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School of Medicine Pharmacy & Health

School of Medicine Pharmacy & Health

What Constitutes Evidence in Public Health?

Presented by David HunterProfessor of Health Policy and Management16th January 2014

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School of Medicine Pharmacy & Health

What we Already KnowImproving health and wellbeing, and tackling inequalities and the social determinants of health

Are complex, ‘wicked issues’: cross-cutting, multi-factorial, multi-levelled

Occur against a backdrop of performance pressures to meet targets across sectors & agencies

Have to contend with a patchy, thin evidence-base – poor fit to local context, often contested

Experience a disappointing uptake of evidence-based changes

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School of Medicine Pharmacy & Health

http://www.ted.com/talks/ben_goldacre_battling_bad_science.html

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School of Medicine Pharmacy & Health

Key Issues

Many factors get in the way of using research We know little about what makes research get

adopted or not Promoting close interaction between

researchers and end users is critical Being clear who the end users are

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School of Medicine Pharmacy & Health

Problems with the Term ‘Evidence’ What is evidence? Hierarchy of evidence – is a typology more

appropriate? Whose evidence? Is ‘knowledge’ a better term? How much do these debates

matter anyway?

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School of Medicine Pharmacy & Health

Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.

Michael Marmot (2004) British Medical Journal

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School of Medicine Pharmacy & Health

Pathways to Evidence-Informed Policy and Practice

Linear model Interactive model

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School of Medicine Pharmacy & Health

Linear Model

Evidence/knowledge is a product Uni-directional flow from producers to

research users Knowledge is generalisable across

contexts

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School of Medicine Pharmacy & Health

Policy-Makers’ Sources of Evidence

Experts’ evidence (including consultants and think tanks) Evidence from professional associations Opinion-based evidence (including lobbyists and pressure

groups) Ideological evidence (including party think tanks, manifestoes) Media evidence Internet evidence Lay evidence (including constituents’ and citizens’ experiences) ‘Street’ evidence (including urban myths, conventional wisdom) Research evidence

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School of Medicine Pharmacy & Health

Interactive Model Embracing knowledge from multiple sources: research, theory,

practice Promoting close interaction between researchers and end-users

in a co-production/co-creation approach Context is important Effective uptake is not only a function of the science but also the

degree to which the purveyor of knowledge is viewed as a credible witness

Relationships are key to use and application of knowledge Dissemination of results through traditional academic channels is

not enough – the media utilised must fit the audience