TOOLS
TO
SUPPORT
EVIDENCE-BASED
PUBLIC
HEALTH |
1.
Health
Impact
Assessment
(HIA)
HIA
is
an
approach
to
assess
burden
on
health
and
the
potential
of
health
improvements
by
modifying
underlying
conditions.(10)
It
is
a
combination
of
procedures,
methods,
and
tools
by
which
a
policy,
program,
or
project
may
be
judged
as
to
its
potential
effects
on
the
health
of
a
population
and
the
distribution
of
those
effects
within
the
population.
It
requires
a
high
degree
of
interdisciplinary
and
inter-sectoral
collaboration,
well-trained
Practitioners,
appropriate
data
sets
for
analysis,
and
funders
that
recognize
the
value
of
the
collaborations
and
the
information.
Because
of
their
focus
on
specific
policy
options
facing
decision-makers,
it
is
more
likely
than
other
evidence-based
decision
tools
to
affect
decisions
outside
the
health
sector.
It
educates
decision-makers
about
how
the
public's
health
is
strongly
influenced
by
many
decisions
in
spheres
outside
health.
2.
Systematic
Reviews
A
systematic
review(11)
is
a
formal
process
that
identifies
all
of
the
relevant
scientific
studies
on
a
topic,
assesses
their
quality,
individually
and
collectively,
and
sums
up
their
results.
Systematic
approaches
for
summarizing
scientific
evidence
and
linking
that
evidence
to
practice
and
policy
recommendations
increase
the
transparency,
understandability,
and
credibility
of
recommendations.
Systematic
reviews
make
it
easier
for
practitioners
and
policymakers
to
understand
all
of
the
relevant
information
that
is
available,
how
it
was
collected
and
assembled,
and
how
the
conclusions
and
recommendations
relate
to
the
information
that
was
reviewed.
In
the
health
sphere,
reviews
now
summarize
information
on
the
efficacy
of
medical
treatments,
clinical
preventive
services,
public
health
interventions
and
policies,
and
related
social
policies.
3.
Portfolio
of
Tools
A
range
of
techniques
and
tools
are
evolving
in
this
area.
Some
of
the
important
ones
include
the
following:
A)
Participatory
research:
performing
research
in
collaboration
with
those
affected
by
the
issue
under
study
for
the
purpose
of
taking
action
or
making
change
has
the
potential
to
increase
the
relevance
of
research
findings
and
their
subsequent
use
in
communities.
(Figure
No:
1)
B)
Increasing
collection
and
reporting
of
qualitative
information
about
the
context
in
which
research
studies
were
conducted
will
provide
users
with
more
information
about
whether
particular
strategies
are
likely
to
be
feasible
and
useful
in
local
contexts
as
well
as
providing
a
basis
for
allowing
systematic
reviews
to
assess
the
impact
of
context
on
results.
C)
Economic
evaluations
of
public
health
interventions
will
provide
critical
information
about
costs
and
value.
D)
Finally,
decision
analytic
and
other
modeling
approaches
can
be
very
helpful
in
systematically
collecting
and
analyzing
available
data,
comparing
the
value
of
two
or
more
decision
options
and
assessing
the
importance
of
uncertainties
on
results.
Figure
1:
The
practice
of
Evidence-Based
Public
Health
(EBPH)
is
an
integration
of
science-based
interventions
with
community
preferences
for
improving
population
health
Public
health
decision
making
is
a
complicated
process
because
of
complex
inputs
and
group
decision
making.
Implementation
of
EBPH
requires
not
only
a
workforce
that
understands
and
can
implement
EBPH
efficiently
but
also
sustained
support
from
health
department
leaders,
practitioners,
and
policy
makers.
With
evidence-based
medicine
guidelines,
physicians
can
use
proven
treatment
methods
based
on
the
best
evidence
available
to
develop
patient-care
strategies.
It
is
necessary
to
develop
and
promote
a
culture
of
Evidence
Based
Public
Health
approach
for
dealing
with
Emerging
Diseases
in
the
region.
This
will
include
use
of
Healthcare
informatics,
Research
in
Gulf
Cooperation
Council
(GCC)
countries
and
multidisciplinary
team
approach.
Multi-sectoral
actions
are
needed
to
strengthen
policies
and
improve
practices
that
are
driven
by
the
best
available
evidence
and
knowledge.
Funders
often
require
programs
to
be
evidence-based.
Because
formal
public
health
training
in
the
workforce
is
lacking,
on-the-job
training
and
skills
development
are
needed.
The
need
may
be
even
greater
in
local
health
departments,
where
practitioners
may
be
less
aware
of
and
slower
to
adopt
evidence-based
guidelines
than
state
practitioners
and
where
training
resources
may
be
more
limited.(12)
There
are
barriers
to
effective
implementation
of
evidence
based
public
health
and
solutions
need
to
be
found.(13,
14)
As
a
first
step
in
the
EBPH
process,
a
community
assessment
identifies
the
health
and
resource
needs,
concerns,
values,
and
assets
of
a
community.
This
assessment
allows
the
intervention
(a
public
health
program
or
policy)
to
be
designed
and
implemented
in
a
way
that
increases
the
likelihood
of
success
and
maximizes
the
benefit
to
the
community.
Public
health
surveillance
is
a
critical
tool
for
understanding
a
community's
health
issues.
Once
health
needs
are
identified
through
a
community
assessment,
the
scientific
literature
can
identify
programs
and
policies
that
have
been
effective
in
addressing
those
needs.
The
amount
of
available
evidence
can
be
overwhelming;
Practitioners
can
identify
the
best
available
evidence
by
using
tools
that
synthesize,
interpret,
and
evaluate
the
literature.
Systematic
reviews
use
explicit
methods
to
locate
and
critically
appraise
published
literature
in
a
specific
field
or
topic
area.
The
products
are
reports
and
recommendations
that
synthesize
and
summarize
the
effectiveness
of
particular
interventions,
treatments,
or
services
and
often
include
information
about
their
applicability,
costs,
and
implementation
barriers.
It
is
useful
to
consider
several
overarching,
common
characteristics
of
an
evidence-based
approach
to
public
health
practice.
Making
decisions
based
on
the
best
available
peer-reviewed
evidence
(both
quantitative
and
qualitative
research);
Using
data
and
information
systems
systematically;
Applying
program
planning
frameworks
(that
often
have
a
foundation
in
behavioral
science
theory);
Engaging
the
community
in
assessment
and
decision
making;
Conducting
sound
evaluation;
Disseminating
what
is
learned
to
key
stakeholders
and
decision
makers;
and
Synthesizing
scientific
skills,
effective
communication,
common
sense,
and
political
acumen
in
making
decisions.
The
successful
implementation
of
EBPH
in
public
health
practice
is
both
a
science
and
an
art.
The
science
is
built
on
epidemiologic,
behavioral,
and
policy
research
showing
the
size
and
scope
of
a
public
health
problem
and
identifying
interventions
that
are
likely
to
be
effective
in
addressing
the
problem.
The
art
of
decision
making
often
involves
knowing
what
information
is
important
to
a
particular
stakeholder
at
the
right
time.
Significant
decisions
in
public
health
must
balance
science
and
art,
since
evidence-based
decision
making
often
involves
choosing
one
alternative
from
among
a
set
of
rational
choices.
Interdisciplinary
cooperation
is
necessary
for
success
of
implementation
of
evidence
based
public
health
initiatives.
(15)
To
increase
the
implementation
of
EBPH
in
practice
settings
(e.g.,
health
departments),
greater
attention
to
administrative
practices
is
needed,
including:
1)
Workforce
development
2)
Leadership
3)
Organizational
climate
and
culture
4)
Relationships
and
partnerships,
and
5)
Financial
processes
All
available
information
must
be
weighed:
Assessment
data
on
the
magnitude
of
the
problem,
epidemiologic
data
on
determinants
Stakeholder
opinion
on
the
nature
of
the
problem
and
acceptable
solutions,
Existing
practices
and
traditions
Less
robust
yet
promising
intervention
evaluations,
program
options
within
budgetary
constraints
Legal
considerations
such
as
privacy
laws
Political
will
to
address
the
issues
There
are
at
least
FOUR
ways
in
which
a
public
health
program
or
policy
may
not
reach
stated
goals
for
success:
Choosing
an
intervention
approach
that's
effectiveness
is
not
established
in
the
scientific
literature;
Selecting
a
potentially
effective
program
or
policy
yet
achieving
only
weak,
incomplete
implementation
or
"reach,"
thereby
failing
to
attain
objectives;
Conducting
an
inadequate
or
incorrect
evaluation
that
results
in
a
lack
of
generalizable
knowledge
on
the
effectiveness
of
a
program
or
policy;
and
Paying
inadequate
attention
to
adapting
an
intervention
to
the
population
and
context
of
interest.
Numerous
benefits
accrue
when
decisions
in
public
health
are
based
on
scientific
evidence
including
the
area
of
emerging
diseases.
By
applying
the
concepts
of
EBPH,
decision
making
and,
ultimately,
public
health
practice
in
emerging
diseases
can
be
improved.
Public
health
doctors
with
sound
clinical
knowledge,
skills
&
competency
armed
with
the
latest
research
evidence
are
able
to
translate
their
role
into
effective
care
and
public
health
interventions
in
emerging
diseases.
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Disease
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Prevention.
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based
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University,
Ontario,
Canada.
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Ross
C.,
Elizabeth
A.
Baker,
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L.
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N.
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a
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