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Promoting action on structural drivers of health inequity: principles for policy evaluation

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dc.contributor.authorSchram, A.
dc.contributor.authorTownsend, B.
dc.contributor.authorMackean, T.
dc.contributor.authorFreeman, T.
dc.contributor.authorFisher, M.
dc.contributor.authorHarris, P.
dc.contributor.authorWhitehead, M.
dc.contributor.authorvan Eyk, H.
dc.contributor.authorBaum, F.
dc.contributor.authorFriel, S.
dc.date.issued2022
dc.description.abstractBackground: Insufficient progress has been made towards reducing health inequities, due in part to a lack of action on the root causes of health inequities. At present, there is a limited evidence base to guide policy decision making in this space. Key points for discussion: This paper proposes new principles for researchers to conduct health equity policy evaluation. Four key principles are presented: (1) where to evaluate – shifting from familiar to unfamiliar terrain; (2) who to evaluate – shifting from structures of vulnerability to structures of privilege; (3) what to evaluate – shifting from simple figures to complex constructs; and (4) how to evaluate – shifting from ‘gold standard’ to more appropriate ‘fit-for-purpose’ designs. These four principles translate to modifying the policy domains investigated, the populations targeted, the indicators selected, and the methods employed during health equity policy evaluation. The development and implementation of these principles over a five-year programme of work is demonstrated through case studies which reflect the principles in practice. Conclusions and implications: The principles are shared to encourage other researchers to develop evaluation designs of sufficient complexity that they can advance the contribution of health equity policy evaluation to structural policy reforms. As a result, policies and actions on the social determinants of health might be better oriented to achieve the redistribution of power and resources needed to address the root causes of health inequities.
dc.description.statementofresponsibilityAshley Schram, Belinda Townsend, Tamara Mackean, Toby Freeman, Matt Fisher, Patrick Harris, Margaret Whitehead, Helen van Eyk, Fran Baum, and Sharon Friel
dc.identifier.citationEvidence and Policy: a journal of research, debate and practice , 2022; 18(4):761-775
dc.identifier.doi10.1332/174426421x16420923635594
dc.identifier.issn1744-2648
dc.identifier.issn1744-2656
dc.identifier.orcidFreeman, T. [0000-0002-2787-8580]
dc.identifier.orcidFisher, M. [0000-0003-3756-1146]
dc.identifier.orcidvan Eyk, H. [0000-0002-8573-4235]
dc.identifier.orcidBaum, F. [0000-0002-2294-1368]
dc.identifier.urihttps://hdl.handle.net/2440/137342
dc.language.isoen
dc.publisherPolicy Press
dc.relation.grantAPP1078046
dc.rights© Policy Press 2022
dc.source.urihttps://doi.org/10.1332/174426421x16420923635594
dc.subjectpolicy evaluation; health equity; social determinants of health; policy impact
dc.titlePromoting action on structural drivers of health inequity: principles for policy evaluation
dc.typeJournal article
pubs.publication-statusPublished

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