Considering multiple governance levels in epidemiologic analysis of public policies

Epidemiology is increasingly asking questions about the use of policies to address structural inequities and intervene on health disparities and public health challenges. However, there has been limited explicit consid-eration of governance structures in the design of epidemiologic policy analysis. To advance empirical and theoretical inquiry in this space, we propose a model of governance analysis in which public health researchers consider at what level 1) decision-making authority for policy sits, 2) policy is implemented, 3) and account-ability for policy effects appear. We follow with examples of how these considerations might improve the evaluation of the policy drivers of population health. Consideration and integration of multiple levels of governance, as well as interactions between levels, can help epidemiologists design studies including new op-portunities for quasi-experimental designs and stronger counterfactuals, better quantify the policy drivers of inequities, and aid research evidence and policy development work in targeting multiple levels of governance, ultimately supporting evidence-based policy making.

Automated summary

Epidemiology is increasingly focused on using policies to address structural inequities and intervene on health disparities and public health challenges. However, the consideration of governance structures in the design of epidemiologic policy analysis has been limited. To advance research in this area, the proposed model of governance analysis encourages public health researchers to consider decision-making authority, implementation levels, and accountability for policy effects.