An Equity‑Focused Proportionate Framework for Evaluating Public Health Interventions

Issue

Public health agencies are increasingly expected to demonstrate the impact, equity, and value of their interventions. While existing evaluation frameworks provide high-level generic or disease‑specific guidance, there is an opportunity to complement this with practical frameworks designed for real-world public health interventions (PHIs). Within the UK Health Security Agency (UKHSA),which delivers PHIs to prevent health threats, build resilience, and support health equity, evaluation frameworks offered an important tool to enhance actionable evidence.

Description

Between 2025-26, UKHSA developed a proportionate evaluation framework for PHIs. Objectives were to embed evaluation into routine practice, support equity‑focused learning, and complement existing guidance. Methods included a scoping review of PHI evaluation frameworks and co‑design with multidisciplinary stakeholders. Key questions addressed were how to plan evaluation proportionately, select appropriate methods, and ensure findings were used.

Results

The UKHSA Evaluation Framework is a continuous cycle with three phases:1) Scoping clarifies the purpose of the PHI and supports theory of change/logic model development, 2) Execution guides selection of evaluation questions, methods, and data collection and 3) Action supports dissemination and identifying lessons. Health equity and stakeholder engagement are embedded throughout. The framework includes standardised templates and case studies and has already informed the evaluation of a Tuberculosis National Action plan. Findings from early implementors indicate improved consistency in evaluation planning and use. Wider implementation is underway.

Lessons

Early use indicates the framework is feasible and easy to adapt in public health settings. Initial user feedback highlights the value of a clear structure, proportionate approach, and embedded equity focus. The framework could be adapted by other public health agencies internationally.

Key messages

• A proportionate evaluation framework to strengthen equitable and actionable evidence for public health interventions.

• Embedding evaluation into routine practice to improve learning, accountability, and public health impact.