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Title: Where there is no evidence, and where evidence is not enough : an analysis of policy-making to reduce the prevalence of Australian indigenous smoking
Author: Vujcich, Daniel Ljubomir
ISNI:       0000 0004 5354 9400
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2014
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Background: Evidence-based policy making (EBPM) has become an article of faith. While critiques have begun to emerge, they are predominately based on theory or opinion. This thesis uses the 2008 case study of tobacco control policy making for Indigenous Australians to analyse empirically the concept of EBPM. Research questions: (1) How, if at all, did the Government use evidence in Indigenous tobacco control policy making? (2) What were the facilitators of and barriers to the use of evidence? (3) Does the case study augment or challenge the apparent inviolability of EBPM? Methods: Data were collected through: (1) a review of primary documents largely obtained under the Freedom of Information Act 1982; and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates and academics. Results: Historically, Indigenous smoking was not problematised because Indigenous people faced other urgent health/social problems and smoking was considered a coping mechanism. High prevalence data acquired salience in 2007/08 in the context of a campaign to reduce disparities between Indigenous and non-Indigenous health outcomes. Ensuing policy proposals were based on recommendations from literature reviews, but evidence contained in those reviews was weak; notwithstanding this, the proposals were adopted. Historical experiences led policy makers to give special weight to proposals supported by Indigenous stakeholders. Moreover, the perceived urgency of the problem was cited to justify a trial-and-evaluate approach. Conclusion: While the policies were not based on quality evidence, their formulation/adoption was neither irrational nor reckless. Rather, the process was a justifiable response to a pressing problem affecting a population for which barriers existed to data collection, and historical experiences meant that evidence was not the only determinant of policy success. The thesis proposes a more nuanced appraoch to conceptualising EBPM wherein evidence is neither a necessary nor a sufficient condition for policy. The approach recognises that rigorous evidence is always desirable but that, where circumstances affect the ability of such research being conducted, consideration must be given to acting on the basis of other knowledge (e.g. expert opinion, small-scale studies). Such an approach is justifiable where: (1) inaction is likely to lead to new/continued harm; and (2) there is little/no prospect of the intervention causing additional harm. Under this approach, non-evidentiary considerations (e.g. community acceptability) must be taken into account.
Supervisor: Fitzpatrick, Ray; Rayner, Mike; Allender, Steven Sponsor: Rhodes Trust
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Disease prevention ; Indigenous peoples ; Public policy ; Public Health ; Health and health policy ; Aboriginal - Australia - Policy making - Evidence - Evidence-based policy - Smoking cessation