Evidence-Based Practice In Public Health

Introduction
Evidence-based practice replaces the ambiguities and unfounded assumptions of practices based on anecdotal evidence or intuition. Moreover, evidence-based practices can mitigate the problems associated with cognitive biases. Especially important in the public health sector, evidence-based practices best inform public policy and institutional procedures. However, it is important to operationalize evidence-based practice so that its implementation is standardized across multiple departments and teams. The greatest challenges to evidence-based practices include the time and resources required to compile and then communicate evidence, and resistance to change.
What is Evidence-Based Public Health Practice?
Evidence-based public health practice has been referred to as a “paradigm” that is adopted by “an energetic intellectual community committed to making clinical practice more scientific and empirically grounded and thereby achieving safer, more consistent, and more cost effective care,” (Greenhalgh & Howick, 2014, p. 3725). Within the public health practice setting, evidence-based practice differs from evidence-based practice in other settings because of the fusion of public policy and economic considerations with epidemiology and health science outcomes. Ultimately, the goal of evidence-based public health practice should be to reduce overall disease burdens, identifying evidence-based interventions based on studies on similar population cohorts, and identifying misplaced global, national, or local resources to improve cost-effectiveness of public health programs (Prince, Wu, Guo, et al., 2015).
To make evidence-based decisions, public health practitioners need to retain a comprehensive overview of prevalence data, risk factors and risk management, and variables that mitigate risk, in order to make suggestions for strategic allocation of resources. Whether in the private or public sector, evidence-based public health practices refer to the application of verifiable, reliable, and accurate data to programs, polices, and services. Evidence-based public health practices can also be used to inform communications strategies and public outreach and advocacy.
Defining “Evidence” In the Public Health Context
Empirical Research
Evidence-based public health practices are ultimately grounded in empirical research from the gamut of social and health sciences literature (Greenhalgh & Howick, 2014; Lewis, 2015; Prince, Wu, Guo, et al, 2015).
Clinical Practices
In addition to building on the body of empirical data compiled by epidemiologists, biologists, organic chemists, physiologists, psychologists, social scientists, and other researchers, public health specialists also rely on evidence-based clinical practice data. Different from empirical research, clinical practice data can be compiled by a single institution or organization or by independent research organizations. Clinical practice evidence is often referred to as practice-based evidence, to be differentiated from research-based evidence (Vaidya, Thota, Proia, et al., 2017).
Qualitative Research
Qualitative research also becomes a considerable component of evidence-based public health practices. Although qualitative research does not yield numerical data, the data gleaned from interviews and case studies forms a substantial portion of the body of information on public health and can be used to inform best practices and public policy (Lewis, 2015).
Challenges to Compiling Evidence For Public Health Practice
Compiling evidence for public health practice can be challenging. The primary barriers to the effective compilation of evidence that can best inform public health practice include perceived credibility, funding constraints, time and human resources, and the external validity of available data. Stakeholder confidence in the body of evidence may be linked to external validity and generalizability concerns, particularly with regards to research-based evidence (Vaidya, Thota, Proia, et al., 2017). Qualitative research can present even greater challenges for evidence compilation because results are not readily extractable or generalizable (Lewis, 2015). When committed to evidence-based practices, public health practitioners need to shift their methodologies in terms of data collection, application, and communication (Greenhalgh & Howick, 2014). The use of technological tools becomes critical in all evidence-based practice settings, and within the realm of public health in particular. Technological tools help with data collection, with data analysis, and with the communication of health-related evidence that can be used to inform institutional practices and public policy. An abundance of evidence within the scientific literature databases forms the core of public health research, and this research needs to be carefully collated and sifted to find which studies apply well to the target population. Randomized controlled trials and practice-based evidence may have a higher level of generalizability versus individually allocated studies, for example, (Vaidya, Thota, Proia, et al, 2017). The problem of “too much evidence” may also become an issue (Greenhalgh & Howick, 2014, p. 3725). Therefore, evidence-based public health practice almost requires several new areas of specialization in research and practice.
Strengths and Limitations of Public Health Evidence
Stakeholders and investors may distort evidence-based public health practices to create the means by which to implement desired policies and procedures. Political goals may conflict with the ethical objectives of a government or private sector organization. Inflexible rules, bureaucratic organizational structures, and other external variables may also impede the ability to apply public health evidence in credible and consistent ways (Greenhalgh & Howick, 2014). As Greenhalgh & Howick (2014) also point out, overreliance on empirical data may lead to problems like narrow focuses, a neglect of outlier characteristics, the inability to take into account comorbidity, marginal gains, and a shift from disease management to risk assessment—all of which divert potential resources from crucial interventions. Another potential limitation of public health evidence is the need to divert resources towards data analysis and the creation of algorithms that would help make the economic decisions analysts need to inform policy (Greenhalgh & Howick, 2014).
Overall, however, evidence-based public health practice remains the ideal. As the evidence base becomes more robust and easier to manage via the implementation of new technologies, public health practitioners may have within their arsenal the means by which to make credible, cost-effective, and reliable decisions. When evidence-based public health practice is as patient- or as person-centered as individual health care practices, the ethics of applying aggregate data to a community become less problematic, too. The most important positive feature of evidence-based public health practice is the ability to create targeted interventions for specific patient cohorts (Prince, Wu, Guo, et al., 2015). The data allows for the creation of complex algorithms to identify public health patterns and risk assessment, enabling a more strategic and effective application of limited funding.
Conclusion
Evidence-based public health practice is results-driven, and motivated by the need for cost-effective programming. When public health practice is evidence-based, the results of programs, policies, and interventions can be assessed and managed over time. As technologies and competencies improve, so too will the efficacy of all evidence-based public health practices and procedures.




References
Greenhalgh, T. & Howick, J. (2014). Evidence-based medicine: a movement in crisis? BMJ 348(2014): 3725.
Lewis, S. (2015). Qualitative inquiry and research design. Health Promotion Practice 16(4): 473-475.
Prince, M.J., Wu, F., Guo, Y., et al. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet 385(9967): 549-562.
Vaidya, N., Thota, A.B., Proia, K.K., et al. (2017). Practice-based evidence in community guide systematic reviews. American Journal of Public Health 107(3): 413-420.