A framework for public health policy evaluation research

The purpose of this paper is to present a framework for comprehensive empirical evaluation of public health policy. Policy evaluation is important to hold policymakers accountable, improve policy, and ensure that government actions including legislative, executive, and judicial actions, aimed at improving public health fulfill their intent without unacceptable tradeoffs in terms of costs, unanticipated negative impacts, or overly burdened private interests or individual rights. Using elements from the fields of program evaluation, decision analysis, empirical legal studies, public health ethics, and health impact assessment, this framework orients research objectives within the normative considerations necessary for policy justification. The framework can be used to guide researchers through an empirical evaluation program that comprehensively addresses the questions that public health decision makers may face when appraising policy. Broad considerations include an analysis of: 1) the nature of risk that the policy aims to reduce, 2) the outcomes of the policy, both intended and unintended, 3) the fairness in terms of the distribution of outcomes, costs, benefits, and burdens, 4) the acceptability of the policy across cultural norms, community values, and political ideals, 5) the legal and moral justification of the policy, and 6) the costs to government and citizens with an economic cost-benefit or cost-effectiveness analysis. Each component lends itself to alternative research methodologies and designs and cumulatively informs the empirical basis for justifying public health policy. Implementing this framework of research would improve public health decision-making by encouraging evidence-based public health policy and highlighting policy that was ineffective.