The application of realist approaches at the research/policy/practice interface: NICE work if you can do it

Professor Mike Kelly is Senior Visiting Fellow in the Department of Public Health and Primary Care at the Institute of Public Health and a member of St John's College at the University of Cambridge. Between 2005 and 2014, when he retired, he was the Director of the Centre for Public Health at the National Institute of Health and Care Excellence (NICE). From 2005 to 2007, he directed the methodology work stream for the World Health Organisation's (WHO) Commission on the Social Determinants of Health. His research interests include the prevention of non-communicable disease, living with chronic illness, health inequalities, health related behaviour change, end of life care, dental public health, the relationship between evidence and policy and the methods and philosophy of evidence based medicine.

This talk will describe the approach to development of public health guidelines adopted by NICE (the National institute for Health and Care Excellence) between 2005 and 2014 when Mike Kelly was leading the public health team there. It will consider the influences that realist theories and methods had on the process which NICE engineered as it applied the conventional model of evidence based medicine to public health matters. Some of the academic opposition to this endeavour will be noted and the broader political environment described. Using the development of the guideline on the prevention of alcohol misuse as a case study, the paper will examine the political consequences of taking a realist approach to the evidence. The controversy, which ensued after NICE, published the guideline, which among other things recommended minimum unit pricing, will be analysed. Some of the lessons of working at the policy/practice/politics/academy interface will be discussed.