A policy effectiveness-feasibility loop? Promoting the use of evidence to support the development of healthy public policy

Background Historically, policy initiatives have made variable contributions to improvements in public health. Today there is a growing interest in translating evidence from health research into healthy public policy. Although research evidence may be a component of policy development, it is rarely enough, because policy makers are subject to a wide range of influences. Furthermore, researchers and policy makers usually work within different time frames and rules of evidence. There is a growing, albeit limited, literature on how researchers can most effectively engage with policy makers. Evidence suggests that more active and effective dialogue between researchers and policy makers is needed, in the formulation of research questions, presentation of evidence, and drafting and choice of policy options. Aim To develop, implement, and evaluate an interactive approach to informing policy for the prevention and management of cardiovascular disease (CVD) and diabetes. Setting This work is being undertaken in four eastern Mediterranean territories, known to have high burdens of CVD and diabetes: Palestine, Tunisia, Turkey and Syria. Methods and results Available epidemiological data are being identified, appraised and used to populate the IMPACT CHD Policy Model in order to examine CHD trends. Two corresponding epidemiological models have been developed to examine trends in type 2 diabetes and ischaemic stroke. An intensive review of the literature and consultation assists in the identification of efficacious policy interventions. A situation analysis is being undertaken within each country using mixed methods, which include: key informant and in depth interviews, document reviews, and participant observation. Its aim is to review current policy (stated and implemented), perceived facilitators and barriers to policy change, including health beliefs, and aspects of the health system. Policy makers are explicitly involved as key informants, participants, advisors and “lobbyists”. The epidemiological modelling, evidence based reviews, and situation analyses are together being used to generate diverse policy options. The cost-effectiveness of each chosen option will then be assessed. Conclusions We have developed a provisional framework for developing policy options, initially for the prevention of CVD and diabetes. This is based on local epidemiological data, an assessment of the socio-political-cultural context and cost effectiveness. Policy makers are involved throughout, and will be presented with costed policy options along with their potential consequences. Implemented options will then be evaluated. The framework represents a “policy effectiveness-feasibility loop”, analogous to Tugwell's clinical effectiveness loop. The impact of this approach, and its potential generalisability, will be rigorously evaluated.