School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia.
Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Int J Health Policy Manag. 2018 Jul 1;7(7):581-592. doi: 10.15171/ijhpm.2018.04.
Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research.
We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated.
We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated.
Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
关于健康不平等的社会决定因素的流行病学证据已经相当充分，但对于评估解决这些社会决定因素的公共政策的影响，关注的程度要低得多。在生成关于政策结果的证据方面存在方法学挑战，这对为健康公平调动政策行动构成了重大障碍。本次审查旨在检查评估健康公平结果的政策评价方法，并确定未来研究有前途的方法。
我们对批判性评估政策对健康公平影响的文献进行了系统的叙述性审查，综合了有关所使用方法的信息。我们按照预先确定的方案从五个电子数据库中搜索和筛选记录，共检索到 50 项符合审查条件的研究。我们根据以下标准对研究进行编码：（1）分析的政策类型；（2）研究设计；（3）分析技术；（4）健康结果；（5）评估的公平维度。
我们发现，越来越多的政策被评估用于健康公平结果，采用了各种研究设计。大多数研究采用了观察性研究设计，其中大部分是横断面研究，但其他方法包括实验设计、模拟建模和荟萃分析。回归技术主导了分析方法，但也使用了一些新的技术，这些技术可能比传统回归分析更有利于研究政策的分配影响。很少有研究进行了国内或跨国比较，也没有收集原始数据。尽管政策结果评价中的归因挑战由来已久，但大多数研究都将身体或心理健康结果的变化归因于所评估的政策。
我们的综述提供了健康公平政策结果评价方法的概述，展示了最常见的方法和新颖方法的机会。我们发现，评估公共政策对健康公平影响的研究数量正在增加，但鉴于不平等现象日益加剧，这一政策评价领域仍需要更多关注。
