Despite concerns that the health policy academy is divorced from policy making, the articles in this special issue generally suggest that academic policy research played important roles in the development, implementation, and subsequent defense of the Affordable Care Act. One reason for this relative success was the presence of many “embedded academics”—researchers who took leaves from universities to spend time working for the Obama administration or Congress. Embedded academics can help bridge the wide gap between the institutional cultures of the academy and of government and can thus act as translators of academic research for policy-making purposes. This essay describes how the cultures of the academy and of government policy research differ and suggests ways to use those cultural differences to improve knowledge translation.
Much research has examined the role of academic policy analysis in the development of policy. The articles in this issue generally suggest that such analyses played roles—larger or smaller, for better or for worse—in the development, implementation, and subsequent defense of the Affordable Care Act (ACA). These conclusions are markedly at odds with the considerable literature lamenting the weak role of academic policy analysis in health policy development (Fox 1979; Macintyre et al. 2001). As Mark Peterson's article suggests, one possible reason for the greater influence of academic policy research in the development of US health policy is the existence of research-focused institutions, such as the Government Accountability Office (GAO) and the Congressional Budget Office (CBO), within the US government. A related reason is that the structure of the US government offers opportunities for academics to move back and forth between government and academia. These “embedded academics,” as I have called them, are ideally situated to translate research knowledge into policy (Glied 2016). The Obama administration and many congressional committees made extensive use of these embedded academics in the design and the implementation of the ACA. As the assistant secretary for planning and evaluation at the US Department of Health and Human Services from 2010 to 2012—on leave from my academic position as a professor of health economics—I was one of them.
The evidence of the Affordable Care Act supports the hypothesis that embedded academics can perform a valuable knowledge translation function. But what's in it for them? Moving from academia to government is often personally disruptive, usually entails financial sacrifice (government pays less than academia), and requires academics to shut up, which goes against the grain. One conjecture is that entering government allows an academic to act as a sort of lobbyist, surreptitiously injecting pet ideas into legislation and regulation. That's not entirely false, but it is successful so rarely that it can explain very little of the attraction of government service. Instead, as my own experience suggests, academics enter government because it offers an opportunity to work within an entirely distinct culture. A better understanding of this culture might improve the link between academic researchers and government policy makers.
Some of the differences between the work of a policy analyst in government and in academia stem from underlying institutional differences. The inward-focused, loosely regulated structure of a university gives individual faculty members, especially those with tenure, tremendous freedom. The professional success of academics is defined largely by what the world of their peers—most of whom are in other institutions—think of their work. They must be creative and develop an innovative research agenda that will advance the bounds of their discipline. Their research must lead to publications and citations in prestigious journals. They must pursue the truth rigorously and carefully, using appropriate and sophisticated methodologies. Their schedule is their own, and they will wait until their findings meet their own standards before putting them forward. If they don't like the results, they're free to withhold them. But even if they have tenure, they are surrounded by colleagues and, at a distance, by rival academics, all pursuing similar agendas. Success matters much more than failure. Uninteresting papers—even results that are later shown to be mistaken—sink below the horizon. Exciting, creative, insightful findings will shine for years.
An employee of the federal government—whether a political appointee or a career civil servant—by contrast, faces very clear lines of internal and external accountability, which are formalized in precise and mind-numbing rules. A newly installed government appointee quickly bangs heads against the Paperwork Reduction Act (no, you can't just change the wording of a survey question); the “logical outgrowth” rule (no, you can't just change the language in a final rule because you've thought up a better way to do something); the Federal Advisory Committee Act (no, you can't just invite your wisest colleagues from academia to a meeting and hash out a problem); and the expense rules (no, the assistant secretary can't pay for coffee for a visiting dignitary from departmental funds). The employee works in a well-structured hierarchy, has very limited discretion, and knows exactly who is boss.
This means that the government department offers a researcher far less flexibility and many more constraints. Most of the problems are defined, either higher up in the hierarchy or by Congress. The boss needs an answer that will work this afternoon, not scientific truth that may take months to discover. There's little room to offer caveats—like Harry Truman, politicians want “one-handed economists.” You can give advice, but you never get the final word, and it's hard to point to something specific as your own accomplishment. Sometimes (though one hopes not too often and not on too big an issue), you have to compromise and go along with a proposal or rule that doesn't look quite the way you'd like. Failure counts much more than success. No one knows who wrote the rules or designed the structures that work, but a politically awkward proposal, a failed implementation, or an inapt remark at a committee hearing will haunt you forever. And in government, there's no tenure to protect your freedom of speech.
These institutional differences generate differences in habits of work. As Rachel Glennerster (2014), a former UK policy adviser, noted, “Policy and academic work are equally intellectually challenging, but in very different ways.” Life in the university is lonely and competitive. Every page in a journal that contains someone else's research means less space for yours; every grant received by someone else is a grant you didn't get. Perhaps surprisingly, government service—at least for academics on leave—is far less competitive. Much work is truly interdisciplinary—a new regulation likely requires the cooperation of the Office of the General Counsel, the Office of Legislative Affairs, the Office of Public Affairs, the Office of Planning and Evaluation, and the administrative agency and draws insights from across academic disciplines. Staff members in these offices are not vying for scarce journal pages or grant dollars. Each office has a different, and important, role.
Most of the time, especially when things work well, individuals in government are valued exclusively for their contribution to the team's success. If you can contribute in a useful way, you will be appreciated for your contributions; if not, you will be ignored. It's never about you—it's about the work. In academia, you have to sell your results, market your papers, get on the conference circuit, see your name in the newspaper. In government, you want to introduce your idea into the conversation as anonymously as possible. It's never a good day when government officials see their names in the paper—most often, it means something has gone wrong. But even good news is frowned upon: it deflects from the accomplishments of the secretary, the president, or the team.
That sense of teamwork and collegiality in government is reinforced by a strong sense of common mission. It's not just that everyone in the agency knows the agenda that's being put forward. It's also that the organization is united in opposition to those who might stymie the mission—whether in Congress, in some other part of government, or externally. There's nothing like a common enemy to bring a team together, and the camaraderie of preparation for an Oversight Committee hearing almost makes up for the torture of the event itself. And while no one outside may ever recognize your contributions, the appreciation of the small band of colleagues who get it can be very satisfying.
It is these differences in the everyday experience of work that draw academics who have worked in government back to it. Despite the loss of control over your time, agenda, and products, knowing what you do matters; being respected for your contributions; checking your ego at the door; working with wonderful, committed colleagues on a common goal; and having a steady stream of projects can be quite addictive. That compensates—at least for a while—for the loss of the chance to think deeply about a problem, to seriously consider all possible alternatives (even the ones that might be politically inauspicious), and to write exactly what you think.
These reflections suggest that one possible reason for the divergence in views about research impact stems from differences in the reward systems of the two cultures. A research paper is successful if it is cited, but a successful piece of regulation or legislation has no author or parent. Academics are successful when they are innovative, exciting, pathbreaking, and risk taking. Regulations and legislation will be successful if they take care to manage all risks, remain within the prevailing paradigm, and break as little new ground as possible to achieve their objectives. Academics want to write the first papers in their fields; policy makers want to rely on the accumulation of evidence, preferably evidence of policy in practice. Academics see a paper as a coherent whole; policy makers want to take it apart and use the pieces, amalgamated with other findings, as they see best.
These differences in culture mean that both government and academia will benefit by understanding the other. Government staff, loath to put their own names in the limelight, shy away from attributing policy ideas or evaluation results to particular researchers or studies. Academics need that recognition to gain reputation and funding. Academics see legislation that subsumes research findings to political and stakeholder interests as an unwarranted dilution of science. Policy makers see it as balancing competing agendas.
Policy makers do turn to academics, but they do so selectively. The usual standards of academic excellence aren't always the ones that apply. Instead, those inside government look for academics that they trust to fit with the culture of government work, which demands humility, deference, and a willingness to opine only when asked to do so. How can academics build this trust? One way comes quite naturally—educate students who themselves enter government service and build on those ties—take their calls! Another way, requiring a bit more work, is to cultivate quotidian contacts with civil servants and appointees, by serving on technical expert panels, on review panels, and as consultants to government-contracted research projects.
But it is the flow of academics between government and the university that can best help address these differences. Embedded academics can effectively take the cover pages off research findings. Their refined habits of inquiry and creative approaches to problem solving often generate insights that move discussions in new directions. While published academic research is rarely directly useful in addressing new policy problems (because it usually describes the outcomes of prior policy experiments), academics are adroit at drawing new inferences from this existing research and in identifying researchers who may have specialized, though unpublished, knowledge about a topic. Through formal and informal communication with researchers, embedded academics can offer reputational gains (future tenure and promotion letters) and evidence of policy impact for grant proposals. By running interference between academics committed to rigorous evidence and stakeholders with other interests, embedded academics can tailor communication about research results to the needs of a team.
Having faculty serve in government agencies, in turn, enriches academia. Coming face to face with the uncertainties of policy challenges generates new, significant research agendas. Academics in government quickly spot policy-relevant but readily addressable gaps in existing research. Understanding the difficulties of making change in a large bureaucracy makes researchers more discerning about what policy approaches belong in the feasible set. Working closely with senior staff from other agencies gives the idea of interdisciplinary research a sense of purpose and reality that's often missing in academia and that academics can take back to the university.
Sherry Glied is dean of the Robert F. Wagner Graduate School of Public Service at New York University. She was formerly professor of health policy and management at Columbia University's Mailman School of Public Health and served as assistant secretary for planning and evaluation at the US Department of Health and Human Services from 2010 to 2012. She is the author of Chronic Condition (1998), coauthor (with Richard Frank) of Better but Not Well: Mental Health Policy in the U.S. since 1950 (2006), and coeditor (with Peter C. Smith) of The Oxford Handbook of Health Economics (2011).