Macintyre(1) is right to point out that the evidence base for
tackling inequalities in health is lacking. This is paradoxical given the
number of studies that have been carried out in recent years(2). However,
the evidence base is extensive but not the kind of evidence required for
macro-policy making. Scientific studies about particular inequalities and
local projects such as smoking cessation, Sure Start, Healthy Schools,
describe controlled micro-environments related to individuals, small
communities and service interventions. These studies throw little light
on policy making to achieve a more equitable health for society as a
whole. To think that it would is analogous to expecting the evidence
about what makes small businesses flourish to apply to achieving a sound
national economy as a whole. Our social science evidence-base, although
eloquent on local initiatives, is largely silent about the big picture of
what will make a healthy population in the future.
The policy to tackle poverty and improve the lot of the worst off in
society is a political and moral agenda, which has strength and standing.
It does not need an evidence-base for us to know that it is a good thing.
We do need more evidence about the effects that different approaches have
on the health of the poor and the rest of society. But by its nature
society is not a closed, controlled environment and social studies have
had little to say about the wider context. If we want to discuss those
areas we need to understand better the role of more global influences like
vested interests and the cultural, political and spiritual factors that
influence what people want.
It is important that the lack of evidence-based policy does not stop
us taking evidenced-based action at a local level. There are micro-
environmental changes that a PCT can influence that will improve the lot
of deprived people and will improve local equity of access to services.
Enabling small-scale local changes is a good policy and one that we should
continue to champion.
__________
1 Macintyre S. Evidence based policy making. BMJ 2003;326:5–6
2 Acheson D. Independent inquiry into inequalities in health: report.
London: Stationery Office, 1998.
Competing interests:
None declared
Competing interests:
No competing interests
02 March 2003
Alexander E Limentani
Director of Public Health
East Kent Coastal PCT, Protea House, New Bridge, Marine Parade, Dover, Kent. CT17 9HQ
Rapid Response:
Evidence based policy making
Macintyre(1) is right to point out that the evidence base for
tackling inequalities in health is lacking. This is paradoxical given the
number of studies that have been carried out in recent years(2). However,
the evidence base is extensive but not the kind of evidence required for
macro-policy making. Scientific studies about particular inequalities and
local projects such as smoking cessation, Sure Start, Healthy Schools,
describe controlled micro-environments related to individuals, small
communities and service interventions. These studies throw little light
on policy making to achieve a more equitable health for society as a
whole. To think that it would is analogous to expecting the evidence
about what makes small businesses flourish to apply to achieving a sound
national economy as a whole. Our social science evidence-base, although
eloquent on local initiatives, is largely silent about the big picture of
what will make a healthy population in the future.
The policy to tackle poverty and improve the lot of the worst off in
society is a political and moral agenda, which has strength and standing.
It does not need an evidence-base for us to know that it is a good thing.
We do need more evidence about the effects that different approaches have
on the health of the poor and the rest of society. But by its nature
society is not a closed, controlled environment and social studies have
had little to say about the wider context. If we want to discuss those
areas we need to understand better the role of more global influences like
vested interests and the cultural, political and spiritual factors that
influence what people want.
It is important that the lack of evidence-based policy does not stop
us taking evidenced-based action at a local level. There are micro-
environmental changes that a PCT can influence that will improve the lot
of deprived people and will improve local equity of access to services.
Enabling small-scale local changes is a good policy and one that we should
continue to champion.
__________
1 Macintyre S. Evidence based policy making. BMJ 2003;326:5–6
2 Acheson D. Independent inquiry into inequalities in health: report.
London: Stationery Office, 1998.
Competing interests:
None declared
Competing interests: No competing interests