What types of health evidence persuade actors in a complex policy system?

Posted in: Evidence and policymaking, Health, Housing

Dr Geoff Bates is a Research Associate at the University of Bath Institute for Policy Research (IPR). Professor Sarah Ayres is Professor of Public Policy and Governance at the School for Policy Studies, University of Bristol. Dr Andrew Barnfield is a Research Fellow at the School for Policy Studies, University of Bristol. Dr Charles Larkin is Director of Research at the IPR. 

This piece was originally published on the Policy & Politics blog on 12 July 2023. 

Good quality urban environments can help to prevent non-communicable diseases such as cardiovascular diseases, mental health conditions and diabetes that account for three quarters of deaths globally (World Health Organisation, 2022). More commonly however, poor quality living conditions contribute to poor health and widening inequalities (Adlakha & John, 2022). Consequently, many public health advocates hope to convince and bring together the stakeholders who shape urban development to help create healthier places.

Evidence is one tool that can be used to convince these stakeholders from outside the health sector to think more about health outcomes. Most of the literature on the use of evidence in policy environments has focused on the public sector, such as politicians and civil servants (e.g., Crow & Jones, 2018). However, urban development decision-making processes involve many stakeholders across sectors with different needs and agendas (Black et al., 2021). While government sets policy and regulatory frameworks, private sector organisations such as property developers and investors drive urban development and strongly influence policy agendas.

In our article recently published in Policy & PoliticsWhat types of evidence persuade actors in a complex policy system?, we explore the use of evidence to influence different groups across the urban development system to think more about health outcomes in their decisions.

The research is based on 132 qualitative interviews with urban development stakeholders in public, private and third sectors, who were asked about what evidence they find credible and likely to influence their decision-making? We sought to identify similarities and differences in types of influential evidence between groups.

The key findings of the research were that:

  1. Evidence-based narratives have wide appeal. Narratives based on real-world and lived experiences help stakeholders to form an emotional connection with evidence and are effective for drawing attention to health problems. Powerful outcomes such as child health and mortality data are particularly persuasive. This builds on literature promoting the use of storytelling approaches for public sector actors by demonstrating its applicability within the private and third sectors.
  2. Credibility of evidence is critical. Compelling narratives backed up with data will have a larger impact. Our findings point to a greater concern for credibility and preference for quantitative data amongst public sector actors, most prominently those in central government.​
  3. The need for many stakeholders to meet priorities other than public health limits the influence of health evidence. Evidence demonstrating the economic impacts of improved health outcomes can be influential on those for whom health outcomes are not a key priority. Evidence demonstrating a commercial advantage to developers and business can be persuasive.​

These insights can be used to design evidence that meets the requirements of different urban development stakeholders and to persuade them to think more about how the quality of urban environments affects health outcomes. Additionally, they point to how changes are needed in governance and regulatory principles to encourage all groups with the power to create healthy environments to prioritise public health outcomes alongside other requirements. Our findings also have wider implications for thinking about how to influence other multi-stakeholder policy environments.

You can read the original research in Policy & Politics:

Bates, G., Ayres, S., Barnfield, A., & Larkin, C. (2023). What types of health evidence persuade policy actors in a complex system?, Policy & Politics (published online ahead of print 2023) from https://doi.org/10.1332/030557321X16814103714008

The views and opinions expressed are solely those of the original blog post authors and other contributors and do not necessarily represent those of Policy & Politics or the IPR.

Posted in: Evidence and policymaking, Health, Housing


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