Intended for healthcare professionals


How evidence based is English public health policy?

BMJ 2011; 343 doi: (Published 17 November 2011) Cite this as: BMJ 2011;343:d7310
  1. Srinivasa Vittal Katikireddi, clinical research fellow1,
  2. Martin Higgins, senior public health researcher2,
  3. Lyndal Bond, associate director1,
  4. Chris Bonell, senior lecturer3,
  5. Sally Macintyre, director1
  1. 1 Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Glasgow G12 8RZ, UK
  2. 2Public Health and Health Policy, NHS Lothian, Edinburgh, UK
  3. 3Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: S V Katikireddi vkatikireddi{at}

Srinivasa Vittal Katikireddi and colleagues’ analysis of the government’s white paper Healthy Lives, Healthy People finds many of the interventions proposed lack evidence of effectiveness and some have even been shown not to work

Use of robust evidence to inform public health policy is likely to ensure the greatest and most equitable population health gains.1 In the United Kingdom and elsewhere there has been prominent support for an “evidence based” policy approach from senior policy makers over the past two decades,2 and the current coalition government has maintained this stance. In his speech to the Faculty of Public Health conference in July 2010, Andrew Lansley, the secretary of state for health, stated: “Our new approach across public health services must meet tougher tests of evidence and evaluation . . . We must only support effective interventions that deliver proven benefits.”3

But how well is the government following its own advice? We examine the quality of evidence that underpins proposed actions in the white paper Healthy Lives, Healthy People.4 This white paper includes organisational reforms that aim to change the structure of the public health workforce, several measures relating to delivery of English NHS services (that are interlinked to the white paper on the NHS5), and an outline of proposals for actions to improve population health.

Identifying the evidence

We identified 51 statements describing specific interventions aiming to improve population health in the white paper. Two reviewers used a systematic approach to search for evidence relating to actions in the white paper and appraise its quality. In addition, we asked topic experts (expert advisers) to review the completeness and accuracy of our evidence assessments. These methods and a discussion of the limitations are available on The nature of interventions suggested and the underpinning evidence varied widely. Full …

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