The relationship between research and health policy is discussed from
a policy process perspective, describing communication problems in the
course of policy formulation, implementation and evalution. Policy pr
ocess is often expected by researchers to be rational, having logical
sequence of steps and the objective evaluation of alternatives based o
n scientific knowledge. In fact, policies are often formulated without
clear problem identification or based on wrong assumption. The timing
of research and policy-making differs. Policy-makers need to respond
quickly. Evaluations may be regarded by politicians as embarrassing if
they point to a need for significant change. It is not satisfactory t
o consider only research and policy-making: their relationship is infl
uenced by the media, different interest groups and by the general publ
ic. Health policy formulation is embedded in the general policy enviro
nment of particular societies. Some countries have a long tradition of
consensus-building, while in others health reforms have been formulat
ed and introduced in a centralized way. Traditional bio-medical thinki
ng influences health policy-makers. The importance of social and polit
ical acceptability tends to be overlooked. The paper emphasizes that w
e are experiencing an era of scarcity of resources and growing tension
concerning allocation decisions. Existing institutions provide insuff
icient incentives for policy-makers and researchers to promote public
dialogue about such issues. The paper concludes that there is a need f
or new approaches to policy development and implementation, new struct
ures in policy-making, changes in research financing and co-operation
between disciplines and new structures for public participation in pol
icy-making. Research should facilitate more open and democratic dialog
ue about policy options and the consequences of alternative choices.