Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop

Public policies, defined here as policies formulated at any level of government, 1 have been key in bringing about some of the great public health achievements of the 19th and 20th centuries, including clean water and sanitation, immunization, safe working conditions and fluoridation of water. Thus, public policies provide one of the primary means for a society to organize its efforts to protect and improve population health. It is increasingly recognized that public policy can also play a key role in the prevention and control of chronic, non-communicable diseases (NCDs). Indeed, the United Nations High-Level Meeting on Non-Communicable Diseases strongly emphasized the need for population-wide interventions involving education, legislation and regulatory and fiscal measures. ublic policy measures are likely to be as important in promoting healthier diets and physical activity as they have been in reducing exposure to tobacco. However, the evidence on which public policies are effective in promoting healthier diets and physical activity is much scantier than the evidence surrounding tobacco control policies, some of which are known to be highly effective. althy public policy should be directed by evidence. owever, an evidence-based approach to formulating healthy public policy has proved difficult to develop and implement. 9 Evidence is required in three broad areas: policy content, policy implementation (i.e. translating content into effective policy) and policy outcomes (i.e. achievement of the desired effect). The aim of this paper is to present a framework designed to facilitate the development and implementation of evidence-based healthy public policy for the prevention and control of NCDs. The framework, known as the "policy effectiveness-feasibility loop" (PEFL), combines epidemiological modelling, local situation analysis and policy option appraisal and is designed to explicitly involve policy-makers. Below we describe the PEFL framework and its application within a project in four parts of the eastern Mediterranean.