Better evidence about wicked issues in tackling health inequities
Mark Petticrew, Professor of Public Health Evaluation1
Peter Tugwell, Professor of Medicine, and Epidemiology & Community Medicine2
Vivian Welch, Research associate2
Erin Ueffing, Field Administrator, Cochrane Health Equity Field and
Elizabeth Kristjansson, Associate Professor2,3
Rebecca Armstrong, Senior Research Fellow, Cochrane Public Health Review Group4
Jodie Doyle, Managing Editor, Cochrane Public Health Review Group4
Elizabeth Waters, Professor, Jack Brockhoff Chair of Child Public Health, and Coordinating Editor, Cochrane Public Health Review Group4
1 Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
3 School of Psychology,
4 McCaughey Centre,
Journal of Public Health Advance Access published online on July 28, 2009
Available online at: http://jpubhealth.oxfordjournals.org/cgi/content/full/fdp076#FDP076C16
“…….The need for better evidence continues to be emphasized by both researchers and users of research. ‘Better evidence for a better world’ was the theme of this year's Campbell Colloquium for example, a gathering of researchers and policy-makers who aim to systematically build the evidence on the effectiveness of social policies and programs, including those aimed at improving social welfare, reducing crime and improving educational outcomes.
This resonates with continuing political interest in making policies more evidence informed. In keeping with this spirit of evidence-based enquiry, it is reasonable to consider what ‘better evidence’ might look like.
One important way to improve current evidence on health and social outcomes is to consider, and report on, the impact of interventions on health equity. Currently much research on the effects of interventions, which address the social determinants of health is focused on the mean population-level effects and less on the differential effects within populations, such as on differences in effectiveness for those who are disadvantaged.
This ‘evidence with a utilitarian bias’1 results in insufficient evidence on how to adequately address health inequalities. Primary studies often fail to collect, analyse and present data on differential effects, and even where such data are available, systematic reviews often fail to use it.2,3
‘Better evidence’, then, means evidence that explores the effects of interventions within different sections of society, and that can be used to tackle inequalities in health. In the absence of this information we may proceed on best guesses and practical experience; however, in both clinical and population-level interventions, we know that current practice and conventional wisdom are often poor guides to what works………….”
The social determinants of health: developing an evidence base for political action.
Kelly M, Morgan A, Bonnefoy J, et al.
Final Report to World Health Organization Commission on the Social Determinants of Health from
the Measurement and Evidence Knowledge Network. (2007)
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