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- Author or Editor: Katherine Smith x
Taking health inequalities in the United Kingdom as a case study, this article adopts a ‘discursive institutionalist’ approach to explore how the organisation of policy-making bodies shapes the relationship between research and policy. It demonstrates how policy ‘silos’ and hierarchies work as filters to research-based ideas, encouraging those ideas that support existing institutionalised ideas (or ‘policy paradigms’), while blocking or significantly transforming more challenging ideas. This limits the extent to which research can inform policy. Yet, a lack of institutional memory within policy making enables recycled ideas to appear innovative, creating an impression of meaningful, ongoing dialogue between research and policy.
Health systems everywhere are experiencing rapid change in response to new threats to health, including from lifestyle diseases, risks of pandemic flu, and the global effects of climate change but health inequalities continue to widen. Such developments have profound implications for the future direction of public health policy and practice.
The public health system in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted and what the origins of dilemmas in public health practice are. The book will therefore appeal to public health professionals and students of health policy, potentially engaging them in political and social advocacy.
This chapter discusses the role of ideas in policy making. The existence of conflicts between evidence-based and ideological approaches to politically contentious issues is widely recognised. However, for policy issues — such as public health — in which there seems to be rather more of a consensus about the overarching objectives, it seems less obvious how or why ‘politics’ might obstruct the use of evidence within policy making. Indeed, the majority of civil servants and politicians in a post-1997 UK context have signed up to taking an evidence-based approach to improving population health and reducing health inequalities. The existence of such a cross-sector consensus suggests that public heath might be one area in which evidence-based policy and practice are feasible. Yet, disappointingly, most assessments of public health policies continue to conclude that they are not evidence-based. A popular explanation for this disjuncture is that it results from communicative, institutional, and cultural gaps between researchers and policy makers.
This chapter examines the relationship between alcohol use and health inequalities. It first reviews the evidence and theories concerning health inequalities in morbidity and mortality as well as evidence and theories that specifically relate to the role of alcohol within these broader inequalities. The available evidence suggests that alcohol-related harms follow the expected social gradient; greater harms are suffered by more disadvantaged groups, at least for men and for younger women. However, some statistics indicate that people living in deprived communities consume less alcohol than more advantaged communities. The chapter analyses potential explanations for this apparent tension, often referred to as the alcohol harm paradox, along with evidence concerning the impact of alcohol-related interventions, such as minimum unit pricing (MUP), Reducing the Strength (RTS) schemes and welfare spending, on inequalities. It concludes with a range of relevant research and policy recommendations.
The past two decades witnessed the international consensus around the idea that health policy decisions should be ‘evidence-based’. These efforts have stimulated a wealth of studies explicitly concerned with understanding the use of research evidence in policy. The majority of such studies suggest there are few examples of public health policy outcomes that might reasonably be labelled ‘evidence-based’. Only a small number of these studies seek to explore how political dynamics interacted with evidence to shape policy outcomes. Here, we draw on two empirical case studies of efforts to promote public health evidence to decision makers (protection from secondhand smoke in Europe and tackling health inequalities in England), to highlight the primacy of ‘policy networks’ and ‘advocacy’ for understanding the role of evidence in achieving policy change. Reflecting on our empirical findings, we argue that the policy networks literature usefully foregrounds the roles that diverse ‘policy actors’ can play in connecting research and policy. However, our case studies also suggest that popular accounts of policy networks, such as Haas’ ‘epistemic communities’ and Sabatier and Jenkins-Smith’s Advocacy Coalition Framework (ACF), overstate the role of core values in driving policy network efforts, while underplaying the role of advocacy, leadership, network communication and trust, scientific consensus, political context and strategic policy trade-offs in network success. We conclude by arguing for further efforts to connect analyses of policy networks and evidence use. We also reflect on the implications of our findings for those seeking to employ evidence to effect policy change.
Concerns about the limited influence of research on decision making have prompted the development of tools intended to mediate evidence for policy audiences. This article focuses on three examples, prominent in public health: impact assessments; systematic reviews; and economic decision-making tools (cost-benefit analysis and scenario modelling). Each has been promoted as a means of synthesising evidence for policy makers but little is known about policy actors’ experiences of them. Employing a literature review and 69 interviews, we offer a critical analysis of their role in policy debates, arguing that their utility lies primarily in their symbolic value as markers of good decision making.
