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Rather, a better understanding of the various interactions between evidence production and use is required, with attention to systems, processes and actors, as well as outcomes. Many participants emphasised the ambiguity and contingency of the policy process, which means that linear narratives connecting a single intervention to a limited set of fixed outcomes are idealisations at best. Moreover, the identification of policies and goals is itself always political in nature, and implicitly prioritises the interests of certain actors or groups over others; and policy itself was described as multiple with multiple goals.
This has long been recognised in the literature on policy studies [ 51 , 52 , 53 , 54 , 55 ], but its implications for the evaluation of the effectiveness of policies, and the utilisation of the resulting evidence, have not always been recognised. At several times in the discussion, participants discussed artefacts of the policy process e. Further research would be required to interrogate how different participants conceptualised or operationalised these ideas, how widely they were shared, and the currency they hold in the practice of policy. Running through all the discussions was a theme about public engagement.
Listening to the right voices, at the right time, may not be a panacea for unintended consequences, but better use of public deliberation may make policy more effective, and more predictable [ 42 , 56 ]. Also, balancing the positive and possible negative effects of policies and interventions implies a deliberation takes place by decision-makers. It would be interesting to know how open and explicit that deliberation is, and whether it is inclusive of relevant stakeholders — and indeed whether deliberative approaches do lead to better policymaking practices [ 57 , 58 ].
As some participants noted, unintended consequences may fall most heavily on the most disenfranchised. Thus, thinking carefully about who is likely to be affected by policies is a question of equity, and one which can be addressed through mindful stakeholder engagement. The aim of these workshops was not to provide rich, in-depth accounts of the perspectives of policymakers, or to generate evaluations of specific unintended consequences. Neither is the methodology a one-size fits-all approach, but designed here to elicit frank and open responses in response to particular provocations.
Rather, we aimed to report perspectives of stakeholders, without relating these to existing work on policy theory or evaluation, in order to give a clear picture of how policymakers and researchers view the complexity of the task facing those researching and managing UCs. Therefore, we have not attempted to critique particular statements, or to impose our own ontological views about evidence production and use on these findings. Rather, we hope that these results offer a set of questions for future researchers, building on these findings.
In particular, we believe that the following would be fruitful avenues for discussion:. An exploration of the implicit models of policymaking which are offered by these perspectives about unintended consequences. The mechanisms which are implicitly or explicitly used to develop or evaluate policies, or which conceptually underpin policies.
The role of evidence in supporting these mechanisms, and particularly the potential for coproducing mechanisms to inform policy development, evaluation and implementation. The importance of identifying unintended consequences for public health in particular, which can affect entire populations. The role of evaluation, monitoring and reporting, and governance of public health policies in identifying and mitigating unintended consequences; and. How best to adapt existing evaluation frameworks to enable a better understanding of unintended consequences in public health.
We also believe there would be significant value in systematically identifying all policies in public health which have had unintended or harmful effects, to begin the work of understanding and avoiding this phenomenon. We believe that public health policy interventions, particularly those addressing social or environmental determinants of health, need to be seen within a broader understanding of the policy process. Finally, we note that while all participants accepted the idea that policies and interventions may have unexpected effects, this is rarely taken into account by research or evaluation funding.
Center for Public Health Practice
Honest policymaking requires a holistic understanding of the ways in which policies play out. This should include equal humility from researchers and commissioners about the ways in which we do not understand, or fail to predict, the impacts of our interventions on social systems. This workshop was relatively limited in size, and we did not have access to complete transcripts. Instead, we delineate a novel field of enquiry for public health research. Unintended consequences of policies and interventions are occasionally, but not systematically reported. Little is known about how they arise, if they fall into categories, or how to evaluate and respond to them.
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Thinking about unintended consequences of policies can help us to learn about how policies and interventions play out, and the actual mechanisms leading to social change. Our study suggests that developing better theories about how policies will work requires input from people who will be affected by the policy, and by those involved in developing and implementing it. Data collected is not available for sharing, as the workshops were conducted under Chatham House rules in order to protect participants.
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Public health has a language problem – Public healthy
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