13 General Introduction economic and political conditions or welfare policies would mostly matter under extreme conditions or crises [62]. Therefore, policies promoting the welfare state seem to have limited effectiveness in addressing health-related behaviours, and the inequalities driven by those [54]. Appropriate and effective action looks particularly difficult to achieve because it should follow the motto health-in-all-policies and target the wide social determinants of health with precision and magnitude. Policy efforts have to go beyond the scope of health policy and be coordinated in a whole-government approach. Awareness around the impact of health in the domains of education, employment or social protection has increased with the recent pandemic crisis, and both the topics of health inequalities and mental health gained attention in the cross-ministry policy agendas. To convert this attention to evidence-based decision-making, it remains crucial to continue expanding our knowledge about the groups that are most vulnerable to (mental) health disparities and the pathways running behind these. We must also better evaluate policy distributional effects and learn what policies work towards closing the gap. RESEARCH AND EVIDENCE TO GUIDE POLICY AND PRACTICE The previous sections discuss several gaps requiring additional evidence to inform the strategy for closing the mental health gap. Well-known moral, socioeconomic and political arguments support research use to inform decision- and policy-making. Using the best evidence can enhance the effective use of public resources, increase transparency and accountability, and improve public policy’s effectiveness, efficiency and equity [63]. Why is this not regularly done, even when the proper evidence is in place? Like with closing the health gap, conducting evidence-based policy-making seems a bigger of a challenge than what its advocates like to admit. Everyone recognises its importance, but the commitment of the several parts is not enough to move it forward. One potential reason behind the difficulty of implementing evidence-based policymaking is the type, breadth and quantity of evidence needed. Analysing the evidence creation funnel (Figure 1.) is helpful to understand that primary research, which is usually the main output of academic work for peer-reviewed publications, is only one part of the evidence needed. In fact, primary research has limited potential to respond to questions on impact, effectiveness and/or cost-effectiveness. Secondary research, which synthesises the results of primary research studies in a larger evidence body, is most suitable to provide those answers. There is still tertiary research, which aims at adapting primary and secondary research to the needs of the evidence users and is the least valued in the academic research context [63]. All these three parts of the funnel consist of scientific evidence, which is produced through formal, systematic and rigorous processes. 1
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