Continuing our series on ‘Better health and wellbeing in Wales’, Dr Charlotte Grey of Public Health Wales tells us why it’s important for everyone that health initiatives are evaluated effectively.
Public health work is grounded in the belief that we can improve lives, reduce inequalities, and create healthier futures for our communities and populations. Every initiative, whether small-scale local interventions or national policies, aims to create meaningful change that contributes to healthy life expectancy. But to understand whether our efforts are making a difference, we need more than good intentions, we need evaluation.
Evaluation is the engine that drives continuous improvement, giving us the clarity and insight we need to strengthen our public health work and make better decisions. It generates recommendations that highlight where improvements can be made for better outcomes.
In a landscape where resources are limited and challenges are complex, evaluation helps ensure our actions are not only effective, but also equitable and efficient.
THE VALUE OF EVALUATION
Public health initiatives rarely unfold in simple or predictable ways. They take place within real-world contexts shaped by social, organisational, cultural, economic, political and environmental conditions, as well as unexpected developments.
As a result, interventions are best understood as ‘events in systems’, continually interacting with and being influenced by their surroundings. Evaluation helps us navigate this complexity by giving us tools to understand whether an intervention is working, how and why it works, for whom, and at what cost.
Evaluation is not about searching for fault or seeking validation, but about accountability – supporting transparent, evidence-informed decision-making. Evaluation creates the learning that improves public health work. It shines a light on the difference we are making and the difference we could make. By holding ourselves accountable to what the evidence shows, we strengthen our ability to deliver meaningful impact.
Evaluation of the Inverse Care Law (ICL) Programme in Betsi Cadwaladr University Health Board showed how voluntary sector insight and community knowledge could improve how services reach people in deprived areas. Using this learning helped partners adapt delivery, improve access to prevention and early support, and contribute to improved health and wellbeing over time.
Evaluation of Prehab2Rehab in Cardiff and Vale University Health Board helped refine how early support for cancer patients in Wales was delivered, in partnership with local leisure centres and voluntary organisations. This improved people’s readiness for surgery and supported better recovery and wellbeing outcomes, supporting further roll out of the programme.
The most effective evaluations are planned from the outset, helping to set clear goals, outcomes and expectations. This helps us define what success looks like, understand the needs we’re addressing, identify the resources and partnerships required, develop a theory of change to guide delivery, and track meaningful progress.
EVALUATION – A SHARED RESPONSIBILITY
Evaluation can sometimes feel like the domain of specialists, but in reality, it is everyone’s business. Many colleagues already play a vital role in evaluation in their day-to-day work, drawing on evidence to shape decisions, monitoring activities and outcomes, listening to feedback, reflecting on and sharing learning with partners.
Evaluation becomes stronger when a diversity of voices, experiences and perspectives are part of the conversation, including meaningful public and patient involvement and engagement (PPIE). Confidence grows for everyone involved when people feel supported to ask evaluative questions and explore data without fear of judgement.
When we create a culture where learning is valued, evaluation becomes a natural part of everyday public health practice.
At its heart, it’s about adopting a curious, questioning perspective about our work in public health. It invites us to pause and ask: ‘What are we trying to achieve? How will we know if we’re making progress? What can we learn and how might we improve?’
LEARNING, IMPROVING AND DELIVERING BETTER OUTCOMES
Evaluation only has real value when the learning it generates is used. That’s why it’s important to be clear from the start about who the evaluation is for, what decisions it will inform, and how it will lead to action.
The insights we generate should spark reflection, and guide future planning. This includes highlighting what worked well, but also acknowledging challenges and areas where approaches fell short. Both forms of learning are essential for improvement.
When findings are shared openly, they strengthen programme design, support informed policy, improve equity and access, reduce duplication, and build organisational memory.
Ultimately, evaluation helps us demonstrate the value of public health initiatives not only through measurable outcomes, but also through their fairness, efficiency and longer-term sustainability.
Find out more about evaluation in public health. There’s further support and resources too.
Find out more about WCVA’s work in health and care.