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Submission of Phd by Publication Submission of PhD by published work: Developing best available evidence to inform healthy public policy Hilary Thomson MRC Social & Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, G12 8RZ. June 2009 Developing best available evidence to inform healthy public policy Contents Author’s declaration (not included in e-thesis version) Acknowledgements Abstract 1 Preface & list of submitted publications 4 Explanatory essay 6 Bibliography 33 The submitted work: Papers I-X 38 Appendices I: Permissions from co-authors and stated contributions to included papers (not included in e-thesis version) II: Journal permissions for reproduction of papers in thesis III: Definitions of key terms Acknowledgements I would like to thank Professor Sally Macintyre and all the members of the MRC SPHSU for the many ways in which they have supported me and the work included in this thesis. In particular I would like to thank Professor Mark Petticrew who has acted as a mentor to me over the past decade. I have been profoundly influenced by Mark’s reflexivity and avoidance of dogma in the pursuit and use of evidence to improve the value of public policy and investment. I hope that some of this is reflected in this thesis and in my own ongoing work. ABSTRACT/OUTLINE Background & rationale Healthy public policy refers to the use of policies beyond the health services which have the potential to improve health, typically by improving determinants of health, for example socio-economic conditions such as employment, income, housing etc.. While improvements to living conditions have long been viewed as an important mechanism to promote public health, the concept of healthy public policy was formally described more recently in the World Health Organisation’s (WHO) Ottawa Charter in 1986. The rationale for healthy public policy rests heavily on a wealth of cross-sectional data reporting links between socio-economic factors and health. Many of these relationships are well established, providing strong empirical support for hypotheses that intervening to improve socio-economic conditions will lead to improved health. However, hypotheses around health benefits need to be validated: There are many examples of well-intended interventions which did not produce the expected benefits, and in some cases had adverse effects. Compared to many clinical interventions, social interventions are characteristically difficult to control, and likely to be more susceptible to the effect of confounding and mediating factors. These issues increase the level of uncertainty inherent in hypotheses about the impacts of social interventions, in particular health impacts which are influenced by many factors, and further underlines the need for empirical validation. Evidence from empirical research evaluating the health impacts of social interventions needs to be used to inform and refine future policy if the potential for public policy to contribute to health improvement is to be realised. Both reviews of previous research evidence as well as the pursuit of new evidence can be used to develop the evidence base. Previous evidence needs to be reviewed rigorously and comprehensively to minimise the potential for selective interpretations which may be subject to bias; this is best done using transparent systematic review methods. New evaluations are required to provide up-to- date evidence as well as to improve the quality of evidence and plug gaps in the evidence 1 which systematic reviews are well placed to identify. Having synthesised previous evidence and generated newly relevant evidence, it is crucial that the available evidence is made available to those in policy and practice who are most likely to use the evidence. It is necessary that the evidence is disseminated beyond academic audiences and translate the evidence or knowledge to provide syntheses of evidence which are accessible to and tailored to the needs of potential evidence-users. The use of systematic reviews, evaluations of health impacts, and knowledge transfer work has existed for many years within both the health and social policy field. However, the application of these approaches to the field of healthy public policy and the health impacts of social interventions is relatively novel. Application of conventional methods to this new area has required adapting and developing existing methods appropriately. The proposed submission The portfolio of publications selected for this submission represents a selection of the applicant’s publications since 2001. Hilary Thomson is the lead author on each of these publications which were prepared from work carried out with the Evaluation programme (original title Evaluation of the health impacts of non-health sector interventions) of research based at the Medical Research Council’s Social & Public Health Sciences Unit, Glasgow. This programme was funded by the Chief Scientist’s Office of the Scottish Government in 1999 to provide evidence on the health impacts of social interventions, and thus to inform the development of healthy public policy. This thesis presents 10 peer reviewed international publications in this field; nine of these are from high impact public health journals, and one is an example of knowledge transfer that was commissioned by the WHO. The work is presented in three key themes each of key relevance to the development of best available evidence for healthy public policy. 2 Theme I: Systematic review Three publications are presented in this theme, each of these reports the key findings of a systematic review. Paper I reports the findings of a systematic review of the health impacts of housing improvement; Paper III reports the findings of a similar review which has been substantially updated, both methodologically and in content. Paper II presents the findings of a systematic review of the health and socio-economic impacts of urban regeneration investment in the UK since 1980. Theme II: Evaluation & generation of new evidence Four publications are presented in this theme. Paper IV and Paper V report the empirical findings of studies investigating the health impacts of local community leisure facilities, and a local programme of housing-led neighbourhood regeneration respectively. Paper VI and Paper VII present a commentary and reflection based on the author’s experience in the field on how to develop best available evidence to inform healthy public policy. These papers focus on assessing the health impacts of income supplementation interventions, such as welfare benefits, and housing and regeneration investment, however, the emerging lessons and issues have a relevance to the wider field of healthy public policy. Theme III: Knowledge transfer Three publications are presented in this theme. Each of these illustrates how my work has gone beyond reviewing and generating evidence for an academic audience, by providing accessible evidence syntheses which are accessible to and tailored to the needs of policy makers and practitioners who wish to use evidence in their work. Paper VIII and Paper IX were commissioned by the Scottish Health Impact Assessment Network and report how I developed evidence syntheses on housing improvement and transport policy. Paper X presents an evidence synthesis on housing and health commissioned by the WHO for use by European policymakers. 3 Preface I joined the MRC Social & Public Health Sciences Unit in November 1999 as a research associate on the newly created programme entitled ‘Evaluating the health effects of social interventions’ (from now on this will be referred to as the Evaluation programme). This programme, funded by the Chief Scientist Office of the then Scottish Executive (now Scottish Government), was set up to conduct primary and secondary research assessing the health impacts of non-health sector interventions and was led by Dr Mark Petticrew. In 2004 I was promoted to the post of research scientist within this programme. Prior to joining the Evaluation programme I had completed a Bachelor of Nursing Degree and a Masters in Public Health and I had worked for three years in primary care research. Since my original appointment I have developed an active research interest within the field of housing and urban regeneration and I have led much of the programme’s work on this topic. I have carried out systematic reviews of existing research, developed evaluations to assess the health impacts of housing and neighbourhood change, as well as working closely with policy makers and practitioners to produce appropriate translations of the research. This body of work has been developed with the overarching aim to provide policy relevant evidence to help promote the pursuit of health outcomes through non-health sector policies, i.e. to promote the development of healthy public policy. The ten papers which I am submitting for the degree of PhD by published works are listed below; these are grouped into three key themes relevant to the development of evidence to develop healthy public policy. In the explanatory essay I provide a brief background to the field, a summary of each paper and what the paper has contributed to the field both in terms of substantive knowledge and methodological development. This collection of ten papers has been selected from a larger body of my published work. For each of these papers I am the lead author and guarantor, preparing the first and subsequent drafts of the papers in light of co-author and referees’ comments. I led on developing the original research idea, developing the methods being used, refining the research question, and performing the analysis being reported within the paper (see Appendix for co-author signatures confirming this). 4 List of submitted publications Theme I: Systematic Review Paper I Thomson H, Petticrew M, Morrison D. Health effects of housing improvement: systematic review of intervention studies. BMJ 2001;323(7306):187-190. Paper II Thomson H, Atkinson R, Petticrew M, Kearns A. Do urban regeneration programmes improve public health and reduce health inequalities? A synthesis of the evidence from UK policy and practice (1980-2004). Journal of Epidemiology & Community Health 2006; 60 (2):108-115.
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