Education And Debate

Using evidence to inform health policy: case study

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7280.222 (Published 27 January 2001) Cite this as: BMJ 2001;322:222
  1. Sally Macintyre (Sally@msoc.mrc.gla.ac.uk), directora,
  2. Iain Chalmers, directorb,
  3. Richard Horton, editorc,
  4. Richard Smith, editord
  1. a MRC Social and Public Health Sciences Unit, Glasgow G12 8RZ
  2. b UK Cochrane Centre, NHS Research and Development Programme, Oxford OX2 7LG
  3. c Lancet, London WC1B 3SL
  4. d BMJ, London WC1H 9JR
  1. Correspondence to: S Macintyre
  • Accepted 18 September 2000

Editorial by George Davey Smith

Doctors are exhorted to practice evidence based medicine, and the British government says that it wants public policy to be based on evidence.1 We share the government's enthusiasm, but can it become a reality rather than an aspiration? How much do we know about what works, and are researchers, government ministers, and civil servants truly committed to developing and using the best evidence?

We had an opportunity to learn about the realities of evidence based policy making when we were invited in late 1997 to become an “evaluation group” to assist the independent inquiry into inequalities in health.2 Our reflections concern the material submitted and the evaluation process, not the final report.

Summary points

The UK government is trying to create a culture of “evidence based policy” that will apply to public health and social policy as well as to health care

Submissions to a government inquiry about possible interventions to reduce health inequalities lacked evidence of effectiveness and information on costs and possible harms

There is a need to improve the evidence base used for making public policy

The independent inquiry into inequalities in health

In 1997 the minister for public health for England and Wales, Tessa Jowell, commissioned Donald Acheson, the former chief medical officer for England, to “moderate a Department of Health review of the latest available information on inequalities in health … and in the light of evidence, to conduct—within the broad framework of the Government's overall financial strategy—an independent review to identify priority areas in future policy development, which scientific and expert evidence indicates are likely to offer opportunities for Government to develop beneficial, cost effective, and affordable interventions to reduce health inequalities.”2 The report was to be submitted by the end of June 1998. Three key limitations were placed on the inquiry: recommendations had to …

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