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Adverse effects of public health interventions: a conceptual framework
  1. Theo Lorenc1,2,
  2. Kathryn Oliver3,4
  1. 1Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Department of Science, Technology, Engineering and Public Policy (STEaPP), University College London, London, UK
  3. 3NIHR Collaboration for Leadership in Applied Health Research and Care in Greater Manchester, Manchester Business School, University of Manchester, Manchester, UK
  4. 4School of Social Sciences, University of Manchester, Manchester, UK
  1. Correspondence to Dr Theo Lorenc, Department of Science, Technology, Engineering and Public Policy (STEaPP), University College London, Gower Street, London WC1E 6BT, UK; t.lorenc{at}


Public health interventions may have a range of adverse effects. However, there is limited guidance as to how evaluations should address the possibility of adverse effects. This discussion paper briefly presents a framework for thinking about the potential harms of public health interventions, focusing on the following categories: direct harms; psychological harms; equity harms; group and social harms; and opportunity harms. We conclude that the possibility of adverse effects needs to be taken into account by those implementing and evaluating interventions, and requires a broad perspective on the potential impacts of public health strategies.

  • Outcome Research Evaluation

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