In answer to the question “How evidence based is English public health policy?” bmj.com has published an analysis, which reveals that many of the proposed actions in the government’s white paper Healthy Lives, Healthy People provide insufficient evidence of effectiveness whilst others have demonstrated that they simply do not work.

Andrew Lansley, the Secretary of State for health declared in his speech to the Faculty of Public Health conference in July 2010, that:

“Our new approach across public health services, must meet tougher tests of evidence and evaluation … We must only support effective interventions that deliver proven benefits.”

This raises the question of how well the government is following its own advice.

Srinivasa Vittal Katikireddi and her team decided to investigate and assessed the quality of evidence that lies beneath proposed actions in the white paper, ‘Healthy Lives, Healthy People’.

The investigators found 51 statements in the white paper that described specific interventions, which aimed to improve population health in areas, such as food, alcohol, tobacco, physical activity, employment and welfare, green space, housing and neighbourhoods. Two investigators subsequently looked for evidence regarding these actions and appraised its quality, in addition to calling on expert advisers to review the statements’ completeness and accuracy of their assessments.

They discovered that although some interventions were in keeping with the existing evidence base, many were potentially ineffective or lacked evidence of effectiveness. The researchers point out that there are still large gaps in the research evidence.

According to the researchers’ suggestions, ineffective interventions, such as universal instead of targeted cardiovascular risk screening for people aged between 40-74 years should not be implemented and novel interventions like children’s sports competitions should be rigorously evaluated.

Given that the white paper advocates for interventions to be based on evidence, the researchers decided to select it for their case study. For this reason they did not account for several other actions implemented by the coalition government that could potentially affect population health and inequalities, as for example cuts in public spending and the increase in VAT. They also took into account that some of the white paper policies have been carried over from the previous Labour government to ensure that the variable quality of evidence is not purely based on the present government.

They write:

“We do not believe that a lack of robust evaluations should prevent an intervention from being implemented, however, when action is taken its effects should be rigorously evaluated.”

They conclude that it should not be forgotten that many public health interventions could cause potential harm, just as medical interventions.

As the House of Commons Health Select Committee puts it:

“Such wanton large-scale experimentation is unethical, and needs to be superseded by a more rigorous culture of piloting, evaluating and using the results to inform policy.”

Written by Petra Rattue