Janice Lee1, Ashley Schram1, Emily Riley2, Patrick Harris2, Fran Baum3, Matt Fisher3, Toby Freeman3, Sharon Friel1. 1. School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia. 2. Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. 3. Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia.
Abstract
BACKGROUND: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research. METHODS: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated. RESULTS: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated. CONCLUSION: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
BACKGROUND: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research. METHODS: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated. RESULTS: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated. CONCLUSION: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
Authors: Gitte C Kloek; Frank J van Lenthe; Peter W M van Nierop; Maria A Koelen; Johan P Mackenbach Journal: Health Place Date: 2005-10-25 Impact factor: 4.078
Authors: Bo Burstrom; Margaret Whitehead; Stephen Clayton; Sara Fritzell; Francesca Vannoni; Giuseppe Costa Journal: Soc Sci Med Date: 2010-01-08 Impact factor: 4.634
Authors: Phil Edwards; Rebecca Steinbach; Judith Green; Mark Petticrew; Anna Goodman; Alasdair Jones; Helen Roberts; Charlotte Kelly; John Nellthorp; Paul Wilkinson Journal: J Epidemiol Community Health Date: 2013-06-13 Impact factor: 3.710
Authors: Tony Blakely; Linda J Cobiac; Christine L Cleghorn; Amber L Pearson; Frederieke S van der Deen; Giorgi Kvizhinadze; Nhung Nghiem; Melissa McLeod; Nick Wilson Journal: PLoS Med Date: 2015-07-28 Impact factor: 11.069
Authors: Ruth Martin-Misener; Sabrina T Wong; Sharon Johnston; Stephanie Blackman; Catherine Scott; William Hogg; Fred Burge; Anne M Grool; John L Campbell; Sara Wuite Journal: BMJ Open Date: 2019-10-17 Impact factor: 2.692