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.

CONCLUSION

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.

REFERENCES

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10. World Health Organization. WHO | Health Impact Assessment.
[Internet] [Cited 2015 Apr 22]. Available from: http://www.who.int/hia/en/
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