How does evidence influence public health policy? Tackling health inequalities in England

This paper examines the place of evidence in the policy-making process, considering as a case study the development of a Programme for Action to tackle health inequalities in England. It attempts to identify ways in which we can maximise the use of evidence in the development of policies to support public health, and the ways in which research can be managed to support public health policy development. It identifies that evidence-based policy is an aspirational goal rather than something that will easily be achieved in the complex, politicised environment of policy making. Key challenges include the need to develop public health evidence that is ‘fit for purpose’ – research that is more overtly directed towards informing policy and producing evidence derived from practical interventions that would allow examination of the relative costs and benefits of different policy options. Research evidence also needs to be provided at the time it is needed, and improved techniques need to found for communicating and managing the uncertainties that arise through scientific research. For the public servants who use evidence in policy making, there is the challenge to develop skills in the critical appraisal of evidence and to judge how to achieve the best ‘fit’ between available evidence, current political priorities, and practical actions to achieve the desired outcomes. In this more complex environment, the development of networks and cultivation of relationships between public health practitioners, advocates and policymakers (public servants and their political masters) will often provide more adaptable and durable opportunities to influence the policy process.