It has been shown in many settings that the simple and direct application of knowledge into action in the field of healthcare is rare. Such application is most likely to happen where: evidence is non-controversial; the problem/issue is uncontested; there is certainty about the best course of action to take; this action requires limited change or upset to current status quo; it is clear who has responsibility for this action; and the wider environment is supportive. These conditions do not characterise the situations where action to address ethnic diversity and inequality is needed. More often, in order to make progress there is a need to mobilise evidence in other ways:

  • Conceptual use to: change understanding; redefine the problems/issues; relocate the causes; suggest alternative places to look for solutions; challenge taken-for-granted assumptions etc.
  • Influential use to: reframe issues to increase their perceived importance, urgency, relevance; empower actors to take action; give legitimacy; persuade etc.

In the words of one of our EEiC respondents:

“there’s the information you need to work out what needs to be done; and then of course there’s the information you need to convince people to let you get on and do it”

As well as gaps in the data/evidence base, mobilising evidence for action on ethnic inequalities can be difficult because:

  • Ethnicity is complex; people struggle to understand its varied links to health
  • Stereotypes and misunderstandings: people pre-judge the issues (e.g. assuming the causes of observed inequalities lie in cultural practices or ignorance)
  • Decision-makers lack confidence: demand a higher standard of evidence before committing resource
  • People assume that addressing ethnic inequality will add complexity and cost
  • Lack of local good practice; people assume inequality is inevitable and progress is impossible
  • Prevailing values and norms: decision-makers question whether it is right to focus attention on minority ethnic groups; issues of race and ethnicity can evoke strong emotions

Therefore, if you want to encourage evidence-informed commissioning that addresses ethnic inequalities, you must adopt explicit knowledge-to-action strategies that are based on

  1. a sound understanding of local context and local decision-makers, and
  2. existing theory and evidence of what works to get knowledge into practice

EEiC tools and resources to support this area of work

See the tools in the creating an enabling environment section.

Mobilising evidence for action on ethnic inequalities: Mobilising evidence – workshop exercise

Other resources and links

Ethnicity/equity focused:

General tools

John Lavis, Andrew Oxman and colleagues in Canada have produced a comprehensive set of resources to support the application of evidence into healthcare policymaking:

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