Healthy public policy refers to the use of policies beyond the health services which have the potential to improve health, typically by improving determinants of health, for example socio-economic conditions such as employment, income, housing etc.. While improvements to living conditions have long been viewed as an important mechanism to promote public health, the concept of healthy public policy was formally described more recently in the World Health Organisation’s (WHO) Ottawa Charter in 1986.
The rationale for healthy public policy rests heavily on a wealth of cross-sectional data reporting links between socio-economic factors and health. Many of these relationships are well established, providing strong empirical support for hypotheses that intervening to improve socio-economic conditions will lead to improved health. However, hypotheses around health benefits need to be validated: There are many examples of well-intended interventions which did not produce the expected benefits, and in some cases had adverse effects. Compared to many clinical interventions, social interventions are characteristically difficult to control, and likely to be more susceptible to the effect of confounding and mediating factors. These issues increase the level of uncertainty inherent in hypotheses about the impacts of social interventions, in particular health impacts which are influenced by many factors, and further underlines the need for empirical validation.
Evidence from empirical research evaluating the health impacts of social interventions needs to be used to inform and refine future policy if the potential for public policy to contribute to health improvement is to be realised. Both reviews of previous research evidence as well as the pursuit of new evidence can be used to develop the evidence base. Previous evidence needs to be reviewed rigorously and comprehensively to minimise the potential for selective interpretations which may be subject to bias; this is best done using transparent systematic review methods. New evaluations are required to provide up-to-date evidence as well as to improve the quality of evidence and plug gaps in the evidence which systematic reviews are well placed to identify. Having synthesised previous evidence and generated newly relevant evidence, it is crucial that the available evidence is made available to those in policy and practice who are most likely to use the evidence. It is necessary that the evidence is disseminated beyond academic audiences and translate the evidence or knowledge to provide syntheses of evidence which are accessible to and tailored to the needs of potential evidence-users.
The use of systematic reviews, evaluations of health impacts, and knowledge transfer work has existed for many years within both the health and social policy field. However, the application of these approaches to the field of healthy public policy and the health impacts of social interventions is relatively novel. Application of conventional methods to this new area has required adapting and developing existing methods appropriately.
The proposed submission
The portfolio of publications selected for this submission represents a selection of the applicant’s publications since 2001. Hilary Thomson is the lead author on each of these publications which were prepared from work carried out with the Evaluation programme (original title Evaluation of the health impacts of non-health sector interventions) of research based at the Medical Research Council’s Social & Public Health Sciences Unit, Glasgow. This programme was funded by the Chief Scientist’s Office of the Scottish Government in 1999 to provide evidence on the health impacts of social interventions, and thus to inform the development of healthy public policy.
This thesis presents 10 peer reviewed international publications in this field; nine of these are from high impact public health journals, and one is an example of knowledge transfer that was commissioned by the WHO. The work is presented in three key themes each of key relevance to the development of best available evidence for healthy public policy.
Theme I: Systematic review
Three publications are presented in this theme, each of these reports the key findings of a systematic review. Paper I reports the findings of a systematic review of the health impacts of housing improvement; Paper III reports the findings of a similar review which has been substantially updated, both methodologically and in content. Paper II presents the findings of a systematic review of the health and socio-economic impacts of urban regeneration investment in the UK since 1980.
Theme II: Evaluation & generation of new evidence
Four publications are presented in this theme. Paper IV and Paper V report the empirical findings of studies investigating the health impacts of local community leisure facilities, and a local programme of housing-led neighbourhood regeneration respectively. Paper VI and Paper VII present a commentary and reflection based on the author’s experience in the field on how to develop best available evidence to inform healthy public policy. These papers focus on assessing the health impacts of income supplementation interventions, such as welfare benefits, and housing and regeneration investment, however, the emerging lessons and issues have a relevance to the wider field of healthy public policy.
Theme III: Knowledge transfer
Three publications are presented in this theme. Each of these illustrates how my work has gone beyond reviewing and generating evidence for an academic audience, by providing accessible evidence syntheses which are accessible to and tailored to the needs of policy makers and practitioners who wish to use evidence in their work. Paper VIII and Paper IX were commissioned by the Scottish Health Impact Assessment Network and report how I developed evidence syntheses on housing improvement and transport policy. Paper X presents an evidence synthesis on housing and health commissioned by the WHO for use by European policymakers
