The cross-cutting projects were selected to address barriers to improving the evidence base for policies to improve health and tackle health inequalities. The barriers were highlighted in a series of reviews of public health research capacity and most notably in the Wanless report. The Wanless report recognised that public health research and policy cover a large canvas, including both ‘interventions to reduce risk factors for disease and interventions to address the wider determinants of health’. Informed by this broad perspective on public health, it provided a helpful summary of the challenges facing the research and policy communities. The Consortium drew on its assessment in identifying priorities for the cross-cutting projects.
Firstly, the report pointed to ‘the almost complete absence of an evidence base on the cost-effectiveness of public health interventions’ and recommended that this gap be urgently addressed. A major issue for cost-effectiveness analyses in public health is that the standard methods have been developed for clinical rather than public health interventions. Assessing the challenges of applying these standard methods was the focus of one of the cross-cutting projects.
Secondly, the Wanless report noted that ‘little is known about the likely impact of interventions that tackle the wider determinants of health and health inequalities’. A project mapped the evidence on interventions addressing wider determinants as a first stage to identifying gaps and priorities for future studies.
Thirdly, the report argued that most public health interventions are not amenable to evaluation through a randomised control trial (RCT). In consequence, it argued that other approaches are required to assess the impact of such interventions. As it observed, ‘there is an urgent need to develop an appropriate practical framework for evaluating public health interventions’. It noted that such frameworks should be capable of capturing the effects of interventions to address wider determinants, including their potential differential effects. These observations have informed the third of our cross-cutting projects. It develops a framework through which to map and to assess how policies in the early years might be expected to influence health inequalities.