Health inequalities in Scotland and England: the contrasting journeys of ideas from research into policy

Abstract

Both the UK's Labour Government and Scotland's devolved Labour–Liberal Democrat coalition Executive have committed themselves to reducing health inequalities. Furthermore, both institutions have emphasised the importance of using evidence to inform policy responses. In light of such political commitments, a significant amount of work has been undertaken in the field of health inequalities in order to: (i) review the available research evidence; (ii) assess the extent to which policies have been based on this research evidence; and (iii) evaluate the success (or failure) of policies to tackle health inequalities. Yet so far only limited attention has been given to exploring how key actors involved in research-policy dialogues understand the processes involved. In an attempt to address this gap, this article draws on data from semi-structured interviews with 58 key actors in the field of health inequalities research and policymaking in the UK to argue that it is ideas, rather than research evidence, which have travelled from research into policy. The descriptions of the varying journeys of these ideas fit three types—successful, partial and fractured—each of which is outlined with reference to one example. The paper then employs existing theories about research-policy relations and the movement of ideas in an attempt to illuminate and better understand the contrasting journeys. In the concluding discussion, it is argued that the third approach, which focuses on the entrepreneurial processes involved in the marketing of ideas, is most helpful in understanding the research findings, but that this needs to be discussed in relation to the political context within which negotiations take place.

Introduction

The election of a New Labour government in 1997 heralded the promise of a new era for health inequalities in the UK. Not only was the government openly committed to reducing health inequalities (Department of Health (1997), Department of Health (1998), Department of Health (1999a), Department of Health (1999b)), it was also promoting an ethos of evidence-based policy (Cabinet Office (1999a), Cabinet Office (1999b)). Following devolution of key social policy responsibilities to Scotland in 1999, the first Scottish Executive (as the devolved government is known) was elected. Over the past decade, New Labour has dominated both the UK Government (with a consistent overall majority) and, since 1999, the devolved Scottish Executive (through coalition with the Liberal-Democrats). Perhaps unsurprisingly, therefore, the Scottish Executive has taken a similar line on many social policy issues, including committing itself to the reduction of health inequalities (Scottish Executive (2000), Scottish Executive (2003)) and to the promotion of knowledge transfer (Clark & Kelly, 2005). As the two political contexts are so closely linked (and several relevant areas, including most fiscal and social security policies, remain reserved with the English-based government), it would be difficult to study policies relating to health inequalities in Scotland without also considering the situation in England. The discussion in this paper employs interview data from Scotland and England to consider issues which appear to be relevant to research-policy relations for health inequalities in both political contexts (any differences between the two contexts will be explored in a separate paper in due course).

The political enthusiasm for evidence-based policy has re-ignited prominent debates from the nineteen-seventies and eighties about how social scientists and policymakers inform each other's work (e.g. Booth, 1988; Weiss (1977c), Weiss (1979)). After the mid-nineteen-sixties, during which significant emphasis had been placed on the use of social research in government, there followed a sense of disappointment with research-policy relations (see Weiss, 1977a). From this emerged a body of work which sought to highlight the non-linear, complex and often muddled processes involved in making policy (e.g. Cohen, March, & Olsen, 1972; Kingdon, 1995 [1st Ed. 1984]). Several models of research-policy relations were outlined in this period (see Davies, Nutley, & Smith, 2000; Weiss, 1977a), the most enduring of which is Carol Weiss’ (1977b) ‘enlightenment model’, which suggests that social research is unlikely to have any direct, measurable impact on policy but may still influence policy in diffuse, indirect ways over long time periods.

New Labour's recent commitments to evidence-based policy have resulted in renewed interest in research-policy relations within the UK (e.g. Naughton, 2005; Sanderson, 2002; Solesbury, 2002). A major funding body, the Economic and Social Research Council, helped establish a UK Centre for Evidence Based Policy and Practice (now known as EvidenceNetwork) and a journal specifically dedicated to discussing the issue has been launched; Evidence and Policy, a Journal of Research, Debate and Practice. Specifically in relation to the issue of health inequalities, interest in research-policy relations has resulted in several reviews of the available research evidence and theories (e.g. Asthana & Halliday, 2006; Bartley, 2004; Gordon, Shaw, Dorling, & Davey Smith, 1999) as well as a number of attempts to assess the extent to which recent policy initiatives relate to the available evidence and/or are likely to reduce health inequalities (e.g. Asthana & Halliday, 2006; Davey Smith, Morris, & Shaw, 1998; Exworthy, Blane, & Marmot, 2003; Exworthy, Stuart, Blane, & Marmot, 2003; Shaw, Dorling, Gordon, & Davey Smith, 1999). Yet there have been relatively few attempts to research the processes involved in the construction of policies relating to health inequalities, or to explore the opinions of the key actors involved in research-policy relations.

The available research which is of direct relevance to the topic of this paper can, approximately, be thought of as providing three rather different perspectives on research-policy relations. The first of these constructs researchers and policymakers as two distinct communities (Caplan, 1979) and focuses on exploring the interactions between the two groups. In Canada, Lomas (2000a), Lomas (2000b) and John Lavis (e.g. Lavis (2002), Lavis (2006); Lavis, Posada, Haines, & Osei, 2004) both underline the importance of achieving shared understandings between researchers and policymakers, arguing that increased interaction between the two groups is essential for improving links between research and policy. A recent exploration of research-policy relations for health inequalities in the UK (Petticrew, Whitehead, Macintyre, Graham, & Egan, 2004; Whitehead et al., 2004) has similarly focused on the distinction between the two communities; exploring the issue through holding separate workshops with ‘senior civil servants’ and ‘research leaders’.

The second body of work focuses on the processes involved in the construction of policies and emphasises the role of politics in shaping research-policy relations. The work of Mark Exworthy and colleagues is a particularly good example of this approach within the field of health inequalities (e.g. Exworthy, Berney, & Powell, 2002; Exworthy, Blane et al., 2003). In conceptualizing how policies are formulated, Exworthy and colleagues (Exworthy, Blane et al., 2003) draw on John Kingdon's (1995 [1st Ed. 1984]) ‘policy windows’ model, suggesting that issues get taken up and implemented in the policy world when a ‘window’ is opened by the coupling of three key streams: ‘problem’, ‘policy’ and ‘politics’. Exworthy et al's (ibid.) work suggests that the criteria for the ‘policy’ and ‘problem’ streams has not yet been met for health inequalities in the UK, which limits policy outcomes and, relatedly, the influence research is likely to have on policy.

The third approach focuses on the construction and marketing of particular ideas. This was the approach taken by Bartley (1988), Bartley (1994) in her research exploring the unemployment and health debates of the nineteen-eighties. Bartley's thesis (1988) draws on the theories of Bruno Latour (e.g. 1988 [1984]; Latour & Woolgar, 1986) to propose that political (career) interests are crucial to understanding research-policy relations, and that professional networks are the fundamental mechanism via which ‘knowledge claims’ (Knorr-Cetina, 1981) travel. Latour (1988 [1984]), Latour (2005) work suggests the quality of research may have rather less relevance to the potential of its influence than the ways in which the ideas emanating from research are received, translated and promoted by others.

Each of the above three perspectives is drawn on in the discussion later in this paper. Prior to this, the paper briefly outlines the rationale for choosing interviews as the main source of data before explaining the decision to focus on the influence of ideas about health inequalities, rather than research evidence. Next, the three differing journey-types of ideas about health inequalities evident in the interview data are summarised, each of which is outlined with reference to one example. It is at this point that the paper returns to the theories discussed in this introduction, in an attempt to better understand the differing journey types. Whilst the conclusions of the paper largely support Bartley (1988), Bartley (1994) assertions that the entrepreneurial processes involved in the marketing of ideas are crucial to understanding research-policy relations, it is argued that these negotiations can only be understood if discussed in relation to the political context within which they take place.