply findings to policy options. As a result, much of the research produced by the institutes have only been relevant academically, with little impact on policy. However, respondents reported that the environment is slowly changing, and the recent creation of a Research Advisory Council at the Ministry of Health offers a promising model. Conclusions Despite some recent changes, in Ethiopia researchers and policymakers alike often tend to consider health policy and systems research (HPSR) to be not very valuable since the findings generated are rarely used for evidence-informed policy development. Research institutes and researchers need to strengthen their technical, analytical, and administrative capacities (through, among other efforts, seeking more funding for research, and better incentives to attract, retain and build skills among qualified researchers); they also need to improve their understanding of the evidence-to-policy cycle and how to engage effectively with policymakers.