ESRC Centre for Evidence-based Public Health Policy

Mark Petticrew

MRC Social and Public Health Sciences Unit

University of Glasgow

CHIEFSCIENTIST OFFICE

Co-ordinating centre: QMW (London) • What Works For Children (London,York)• Centre for Neighbourhood Research (Glasgow/Bristol)• Centre for Economic Evaluation

(IFS, London)• Research Unit for Research Utilisation (RURU) (St. Andrews)

• Centre for Evidence in Ethnicity, Health and Diversity (Warwick/De Montfort)

• Social Policy and Social Care(YORK)

• Centre for Comparative European Policy Evaluation (London)

• Centre for Evidence-Based Public Health Policy (Glasgow/Lancs/Liverpool)

• Glasgow (Mark Petticrew, Sally Macintyre, Matt Egan, Sian Thomas, Val Hamilton)

• Liverpool (Margaret Whitehead, Frances Drever, Beth Milton)

• Lancaster (Hilary Graham, Liz McDermott, Pam Attree)

• Sheffield (Clare Bambra)

1. To explore the wider evidence base for improving the public health and reducing inequalities in health;

2. To collate and synthesise the evidence base (improving public health and reducing inequalities in health); and

3. Engage with policy/practitioner/and academic users.

Systematic reviews: Housing and regeneration

• Housing improvement and health (Thomson et al; BMJ 2001).

• Are national area-based initiatives a public health investment? A systematic review (Hilary Thomson & Rowland Atkinson; est Jan 2005)

• Using systematic review methodology, we have examined the national evaluations of UK regeneration programmes (1980-2004) to assess how the effectiveness of two decades of regeneration investment has been evaluated

Transport

• Health impacts of new road building (Egan et al., Am J Public Health 2003)

• “Systematic review of reviews” of transport policies (Morrison, J Epidemiol Comm Health 2003)

• Promoting walking and cycling as an alternative to

using cars (“modal shift”) (Ogilvie et al., Br Med J 2004)

Employment

• The health and employment impacts of state-subsidies (Egan et al., submitted)

• The health impacts of workplace re-organisation: a systematic review (Egan, Bambra et al., Jan 2005)

• How effective are labour market interventions in helping disabled people gain employment? (Bambra, Whitehead; In press, Soc Sci Med)

• The epidemiology of sickness absence: a systematic review. (Bambra, Whitehead, In press)

Childhood disadvantage: Systematic Reviews• Social consequences of poor health in childhood (Milton,

Whitehead)

• Childhood disadvantage & health inequalities (Raine &

Graham, In press: Child). Other• Young women & contraceptive use: SR of research on

uptake, choice, & discontinuation among adolescent girls (Williamson, et al., ongoing)

• Teenage mothers & smoking: systematic review of qualitative research (McDermott, Graham; Journal of Youth Studies Vol. 8 (1))

Increasing utility

• A systematic review is not the end product (or even the most useful product)

• ...Because research evidence on its own is often not very useful to users

Housing systematic review

Joint academic/ practitioner report incorporating Scottish Housing Law etc Evaluation by practitioners

of its use and utility

Report, incorporating wider range of evidence on damp, noise, asthma

WHO briefing paper

Academic paper (evaluations of interventions)

New roads review

Academic paper (evaluations of health and social impacts of new roads)

Summary report aimed at “Transport community” (experts and users)

Input into public inquiry into the M74 extension

Problems with public health evidence…

• Problems with “high concept” notions of evidence preferred by academics

• “In policy circles a mixed economy of evidence prevails, with different types of scientific and non-scientific evidence used”

• Research that is explanatory, rather than evaluative• Evidence that lacks an equity dimension• Little information on costs

Evidence with an equity dimension:

• Systematic reviews assessing “differential effectiveness” of interventions

• Do the effects vary by social class, gender, education, ethnicity, etc?

• Pilot study of differential effects of community level smoking cessation/prevention interventions

• Based on existing Cochrane reviews

DH-funded project, collaboration between CRD & MRC SPHSU & University of Liverpool, Glasgow

Systematic reviews

CDSR DARE etcetc

Primary studies

Unpublished analyses

New analyses

Evidence on smoking & inequalities

Methodological “challenges”

• Post hoc analysis of primary studies• Sub group analyses underpowered• Within study (direct) comparisons between social

groups are probably rare• Between study (indirect) comparisons are possible

but biased• “Primary” versus “secondary” outcomes• Cochrane/Campbell Equity Methods group

No bricks without straw...

• Little recent history in the UK of outcome evaluation of social interventions...

• Need to carry out new primary research

•Scotland-wide, prospective, controlled study of housing renewal (Intervention=300; Control=300)

•Two-year follow up (postal, then face to face)

•Qualitative interviews

...To finish 2006

1. SHARP: Scotland’s Housing and Regeneration Project

(Cummins S, Higgins C Petticrew, M Sparks L, Findlay A)

2. The Springburn Supermarket study**Funded through the DH Health Inequalities Initiative

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3. Study of the health impacts of Edinburgh’s Congestion Charging scheme

www.evidencenetwork.org