Beyond the counterfactual? Evaluating community-led organisations and the challenge of evidence for complex public health interventions

Manoukian and colleagues provide new longitudinal evidence that engagement with community-led organisations (CLOs) is associated with better mental well-being and there are dose–response relationships with outcomes among residents of disadvantaged communities.1 The findings arrive at an important time for UK health policy. Prevention, neighbourhood health, community power and social prescribing have become increasingly prominent within policy discussions; the NHS 10 Year Health Plan emphasising shifting care closer to communities and addressing the wider determinants of health. If community-based organisations are expected to play a greater role in creating health and reducing inequalities, then understanding how to generate credible evidence about their contribution becomes an increasingly important challenge.

More importantly, the study reopens a fundamental methodological question for public health research: how should we evaluate complex community interventions when a conventional control group is difficult, or impossible, to construct?

Public health research has been strongly influenced by the evidence hierarchy inherited from…

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