Building Better Public Health Policy Knowledge: The Case for Pluralism

iven the multiple challenges facing public health across the globe it is timely to reflect on how different types of knowledge are of use for public health policy.Public health policy, like all public policy, operates in complex, contested environments where multiple forms of knowledge are needed-both for policy (technical evidence to inform decisions and implementation) and about policy (sociopolitical to understand systems, processes, and power).1,2 This viewpoint reflects on how four foundational approaches [1] positivism, pragmatism, critical social science (CSS), and critical realism (CR)-offer distinct yet complementary contributions to public health policy knowledge generation.I use climate change and populism-along with health equity, my professional focus-as concrete examples.My purpose is to motivate a reflective lens about the value and complementary use of different approaches for effectively generating, commissioning, reviewing, or using evidence.I proceed in three steps.First, I introduce climate change and populism as illustrative challenges.Second, I compare the four approaches in terms of causation, methods, macromicro orientation, methods, and theory use.Third, I then detail hypothetical research protocols for the first three and suggest CR as a connecting meta-methodology.I conclude by reiterating the necessity of complementarity despite systematic institutional barriers.