Trading quality for relevance: non-health decision-makers' use of evidence on the social determinants of health

Elizabeth McGill, Matt Egan, Mark Petticrew, Lesley Mountford, Sarah Milton, Margaret Whitehead, Karen Lock

Research output: Contribution to journalArticlepeer-review

48 Citations (Scopus)


OBJECTIVES: Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment.

DESIGN: A qualitative study using three focus groups. A thematic analysis was undertaken.

SETTING: The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada.

PARTICIPANTS: UK and international practitioners working in the design and management of the built environment at a local government level.

RESULTS: Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own.

CONCLUSIONS: Local-level built environment practitioners utilise evidence to make decisions, but their view of 'best evidence' appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.

Original languageEnglish
Pages (from-to)e007053
JournalBMJ open
Issue number4
Publication statusPublished - 2 Apr 2015


  • Brazil
  • Canada
  • City Planning
  • Decision Making
  • Environment Design
  • Evidence-Based Practice
  • Focus Groups
  • Housing
  • Humans
  • Local Government
  • Public Policy
  • Qualitative Research
  • Social Determinants of Health
  • Transportation
  • United Kingdom
  • United States


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