Evidence for public health policy on inequalities: 1: The reality according to policymakers

Abstract

Objective: To explore with UK and international policy advisors how research evidence influences public health policy making, and how its relevance and utility could be improved, with specific reference to the evidence on the production and reduction of health inequalities. Design, setting, and participants: Qualitative residential workshop involving senior policy advisors with a substantive role in policy development across a range of sectors (mainly public health, but also including education, social welfare, and health services). In four in depth sessions, facilitated by the authors, focused questions were presented to participants. Their responses were then analysed thematically to identify key themes, relating to the availability and utility of existing evidence on health inequalities. Main results: The lack of an equity dimension in much aetiological and evaluative research was highlighted by participants. Much public health research was also felt to have weak underlying theoretical underpinnings. As well as evaluations of the effectiveness and cost-effectiveness of policy and other interventions, they identified a need for predictive research, and for methodological research to further develop methods for assessing the impact on health of clusters of interventions. Conclusions: This study reinforces the view that there is a lack of information on the effectiveness and costeffectiveness of policies, and it uncovered additional gaps in the health inequalities evidence base. A companion paper discusses researchers' views of how the production of more relevant public health evidence can be stimulated.T he part that evidence should play in informing public health policy and in reducing health inequalities has been a topic of recent debate among researchers and policymakers.1-4 Some commentators however have argued that while researchers would like their research to influence policy, in practice this often does not happen because they take little account of the needs of policymakers and of the reality of the policy process. Moreover, researchers have been castigated for their political naivety, for lacking understanding of how policy is made, and for having unrealistic expectations about what research can achieve.3 5 A particular problem, it is suggested, may be caused by their over-reliance on simplistic, linear models of decision making, though such models rarely apply even where the policy questions are ostensibly fairly clear, such as in health technology assessment. 3 5-7 All this suggests that strengthening the bridge between research and policy is an urgent priority if evidence based policy is to become the norm, rather than the exception. Although improving the accessibility of primary and secondary research evidence will help achieve this aim, 2 we also require a clearer understanding of how current public health evidence is viewed by users; if the evidence currently available is not valued by decision makers, then evidence based policy will be no more than an aspiration. Similarly, we need a cleare...

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