What would you sacrifice to reduce health inequalities?

Neil McHugh

This blog post is based on the Evidence & Policy article ‘Eliciting public values on health inequalities: missing evidence for policy windows?

What would you be willing to sacrifice to reduce health inequalities? What is the most you would be willing to give up for the introduction of a basic income? How does this compare to what you would trade off for an increase in Universal Credit? Does your support depend on the income and health implications of these policies? And on your own income and/or health status? At present, we do not know the answer to these questions. Arguably, providing answers could help create the conditions to improve current policies and/or introduce more radical policies for tackling health inequalities.

There is a health divide in the UK. Individuals who are poorer die earlier and have worse health than those who are better off. We have known this for many years. Yet despite health inequalities being a focus of research and policy, health gaps continue to widen. To tackle socio-economic inequalities in health we need macro policies that will change the socio-economic, cultural and environmental conditions of people’s lives. These policies could include, but are certainly not limited to, taking action to reduce homelessness, increasing the availability and accessibility of good quality and affordable social housing, introducing a basic income that supports a minimum income standard and implementing a more progressive taxation system. However, it is difficult to create the political conditions necessary to implement these types of policy. One form of evidence which could help facilitate policy change is knowledge of a specific type of public value – economic value – for non-health policies and their associated (non-)health outcomes. This evidence is currently missing from decision-making processes.

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What does the literature tell us about brokers, intermediaries and boundary spanners?

Jennifer Watling Neal, Brian Brutzman and Stephen Posner

This blog post is based on the Evidence & Policy article ‘Understanding brokers, intermediaries, and boundary spanners: a multi-sectoral review of strategies, skills, and outcomes

Research evidence can help policymakers make decisions about society’s biggest challenges such as combating climate change, responding to the COVID-19 pandemic and seeking racial justice. However, exchanges between policymakers and researchers are complex and often require the help of individuals and organisations serving in broker, intermediary or boundary spanner roles.

Although brokers, intermediaries and boundary spanners are recognised across the environment, health and education sectors, there have been limited opportunities to explore how literature across sectors characterises what these individuals and organisations do, what skills they need and what outcomes they produce. Therefore, in a recently published Evidence & Policy article, we reviewed 185 conceptual and review papers across the environment, health and education sectors with the goal of understanding the strategies, skills and expected outcomes of brokers, intermediaries and boundary spanners.

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On the origin of a new knowledge exchange species: engineering evidence in policy

Adam Cooper

This blog post is based on the Evidence & Policy article ‘Engineering advice in policy making: a new domain of inquiry in evidence and policy’

Every day in government ministries, decisions are being made that shape the world. Literally, not figuratively. Decisions are made that can move mountains, make holes in the ground, cause buildings to appear, decide where other things can land, park or moor. This shaping involves a profession of highly trained and skilled individuals known commonly as ‘engineers’. Most engineers work in the private sector but a small fraction work in government, providing advice to policy officials and ministers. In the UK, engineers in government are a hidden species, commonly clustered into the STEM acronym. Science and engineering are often used interchangeably, which may explain why there is a body of research on science advice but nothing explicitly on engineering advice.

In addition to the common failure to distinguish between scientists and engineers in policy is the way in which science advice is commonly understood: as a regulatory function that helps monitor the presence of toxic elements in the environment, and work out what to do about them. The work of Jasanoff in her book The Fifth Branch is an example of this, and it also tends to exemplify the ‘at a distance’ approach of the majority of science advice research. Engineers aren’t normally involved in this kind of ‘regulatory science’ – in the UK at least they are involved in implementation (though of course engineering, if nothing else, is a discipline of standards, as Yates & Murphy show). Instead, discovering this new evidence for policy species took a more ethnographic moment to reveal it.

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