Government programmes driven by politics not evidence, report says
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《英国医生杂志》
The government抯 assertion that its programmes to tackle social exclusion and health inequalities are strongly based on evidence and on "what works" has been challenged in a new report from the independent health think tank the King抯 Fund.
Complex, community based initiatives such as "Sure Start" and the national strategy for neighbourhood renewal are designed by "informed guesswork and expert hunches ?enriched by some evidence and driven by political and other imperatives," says the report.
Many of the professionals interviewed for the research felt that political values played a greater part than evidence in developing programmes. The report reveals that Sure Start, which aims to provide child care, early education, and parenting support for children up to 3 years old, ignored most of the evidence from its US equivalent, Head Start.
A senior government researcher interviewed for the report said that when an election was coming up the clear message for evaluators of social programmes was "give us some tangible quick wins and a feeling of progress." Another government researcher said that in the case of the neighbourhood renewal strategy she was "not sure evidence was used, except in a very headline way."
No agreed framework for evaluating complex social programmes exists, says the report. It argues that uncertainty about the reliability and status of different kinds of evidence and competing ideas about "what works" mean that innovations—especially those addressing complex, interrelated causes of ill health—are particularly vulnerable to attack.
It adds that policy and practice aimed at preventing illness and reducing health inequalities are currently beset by problems, including a "lack of clarity and consistency in approaches to policy making and programme design, muddled messages and confused incentives at all levels, unresolved tensions between different interest groups, and a largely unacknowledged gap between political rhetoric and practical experience."
Anna Coote, the King抯 Fund director of health policy, who wrote the report with Jessica Allen and David Woodhead, said complex, locally based initiatives were notoriously hard to evaluate and that the serious tensions between policy makers, researchers, and local practitioners "give rise to confusion and can get in the way of effective social change."
The paper recommends the development of a "learning culture" in government and among evaluators and practitioners and the integration of the experience of practitioners and local residents with research findings. Above all a "more explicit understanding of the trade-offs required by the political context of the day" is needed, it says.
Ms Coote told the BMJ that what is also needed is "much more honesty and openness about how limited the evidence base is" and an acceptance of its limitations, "because that抯 what you have to do in the real world."
"But people should not go round saying that Sure Start is a shining success, when we have not got the evidence base, or ditching health action zones before you have the evidence," she said.(London Ann McGauran)
Complex, community based initiatives such as "Sure Start" and the national strategy for neighbourhood renewal are designed by "informed guesswork and expert hunches ?enriched by some evidence and driven by political and other imperatives," says the report.
Many of the professionals interviewed for the research felt that political values played a greater part than evidence in developing programmes. The report reveals that Sure Start, which aims to provide child care, early education, and parenting support for children up to 3 years old, ignored most of the evidence from its US equivalent, Head Start.
A senior government researcher interviewed for the report said that when an election was coming up the clear message for evaluators of social programmes was "give us some tangible quick wins and a feeling of progress." Another government researcher said that in the case of the neighbourhood renewal strategy she was "not sure evidence was used, except in a very headline way."
No agreed framework for evaluating complex social programmes exists, says the report. It argues that uncertainty about the reliability and status of different kinds of evidence and competing ideas about "what works" mean that innovations—especially those addressing complex, interrelated causes of ill health—are particularly vulnerable to attack.
It adds that policy and practice aimed at preventing illness and reducing health inequalities are currently beset by problems, including a "lack of clarity and consistency in approaches to policy making and programme design, muddled messages and confused incentives at all levels, unresolved tensions between different interest groups, and a largely unacknowledged gap between political rhetoric and practical experience."
Anna Coote, the King抯 Fund director of health policy, who wrote the report with Jessica Allen and David Woodhead, said complex, locally based initiatives were notoriously hard to evaluate and that the serious tensions between policy makers, researchers, and local practitioners "give rise to confusion and can get in the way of effective social change."
The paper recommends the development of a "learning culture" in government and among evaluators and practitioners and the integration of the experience of practitioners and local residents with research findings. Above all a "more explicit understanding of the trade-offs required by the political context of the day" is needed, it says.
Ms Coote told the BMJ that what is also needed is "much more honesty and openness about how limited the evidence base is" and an acceptance of its limitations, "because that抯 what you have to do in the real world."
"But people should not go round saying that Sure Start is a shining success, when we have not got the evidence base, or ditching health action zones before you have the evidence," she said.(London Ann McGauran)