This chapter considers health inequalities, an area in which Peter used his science and his art to press for more effective action. It notes that far from allowing the Conservative government at the time to bury the findings of the Black Report on health inequalities, which focused on the social determinants of health, Peter’s efforts turned it into a Penguin best-seller with three editions. It also draws on Peter’s work to discuss both the nature of the national and global challenges that remain, as well as considering the link between poverty and health.
Understanding the ‘evidence’ for policy is complicated. This article examines the relationship between evidence and policies on early childhood interventions in two states of Australia, revealing powerful insights into what constitutes the evidence for policy and the importance of ‘killer facts’ to decision makers. The nature of evidence in the policy environment is broad and complex, going well beyond research to incorporate policy context and processes. These findings reinforce an evidence-informed approach to health policy making and the need for researchers to develop a more sophisticated understanding of the policy context.
Insufficient progress has been made towards reducing health inequities, due in part to a lack of action on the root causes of health inequities. At present, there is a limited evidence base to guide policy decision making in this space.
Key points for discussion:
This paper proposes new principles for researchers to conduct health equity policy evaluation. Four key principles are presented: (1) where to evaluate – shifting from familiar to unfamiliar terrain; (2) who to evaluate – shifting from structures of vulnerability to structures of privilege; (3) what to evaluate – shifting from simple figures to complex constructs; and (4) how to evaluate – shifting from ‘gold standard’ to more appropriate ‘fit-for-purpose’ designs. These four principles translate to modifying the policy domains investigated, the populations targeted, the indicators selected, and the methods employed during health equity policy evaluation. The development and implementation of these principles over a five-year programme of work is demonstrated through case studies which reflect the principles in practice.
Conclusions and implications:
The principles are shared to encourage other researchers to develop evaluation designs of sufficient complexity that they can advance the contribution of health equity policy evaluation to structural policy reforms. As a result, policies and actions on the social determinants of health might be better oriented to achieve the redistribution of power and resources needed to address the root causes of health inequities.