Kara Helen, Arvidson Malin
We Research It Ltd, The Office, St Mary's Crescent, Uttoxeter, UK
Third Sector Research Centre, School of Social Policy, University of Birmingham, Birmingham, UK.
Perspect Public Health. 2015 Jul;135(4):191-6. doi: 10.1177/1757913914536155. Epub 2014 Jun 24.
Tackling health inequalities is a top priority for public health services in England. Third sector organisations, or non-governmental organisations (NGOs), are seen as having a key role in providing these services, particularly to the socially excluded, often dubbed 'hard to reach', for whom services must be provided if health inequalities are to be reduced. The plethora of evaluation frameworks available to NGOs have a variety of value bases, ranging from those which unambiguously support commissioners and providers to address health inequalities and work with the 'hard to reach', through to those which could offer such support if suitably adapted, to those that would struggle to address these issues in practice. In this context, the aim of this article is to answer the question, 'to what extent can evaluation frameworks help NGOs to address health inequalities caused by social exclusion?'
The literature on health inequalities, evaluation frameworks, and the policy context within which NGOs deliver public health services, is briefly reviewed. We then draw on the concepts of 'comparative advantage' and the 'space of access' to explore the extent to which evaluation frameworks can help NGOs to address health inequalities caused by social exclusion.
We identify contradictions between recent government policies around public service delivery in England which can make it difficult for service providers and commissioners to know which value(s) to focus on. This confusion is likely to at least perpetuate, perhaps even exacerbate, the marginalisation of socially excluded people, particularly in the current climate of austerity. The evaluation frameworks NGOs choose to use, and how they decide to use them, can have a real impact on health inequalities. We argue that, wherever possible, NGOs should place social value at the centre of the evaluation process, or at least make sure they capture as much as they can of the social value they create, in line with their own value base.
Commissioners and providers do not always have a free choice about which evaluation framework to use, for example, due to resource constraints. Nevertheless, commissioners or providers can still influence evaluators to address health inequalities and involve the 'hard to reach'.
解决健康不平等问题是英格兰公共卫生服务的首要任务。第三部门组织，即非政府组织（NGO），被视为在提供这些服务方面发挥关键作用，尤其是为那些通常被称为“难以触及”的社会排斥群体提供服务。若要减少健康不平等现象，就必须为这些群体提供服务。可供非政府组织使用的大量评估框架具有多种价值基础，从明确支持委托方和服务提供方解决健康不平等问题并与“难以触及”群体合作的框架，到经过适当调整后可提供此类支持的框架，再到在实践中难以解决这些问题的框架。在此背景下，本文旨在回答“评估框架在多大程度上能帮助非政府组织解决因社会排斥导致的健康不平等问题？”这一问题。
简要回顾了关于健康不平等、评估框架以及非政府组织提供公共卫生服务的政策背景的文献。然后，我们借鉴“比较优势”和“准入空间”的概念，探讨评估框架在多大程度上能帮助非政府组织解决因社会排斥导致的健康不平等问题。
我们发现英国近期围绕公共服务提供的政府政策之间存在矛盾，这使得服务提供方和委托方难以知晓应关注哪些价值。这种混乱可能至少会使社会排斥群体的边缘化状况持续存在，甚至可能使其加剧，尤其是在当前的紧缩环境下。非政府组织选择使用的评估框架以及它们决定如何使用这些框架，可能对健康不平等产生实际影响。我们认为，只要有可能，非政府组织应将社会价值置于评估过程的核心，或者至少确保它们尽可能多地捕捉到自身创造的社会价值，这与它们自身的价值基础相符。
例如，由于资源限制，委托方和服务提供方在选择使用哪种评估框架时并不总是有自由选择权。然而，委托方或服务提供方仍可影响评估者解决健康不平等问题并让“难以触及”群体参与进来。
