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February 28, 2025
Quarterly Article
Bomi Kim Hirsch
Kiersten Frobom
Gillian Giglierano
Michael C. Stevenson
Marjory L. Givens
Feb 14, 2025
December 2024
Back to The Milbank Quarterly
Policy Points:
Over the past 50 years, population health researchers have made significant progress in clarifying the empirical and theoretical relationships between socioeconomic conditions and health disparities1-3 particularly for social constructs such as race and ethnicity.4 Health disparities, defined as “differences in health or its determinants that adversely affect marginalized or excluded groups,” are the metric to measure progress toward health equity,5,6 meaning “assurance of the conditions for optimal health for all people.”7 At the same time, policymakers and public health practitioners have invested in and implemented interventions (i.e., policies and programs) that have empirical evidence supporting their effectiveness in a process called evidence-informed decision making (EIDM). EIDM refers broadly to a wide variety of approaches to find, assess, and implement relevant knowledge in decision making about social issues.8, 9 EIDM originated from evidence-based medicine, a process popularized in the 1990s to improve clinical decision making by emphasizing systematic searches and evaluation of scientific literature and noting that “intuition, unsystematic clinical experience, and pathophysiologic rationale” were not sufficient for producing desirable outcomes.10 EIDM has been broadly adopted in many forms, including in population health, to improve decision making by practitioners and policymakers. Scientific or research evidence is often distinguished from tacit or colloquial evidence such as opinions, values, and habits and can be called “evidence based” or “evidence informed” to represent that research evidence is one of several factors influencing policymaking.9 EIDM—based on the process of searching, appraising, synthesizing, adapting, and implementing evidence into policies and practices11—improves effectiveness and efficiency of interventions, facilitates an efficient use of limited resources, and improves transparency of decision making.9 As our knowledge has deepened about what shapes health and results in health disparities, the data and evidence we use to support EIDM have not evolved and now largely lack the precision and focus needed to address health equity. In 2021, the World Health Organization named equity as an explicit principle to consider in EIDM and thus urged monitoring observable differences in health to identify groups at risk9—meaning at risk for health inequity. The US Centers of Disease Control and Prevention (CDC) also launched its Cultivate, Optimize, Reinforce, and Enhance (CORE) Commitment to Health Equity framework in 2021, which marked the CDC’s first agencywide health equity strategy.12 Recent research encourages broadening focus beyond health disparities to their structural causes and corresponding structural interventions,4, 13 including scholar Camara Phyllis Jones, who notes, “Achieving health equity requires valuing all individuals and populations equally, recognizing and rectifying historical injustice, and providing resources according to need.”7
