Public health

Local organisations and researchers can play a key role as intermediaries in municipal policymaking for improving community health

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Renee Parks and Fanice Thomas

This blog post is based on the Evidence & Policy article, ‘Municipal officials’ perspectives on policymaking for addressing obesity and health equity’.

More than 30% of adults in the US have obesity, with higher rates among those who have lower incomes or are racially or ethnically minoritised. Local-level policymakers within municipal governments can play a unique role in addressing obesity and related health disparities through policy strategies, including zoning and other land use laws, city or park master plans, and local, healthy food procurement policies that create healthy environments and promote community members’ engagement in health promoting behaviours.

In our Evidence and Policy article, we discuss municipal officials’ decision-making regarding policies impacting community health, their views on the prevalence of obesity and health disparities in their communities, and their role in addressing them. By understanding policymakers’ views on obesity and health disparities, we can identify best practices for sharing evidence with policymakers and promoting its integration into policies that address health disparities in communities.

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Guidelines for healthcare about promotion of healthy lifestyle habits – what knowledge should they be based on?

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Helena Lagerlöf, Teun Zuiderent-Jerak and Morten Sager

This blog post is based on the Evidence & Policy article ‘Epistemological deliberation: the challenges of producing evidence-based guidelines on lifestyle habits‘

Drafting recommendations is an art that requires more attention to the choices between different views of knowledge, formats and standards and their ramifications.

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Rapid responsive evidence synthesis to inform decision-making and research

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Evidence is power

Duncan Chambers

An evidence synthesis programme commissioned by the UK’s National Institute for Health Research from two academic teams produced a diverse range of outputs and methodological insights in its first three years of operation. The programme was subsequently re-commissioned for two further cycles. Scoping the topic and involving stakeholders were key to its success.

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Why we must work toward a recognised international standard in evaluation of upstream interventions

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Feather

Matthew Johnson, Elliott Johnson, Laura Webber and Kate Pickett

The COVID-19 pandemic has increased interest in Universal Basic Income (UBI) as a means of addressing a range of socio-economic insecurities. While previous trials of cash transfer schemes have often focused on low-level transfers inadequate to satisfy the needs for which the policy was originally developed, emerging pilots are moving toward a position of increasing generosity. Our multidisciplinary project, Examining the Health Case for UBI, has brought together colleagues in behavioural science, public health, epidemiology and economics to establish pathways to health impact outlined in Figure 1 below. Our work suggests the potential for significant health impact and attendant economic benefit via reduced healthcare costs and increased economic activity. The model suggests that elements of impact may only be felt if payment is set at a more generous level. This could create greater return on investment and, ironically, a more cost-effective system.

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Policy impact is the result of networked approaches to knowledge exchange

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Naomi Nichols, Kaitlin Schwan and Jayne Malenfant

We have spent much of our academic and professional careers participating in and leading initiatives that are trying to change how organisations, institutions and systems function. The relentless demands of this work mean there is often little opportunity to reflect on the efficacy of our efforts. To address this gap, we conducted more than two years of ethnographic research to learn how community-university-policy partnerships use research and strategic communication to change how youth homelessness is addressed on a pan-Canadian scale. Our intention was to improve our own tactical efforts to ensure our research contributes to the types of changes we want to see (e.g. an end to youth poverty and homelessness).

We learned that networked knowledge exchange is central to ensuring research-to-policy impact.

In this blog post, we suggest three things researchers can do to produce research that addresses persistent social problems.

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Focus on the people, not the technology

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Senior woman with facial mask,Covid 19.

Sheena Asthana, Rod Sheaff, Ray Jones and Arunangsu Chatterjee

In an article published in Evidence & Policy last year, ‘eHealth technologies and the know-do gap: exploring the role of knowledge mobilisation’, we described the eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC) project, which aims to support the development of a sustainable innovation ecosystem. We found that, in order to build practically useful links between user (and/or carer) groups and those developing new eHealth technologies, the EPIC team had to invest significant resources in knowledge sharing, one-to-one networking, building focused linkages and capacity building; that financial support can play a key role in supply-side dynamics; but that the contextual and organisational barriers to eHealth innovation in England should not be underestimated.

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Is evidence-based policymaking driven by Machiavellianism or altruism in US states?

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Luke Yingling and Daniel J. Mallinson

We find that the adoption of evidence-based policies in US states is driven more by Machiavellianism than altruism. Although engagement with evidence-based policymaking (EBP) can produce more efficient and effective government, it can also supply new levers of control to politicians and bureaucrats, which can be used to produce electoral benefits. An appeal to EBP can be used to centralise control of executive functions, as well as to manipulate budgets, that incentivise adoption. Further, the construction, purpose and outcomes of these laws are influenced by the institutions, parties and officeholders who craft them. Our study finds that Democratic governors, Republican legislatures and state innovativeness are significant predictors of EBP adoption in the American states. 

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Knowledge translation opportunities and challenges

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Agnes Black

Complexity in healthcare systems presents knowledge translation (KT) challenges but also opportunities. Our Evidence & Policy article, ‘Connecting knowledge and action in complex health systems: examples from British Columbia, Canada’, illustrates ways we have harnessed complexity to narrow the gap between knowledge and action. We work across different health authorities and funding agencies building strong relationships with those who use research, fostering innovation, supporting evidence-based decision-making and helping people to de-implement obsolete practices. We share a commitment to building strong connections between knowledge and action, and our work is enhanced by embracing the inherent intricacies of the systems in which we work.

We share examples from our practice areas of how we navigate the demands of knowledge translation using responsive solutions and relationship building to support KT that promotes health. While many health systems leaders continue to perceive researchers and research as irrelevant and disconnected from their realities, we have found that when research is undertaken with people who use it, reciprocal and responsive relationships can overcome this barrier and lead to collaborations that support healthcare improvements. Embracing research as a public good requires reimagining the relationships and structures of both research and KT, and we are encouraged by the many ways we’ve seen this happen.

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Implementing shared decision-making into practice: embracing complexity

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Light string

Sarah Munro

How do we implement shared decision-making into routine practice? Health systems are struggling with this question worldwide. Instead of simplifying this challenge into barriers and facilitators, what if we embraced its complexity? 

In recent years there have been increasing calls for the implementation of shared decision-making in routine clinical care. Shared decision-making is particularly helpful for decisions where there are multiple appropriate options, and the ‘best’ decision rests with the patient’s preferences.

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