How has increased local accountability in public health decision making changed how local evidence is used?




Poster session 3


Tuesday 18 September 2018 - 12:30 to 14:00

All authors in correct order:

Rojas-García A1, Kneale D2, Thomas J2
1 NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, UK
2 Evidence for Policy and Practice Information and Coordinating Centre, Institute of Education, University College London, UK
Presenting author and contact person

Presenting author:

Antonio Rojas-García

Contact person:

Abstract text
Background: The transition of responsibilities for delivering most public health functions from the National Health Service into Local Authorities in England in 2013 theoretically provided greater opportunities for local evidence to be integrated into decision making. However, the extent to which such local evidence is being incorporated into local public health decision making, and the types and rigour of evidence being used has been relatively unexplored.
Objectives: This presentation will report on findings from a mixed methods study on evidence use in public health and seeks to: 1) explore how evidence from local areas is incorporated into local public health decision making; 2) understand the influence of political accountability on evidence use practices; and 3) develop and co-develop recommendations for practice.
Methods: This presentation reports on findings from: 1) a systematic review of evidence use studies; 2) documentary analysis of public health strategies using Qualitative Comparative Analysis; 3) interviews conducted with public health practitioners (PHPs); 4) reflections of a lay research panel on the findings and recommendations.
Results: The systematic review and interview findings are consistent in that public health decision making has become increasingly politicised, although for some interview participants, this can bring advantages. Despite interview participants stressing that politicisation introduced a renewed interest in local provenance of evidence, documentary analyses revealed that local evidence was almost exclusively drawn from local surveys or statistical evidence disaggregated to a local level; in contrast qualitative evidence was virtually absent. Interviews revealed that decision makers could be drawn to a plurality of local evidence, with economic evidence viewed as particularly influential, although PHPs held concerns about the vulnerability of qualitative evidence to misappropriation in its use.
Conclusions: This presentation uncovers a discrepancy between localism and democratisation in public health decision making in England, and barriers to the use of evidence on the understandings of (local) people being incorporated into decision-making.
Patient or healthcare consumer involvement: Data have been collected from PHPs, and lay research panel members will critically appraise and co-develop recommendations.

Relevance to patients and consumers: 

Data have been collected from public health practitioners, and lay research panel members will critically appraise and co-develop recommendations.