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Populating the Public Health Evidence Base: an historical perspective on area-based interventions

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Title: Populating the Public Health Evidence Base: an historical perspective on area-based interventions


1
Populating the Public Health Evidence Base an
historical perspective on area-based
interventions
  • Presenter Dr Sara Mallinson
  • Professor Jennie Popay, Dr Pam Attree,Dr Bev
    French

2
Populating the Public Health Evidence Base a
call for innovative strategies
  • This work is exploring ways of identifying and
    synthesising information from diverse sources in
    order to inform policy decisions and enhance
    local implementation.
  • We are focusing on the relationship between place
    and health in the context of areabased
    initiatives (ABIs).

3
  • Evidence of effects?
  • We have have 40 years of ABI experience in
    deprived localities to inform contemporary social
    policy development and implementation. However
    the evidence on the impact of previous
    initiatives is thin.
  • Evidence from earlier social policy
    implementation has not been accumulated
    centrally.
  • Evaluations have been variable both in terms of
    quality and method because evaluating ABI health
    impacts is tricky.

4
  • Can we learn from the past?
  • Methods for evaluating contemporary social
    programmes is a growing field of academic
    endeavour in the UK and elsewhere (eg via the
    Campbell Collaboration).
  • But what can we learn from earlier initiatives?
  • Is there historical evidence we can identify and
    explore?

5
  • The challenge for historically sensitive evidence
    based policy
  • What do we want to know about the local history
    of policy implementation and why?
  • What kinds of materials can provide us with
    knowledge about local processes?
  • Are resources to inform a study of local policy
    history accessible?
  • Is it feasible to systematically review
    historical evidence on local policy context?

6
Our Research Social Capital, History and
Policy Implementation A synthesis and review
of the literature. Aims To understand how
local historical context might shape the
implementation of contemporary area-based
interventions to improve health. To explore
the methodological challenges of identifying,
retrieving and synthesising evidence from
diverse literatures and other resources.
7
  • Why the Social Capital focus?
  • Definitions of social capital are contested. We
    are focusing on the constructs of trust and
    participation/engagement because it has been
    mooted that
  • 1. Trust and civic engagement might be more
    health enhancing than other dimension of social
    capital.
  • 2. Trust and engagement may buffer some
    communities against the worst effects of
    deprivation.
  • 3. The breakdown of trust and engagement might
    be one of the pathways through which income
    inequality exerts its influence on mortality.
  • .

8
  • The Community Development Project
  • We are using a case-study approach.
  • Our target ABI is the Community Development
    Project (CDP) that ran from 1969-1978.
  • The CDP was a home office initiative to tackle
    poverty and deprivation. At the time it was
  • Britains largest ever government funded
    social- action experiment. (Loney,1983)

9
  • The CDP
  • Announced by the Wilson government in 1969, it
    encompassed twelve sites around Britain with
    marked deprivation.
  • The initial aim was to identify ways of creating
    a more integrated community by building
    inter-agency ties to support and promote
    self-help and participation in the community.
  • Total cost was 5 million. The Home Office
    supplied 75 of the funding, the host LA
    contributed the remaining 25.

10
  • The CDP
  • Each CDP had a steering group consisting of local
    authority officers and councillors, voluntary
    sector representatives and a Home Office
    representative.
  • Each site had an action team consisting of a
    director and action workers plus a research team
    and research director who were linked to an
    academic institution.
  • All the CDP sites produced working papers,
    interim reports and final reports to the Home
    Officer detailing their activities and
    evaluations.

11
  • Fieldwork Sites
  • We selected four sites on the basis of
    geographic, cultural and historical factors. Our
    sites are
  • Newington, Southwark.
  • Glyncorrwg, Upper Afan.
  • Hillfields, Coventry.
  • Cleator Moor, Cumbria.

12
  • Central searches
  • A search for published materials produced at the
    time the CDPs were running.
  • Secondly, a search of wider and more recent
    literatures about the CDP and more general
    concepts relevant to its implementation.

13
  • Published Documents
  • We have used
  • Web-of-Knowledge
  • COPAC
  • WorldCat
  • Public Library Catalogues
  • JISC mail a call for expert advice.
  • Key reference snowballing.

14
  • The Site Searches main aims
  • To identify and map diverse documentary sources
    of information about the CDP which are accessible
    in the local sites but not identifiable through
    traditional search strategies done by the central
    Lancaster team (newspapers, pamphlets, minutes,
    local reports).
  • Identify a range of people with knowledge of the
    CDP and conduct oral history interviews with a
    purposively selected sample (residents, CDP
    action and research team members, councillors,
    local officers etc)

15
What challenges have we experienced?
  • Time consuming and labour intensive to map and
    access materials locally.
  • Records are incomplete and partial.
  • Using a narrative synthesis model to extract
    information but the materials are diverse,
    unstructured and non-research making appraisal
    difficult.

16
An historical approach to narrative evidence
synthesis
  • Authentification Who wrote this? For what
    purpose and in what context?
  • Corroboration What do different sources
    contribute to the story?
  • Connection What recurrent themes emerge from
    across the sources?

17
Potential
  • Connecting past and present initiatives and
    experiences.
  • Unearthing locally significant information about
    the successes and failings of previous trenches
    of ABIs.
  • Beginning to map existing materials for future
    synthesis (creation of searchable archives?)

s.mallinson_at_lancaster.ac.uk
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