Populating the Public Health Evidence Base: an historical perspective on area-based interventions Presenter: Dr Sara Mallinson Professor Jennie Popay, Dr Pam Attree,Dr Bev French

Populating the Public Health Evidence Base: a call for innovative strategies This work is exploring ways of identifying and synthesising information from diverse sources in order to inform policy decisions and enhance local implementation. We are focusing on the relationship between place and health in the context of area–based initiatives (ABIs).

Evidence of effects? We have have 40 years of ABI experience in deprived localities to inform contemporary social policy development and implementation. However the evidence on the impact of previous initiatives is thin.  Evidence from earlier social policy implementation has not been accumulated centrally.  Evaluations have been variable both in terms of quality and method because evaluating ABI health impacts is tricky.

Can we learn from the past? M ethods for evaluating contemporary social programmes is a growing field of academic endeavour in the UK and elsewhere (eg via the Campbell Collaboration). But what can we learn from earlier initiatives? Is there historical evidence we can identify and explore?

The challenge for historically sensitive evidence based policy What do we want to know about the local history of policy implementation and why? What kinds of materials can provide us with ‘knowledge’ about local processes? Are resources to inform a study of local policy history accessible? Is it feasible to systematically review historical evidence on local policy context?

Our Research “ Social Capital, History and Policy Implementation: A synthesis and review of the literature.” Aims: * To understand how local historical context might shape the implementation of contemporary area-based interventions to improve health. * To explore the methodological challenges of identifying, retrieving and synthesising ‘evidence’ from diverse literatures and other resources.

Why the ‘Social Capital’ focus? Definitions of social capital are contested. We are focusing on the constructs of trust and participation/engagement because it has been mooted that: 1. Trust and civic engagement might be more health enhancing than other dimension of social capital. 2. Trust and engagement may ‘buffer’ some communities against the worst effects of deprivation. 3. The breakdown of trust and engagement might be one of the pathways through which income inequality exerts its influence on mortality..

The Community Development Project We are using a case-study approach. Our target ABI is the Community Development Project (CDP) that ran from The CDP was a home office initiative to tackle poverty and deprivation. At the time it was: ‘Britain’s largest ever government funded social- action experiment.’ (Loney,1983)

The CDP  Announced by the Wilson government in 1969, it encompassed twelve sites around Britain with marked deprivation.  The initial aim was to identify ways of creating a ‘more integrated community’ by building inter-agency ties to support and promote self-help and participation in the community.  Total cost was £5 million. The Home Office supplied 75% of the funding, the host LA contributed the remaining 25%.

The CDP  Each CDP had a steering group consisting of local authority officers and councillors, voluntary sector representatives and a Home Office representative.  Each site had an action team consisting of a director and action workers plus a research team and research director who were linked to an academic institution.  All the CDP sites produced working papers, interim reports and final reports to the Home Officer detailing their activities and evaluations.

Fieldwork Sites We selected four sites on the basis of geographic, cultural and historical factors. Our sites are:  Newington, Southwark.  Glyncorrwg, Upper Afan.  Hillfields, Coventry.  Cleator Moor, Cumbria.

Central searches  A search for published materials produced at the time the CDPs were running.  Secondly, a search of wider and more recent literatures about the CDP and more general concepts relevant to its implementation.

Published Documents We have used:  Web-of-Knowledge  COPAC  WorldCat  Public Library Catalogues  JISC mail: a call for ‘expert’ advice.  Key reference ‘snowballing’.

The Site Searches: main aims To identify and map diverse documentary sources of information about the CDP which are accessible in the local sites but not identifiable through traditional search strategies done by the central Lancaster team (newspapers, pamphlets, minutes, local reports). To identify and map diverse documentary sources of information about the CDP which are accessible in the local sites but not identifiable through traditional search strategies done by the central Lancaster team (newspapers, pamphlets, minutes, local reports). Identify a range of people with knowledge of the CDP and conduct oral history interviews with a purposively selected sample (residents, CDP action and research team members, councillors, local officers etc) Identify a range of people with knowledge of the CDP and conduct oral history interviews with a purposively selected sample (residents, CDP action and research team members, councillors, local officers etc)

What challenges have we experienced? Time consuming and labour intensive to map and access materials locally. Time consuming and labour intensive to map and access materials locally. Records are incomplete and partial. Records are incomplete and partial. Using a narrative synthesis model to extract information but the materials are diverse, unstructured and non-research making appraisal difficult. Using a narrative synthesis model to extract information but the materials are diverse, unstructured and non-research making appraisal difficult.

An historical approach to narrative evidence synthesis Authentification – Who wrote this? For what purpose and in what context? Authentification – Who wrote this? For what purpose and in what context? Corroboration – What do different sources contribute to the ‘story’? Corroboration – What do different sources contribute to the ‘story’? Connection – What recurrent themes emerge from across the sources? Connection – What recurrent themes emerge from across the sources?

Potential Connecting past and present initiatives and experiences. Connecting past and present initiatives and experiences. Unearthing locally significant information about the successes and failings of previous trenches of ABIs. Unearthing locally significant information about the successes and failings of previous trenches of ABIs. Beginning to map existing materials for future synthesis (creation of searchable archives?) Beginning to map existing materials for future synthesis (creation of searchable archives?)