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The Health Development Agency’s approach to evidence

The Health Development Agency’s approach to evidence. Professor Mike Kelly . The rise of the evidence based approach in Britain. Cochrane, A.L.(1972). Effectiveness and Efficiency: Random Reflections on Health Services , British Medical Journal/Nuffield Provincial Hospitals Trust, London.

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The Health Development Agency’s approach to evidence

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  1. The Health Development Agency’s approach to evidence Professor Mike Kelly

  2. The rise of the evidence based approach in Britain

  3. Cochrane, A.L.(1972) • Effectiveness and Efficiency: Random Reflections on Health Services, British Medical Journal/Nuffield Provincial Hospitals Trust, London.

  4. Archie Cochrane’s Principles • The best care available to all- universalism • The need for a means to determine what was best-rationality • The importance of rooting out harmful or useless practice-compassion • The necessity of ascertaining costs and benefits-accountability

  5. The legacy • The importance of the randomised control trial • Clinical resistance • Health economics

  6. The legacy • The Cochrane and Campbell Collaborations • The importance of the systematic review and meta analysis • NHS Centre for Reviews and Dissemination • Health Evidence Bulletins Wales • The Health Development Agency

  7. The inequalities conundrum • The unintended consequences of health policy and health delivery • Regressive population health • Widening inequalities

  8. HDA Remit to support work on reducing inequalities • What is effective? • What is ineffective? • What is harmful or dangerous?

  9. Application of similar evidence based principles in public health

  10. Key problems

  11. Lack of evidence of what works (less than 0.4% of studies) • Lack of cost effectiveness data

  12. The evidence about upstream and downstream interventions • Bulk of the evidence about downstream interventions

  13. Biological variation and social variation • Social differences in the population • Different dimensions of social difference • Differential responses to interventions

  14. When should effectiveness be measured?

  15. Starting Point for the HDA • to synthesise review level work in public health priority areas • to bring in other forms of scientific evidence • to bring evidence and practice together to target public health priorities and get the evidence into action

  16. Teenage pregnancy HIV/AIDS STIs Smoking Alcohol Drugs Obesity Low birth weight Breastfeeding Housing Qualitative evidence Definitions of inequalities Social support in pregnancy Physical activity Mental health Accidental injury Depression Health Impact Assessment Transport Child poverty Health Impact Assessment Gradients and gaps

  17. Evidence Briefings • Strengths and weaknesses of the evidence • Identification of gaps • Implications for practice and policy • Recommendations for future research

  18. Comprehensive,systematic up to date map of the evidence • Passive resource • Baseline resource from which other products can be developed

  19. Evidence Reviews • Broader approach to data and evidence

  20. Epistemological and related problems

  21. Biases Biases of method (the dominance of the RCT) Compounding biases (errors repeated) Content biases (some problems not investigated)

  22. Practical problems • Evidence synthesis of qualitative and quantitative information • Threshold standards • Academic hostility • Practitioner hostility

  23. What the evidence does not tell you • How to do it • Process data • Implementation problems • Local infrastructures

  24. Two different aspects of how things work • Plausibility: a scientific assessment – biologically, organizationally, socially, psychologically. • Likelihood of success: the nature of local conditions married to tacit knowledge of practitioners

  25. Thinking beyond the evidence • The evidence as a framework of plausible possibilities • The evidence as a starting point for intervention not an imperative or a recipe

  26. Developing Guidance and Resources: A new form of synthesis • Involving the practitioners • Establishment of Evidence and Guidance Collaborating Centres

  27. Permissions and facilitations • For practitioners to think creatively beyond the evidence • For researchers to take responsibility for their evidence

  28. Muted voices • Dominant discourses of evidence • Qualitative methods of data elicitation • Access to tacit knowledge • Access to life worlds

  29. Conclusion • Embracing a range of evidence and learning • Evidence from traditional research • Evidence from practice • Evidence into practice and policy • Practice into evidence

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