Category Archives: Healthy Settings

Sector-led improvement for public health, prevention and early intervention

By Local Government Association (2017)

The LGA is working with partners at Public Health England and the Association for Directors of Public Health to deliver sector-led improvement activity in 2017/18 for public health, prevention, and early intervention through the care and health improvement programme funded by the Department of Health.

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Urban green space interventions and health

By WHO (2017)

This report aims to fill the knowledge gap on the benefits of urban green spaces. It outlines the results of an evidence review and an assessment of local case studies on urban green space interventions, and finds that increasing or improving urban green space can deliver positive health, social and environmental outcomes for all population groups, particularly among lower socioeconomic status groups. It highlights the need to include more health and equity outcomes in studies on green space interventions in future.

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Welfare confidentiality: sanctions, support and behaviour change

By Welfare Confidentiality Project (2016)

Below is the overview, summarising our key first wave findings on the effects and ethics of welfare conditionality. It draws on data from interviews with 52 policy stakeholders, 27 focus groups conducted with practitioners, and 480 ‘wave a’ qualitative longitudinal interviews with with nine groups of welfare service users in England.Overview

Below are nine first wave findings papers covering each of our study’s policy areas in more detail.

First wave findings: anti-social behaviour

First wave findings: disabled people

First wave findings: homelessness

First wave findings: jobseekers

First wave findings: lone parents

First wave findings: migrants

First wave findings: offenders

First wave findings: social tenants

First wave findings: Universal Credit

Big cuts planned to public health budgets

by The King’s Fund (2017)

Central government cuts have forced councils to reduce planned spending on vital public health services such as sexual health clinics and reducing harm from smoking, alcohol and drugs by £85 million, according to new analysis by The King’s Fund.

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Evidence based policy making and the ‘art’ of commissioning – how English healthcare commissioners access and use information and academic research in ‘real life’ decision-making: an empirical qualitative study

Wye, L. et al. BMC Health Services Research, 2015; 15: 430

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Abstract

Background
Policymakers such as English healthcare commissioners are encouraged to adopt ‘evidence-based policy-making’, with ‘evidence’ defined by researchers as academic research. To learn how academic research can influence policy, researchers need to know more about commissioning, commissioners’ information seeking behaviour and the role of research in their decisions.

Methods
In case studies of four commissioning organisations, we interviewed 52 people including clinical and managerial commissioners, observed 14 commissioning meetings and collected documentation e.g. meeting minutes and reports. Using constant comparison, data were coded, summarised and analysed to facilitate cross case comparison.

Results
The ‘art of commissioning’ entails juggling competing agendas, priorities, power relationships, demands and personal inclinations to build a persuasive, compelling case. Policymakers sought information to identify options, navigate ways through, justify decisions and convince others to approve and/or follow the suggested course. ‘Evidence-based policy-making’ usually meant pragmatic selection of ‘evidence’ such as best practice guidance, clinicians’ and users’ views of services and innovations from elsewhere. Inconclusive or negative research was unhelpful in developing policymaking plans and did not inform disinvestment decisions. Information was exchanged through conversations and stories, which were fast, flexible and suited the rapidly changing world of policymaking. Local data often trumped national or research-based evidence. Local evaluations were more useful than academic research.

Discussion
Commissioners are highly pragmatic and will only use information that helps them create a compelling case for action.Therefore, researchers need to start producing more useful information.

Conclusions
To influence policymakers’ decisions, researchers need to 1) learn more about local policymakers’ priorities 2) develop relationships of mutual benefit 3) use verbal instead of writtencommunication 4) work with intermediaries such as public health consultants and 5) co-produce local evaluations.

Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

Cairney, P. et al.  Health Research Policy & Systems, 2017; 15: 35

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There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.

We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.

We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.

We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.

Return on investment of public health interventions: a systematic review

Masters R, et al. J Epidemiol Community Health 2017;0:1–8. doi:10.1136/jech 2016-208141

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ABSTRACT
Background Public sector austerity measures in many
high-income countries mean that public health budgets
are reducing year on year. To help inform the potential
impact of these proposed disinvestments in public
health, we set out to determine the return on investment
(ROI) from a range of existing public health
interventions.
Methods We conducted systematic searches on all
relevant databases (including MEDLINE; EMBASE;
CINAHL; AMED; PubMed, Cochrane and Scopus) to
identify studies that calculated a ROI or cost-benefit ratio
(CBR) for public health interventions in high-income
countries.
Results We identified 2957 titles, and included 52
studies. The median ROI for public health interventions
was 14.3 to 1, and median CBR was 8.3. The median
ROI for all 29 local public health interventions was 4.1
to 1, and median CBR was 10.3. Even larger benefits
were reported in 28 studies analysing nationwide public
health interventions; the median ROI was 27.2, and
median CBR was 17.5.
Conclusions This systematic review suggests that local
and national public health interventions are highly costsaving.
Cuts to public health budgets in high income
countries therefore represent a false economy, and are
likely to generate billions of pounds of additional costs
to health services and the wider economy.