Improving social policy and practice: knowledge matters.

Action is needed beyond health care to improve life expectancy and health. Health for all is only possible through the provision of jobs, education, crime prevention, housing, and strong social-welfare systems. And health gains are the added benefi t; improved social policies and services will fi rst and foremost create better opportunities for the individual, and bring security and prosperity to the community. One of many illustrations is the dramatic diff erence in living conditions and health according to educational level, whether the outcome is maternal deaths in Bangladesh or diabetes-related deaths in the USA. Social policy has always been important, but never more so than now: there is every reason to fear that the current recession will aff ect health negatively in a more profound manner than anything doctors can hope to prevent or repair. It is thus reassuring that social policy has moved up the agenda in many countries with renewed commitments to maintaining or increasing funding to health, education, and social welfare. A world in economic crisis is scrambling to retain and even improve its social structure. However, social change does not come easily and equity can be an elusive goal; societal structures are deeply rooted and behavioural change can be diffi cult to inspire. The potential for doing more harm than good by intervening in peoples’ lives is also real. Exposing juvenile off enders to prison conditions and adult inmates who warn them of the consequences of continued criminal behaviour, for example, have intuitive appeal and are widely implemented. Whilst the initial fi ndings from observational studies were positive, controlled studies revealed that juveniles in these programmes were more likely to reoff end, not less. Thus evidence-informed action is needed in all areas of social policy. Good intentions, strong opinions, endless reorganisations, and millions of dollars are not enough to bring about a safe childhood, equal opportunities, good education, less crime, more jobs, social security, and dignifi ed care of the elderly. For such evidence to be useful, however, it must answer important questions for policy and practice in a trustworthy and easily accessible way. The Campbell Collaboration aims to establish a global library of relevant and reliable systematic reviews on eff ects of programmes and interventions in education, crime and justice, social welfare, and other social-policy domains such as development and disability. Such a library will inform decision making, reveal knowledge gaps, and create a stronger focus on what constitutes useful evidence among policy makers, funders, and researchers. This international network is picking up speed. It is based on cooperation among researchers from various backgrounds assisted by a small secretariat now hosted by the Norwegian Knowledge Centre for the Health Services. Work mainly takes place via fi ve coordinating groups (social welfare, crime and justice, education, methods, users) and a jointly registered group with the Cochrane Collaboration (developmental, psychosocial, and learning problems). Key factors that contribute to the enthusiasm in this network are collaboration, explicit standards, methodological assistance, thorough peer-review, open-access pub lishing, and a lean, effi cient, and reasonably funded organ isational structure. Annual colloquiums provide a meeting place for policy makers, practitioners, and researchers. Organising what is known on social and educational interventions is challenging for many reasons. Early child development, education, environment, employ ment, crime prevention, and social protection across the lifespan— wherever we look there is a need for improve ments in services and policy. However, across the board there is a worrying lack of empirical research, too few experi mental Published Online May 14, 2009 DOI:10.1016/S01406736(09)60783-2