Advocacy for Using Evidence in Public Health Nutrition Policy Making

Abstract

Do advocates for using evidence make a difference? A case study of public health nutrition policymaking in New Zealand. There is a growing body of evidence supporting interventions that will effectively address nutrition-related non-communicable disease. However, researchers and other stakeholders often despair that such evidence is not informing government policy. The emerging field of ‘evidence-informed’ policy addresses the question, ‘What works?’ to improve the use of evidence in policymaking. This thesis aims to contribute to this enquiry by exploring how advocates for the use of evidence can make a difference. Advocacy can connect science, society and politics and build ‘multiple footbridges’ between the worlds of decision makers and those who generate evidence. A theoretical model for advocacy for evidence use was developed following an extensive literature review. The model was evaluated against a rival explanation in a policy case study of food marketing to children. Data were collected by interviews with senior members of the New Zealand public health nutrition policy community, documentary analysis and field notes. Results indicate that current policymaking systems are ad hoc and non-deliberate, informal relationships are the primary channel by which evidence informs bureaucrats’ decision making and the powerful role of meta-level policy is largely unknown. Major determinants of advocacy activity are access to resources and the opportunities presented by political timing. Concurrently the trend for sovereign government to be replaced by governance mechanisms and a government agenda to give science a greater role in policymaking are shifting established policy processes. These factors, together with a growing realisation that public health nutrition policymaking needs a paradigm shift, are creating opportunities for advocacy for the use of evidence. The findings of this research lead to the conclusion that public health nutrition policy processes will deliver better outcomes when the ‘idea’ of using evidence is actively advocated. Politically aware advocacy should enhance evidence use when it brings about shifts in meta-level policy, policymaking processes and relationships across the policy community.