Addressing Health Equities in Social Epidemiology: Learning from Evaluation(s)

This chapter examines how evaluations and evaluative thinking can help in the social epidemiologic study of complex interventions. There is increasing interest within the field of social epidemiology in studying interventions, as well as increasing pressure from funders and decision makers to make research more relevant for addressing social problems. Within the field of evaluation, there is a parallel move towards embracing the study of complex interventions − the very kinds of interventions that will almost invariably be the focus of social epidemiology. Using the example of interventions that seek to address health inequities in urban settings, we introduce a framework of steps through which evaluations can impact such health inequities. Rather than discussing a series of tools and methods, we use these steps to describe the importance of thinking evaluatively in addressing complex social problems. Specifically, we highlight a realist approach to evaluation. This approach focuses not only on whether an intervention works, but also on how it works, for whom and under what conditions (Pawson and Tilley 1997). This perspective marks a significant departure from traditions of other branches of epidemiology, such as clinical epidemiology, where the whether question is paramount and the how question is less important, often because of the uniformity and simplicity of interventions (e.g., administration of a drug). Research within epidemiology on social interventions has been relatively uncommon to date, and this chapter seeks to provide some guidance to expanding the literature on the health effects social interventions by engaging with cutting-edge theory on thinking evaluatively.