scholarly journals Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head

2019 ◽  
Vol 74 (2) ◽  
pp. 203-208 ◽  
Author(s):  
David Ogilvie ◽  
Jean Adams ◽  
Adrian Bauman ◽  
Edward W. Gregg ◽  
Jenna Panter ◽  
...  

Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.

2019 ◽  
Author(s):  
David Ogilvie ◽  
Jean Adams ◽  
Adrian Bauman ◽  
Edward Gregg ◽  
Jenna Panter ◽  
...  

Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population- and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments, and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated, and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior, nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.


2021 ◽  
Author(s):  
Raimi Morufu Olalekan ◽  
Aziba-anyam Gift Raimi ◽  
Teddy Charles Adias

Given the unprecedented novel nature and scale of coronavirus and the global nature of this public health crisis, which upended many public/environmental research norms almost overnight. However, with further waves of the virus expected and more pandemics anticipated. The COVID-19 pandemic of 2020 opened our eyes to the ever-changing conditions and uncertainty that exists in our world today, particularly with regards to environmental and public health practices disruption. This paper explores environmental and public health evidence-based practices toward responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward retrieving research publications, “gray literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which include effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do a thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioral, environmental, social as well as systems interventions (BESSI) toward reducing transmission.


Author(s):  
Rhiannon T. Edwards ◽  
Emma McIntosh

Chapter 3 opens with a discussion of the role of study design, the gold standard traditionally being a randomized controlled trial, and widens this to consider other types of study design such as cohort studies and natural experiments. Readers are introduced to the idea that many public health interventions are ‘complex interventions’ and there is a need for a ‘systems-based approach’ to understanding their potential effectiveness and cost-effectiveness. The chapter highlights the relevance of behavioural economics to the evaluation of public health interventions. This chapter goes on to summarize a range of challenges faced by economists, used to evaluate healthcare technologies in a healthcare setting, when they start evaluating public health interventions, which are often delivered outside the health sector in, for example, schools and workplaces. UK guidance from NICE is presented on good practice in economic evaluation of public health interventions along with ideas about how such evaluations are best reported in the literature.


2017 ◽  
Vol 46 (2) ◽  
pp. 555-556 ◽  
Author(s):  
Sandul Yasobant

The number of elderly people is increasing rapidly because of decreasing mortality rates and increasing lifespans throughout the world. Policies and programs for elderly people are limited, and existing programs/policies are not implemented effectively towards the goal of healthier aging. Unlike other public health issues and actions, there is an urgent need to build an evidence-based comprehensive public health action policy for healthy aging.


2006 ◽  
Vol 30 (4) ◽  
pp. 458 ◽  
Author(s):  
Bradley Forssman ◽  
Leena Gupta ◽  
Graham Burgess

Large public health interventions to control infectious disease outbreaks are common, but rigorous evaluation to improve the quality and effectiveness of these is rarely undertaken. Following a large community-based clinic to prevent a hepatitis A outbreak, a multifaceted and multidisciplinary evaluation was conducted involving consumers, health professionals and industry partners. The results of this evaluation were used to produce practical operational guidelines for the planning and conduct of future interventions. These guidelines have been distributed to all public health units in New South Wales and may be included in the next edition of the NSW Health notifiable diseases manual. The evaluation approach can be applied to all public health interventions across NSW and Australia to assist in the development of operational guidelines, in order to increase the quality of public health action in outbreak prevention.


2017 ◽  
Vol 41 (spe) ◽  
pp. 14-21 ◽  
Author(s):  
Astrid Brousselle ◽  
Samantha Gontijo Guerra

ABSTRACT The way in which we have structured our societies has made possible major advances in population health. However, this model, based on intensive exploitation of natural resources, is now the source of the greatest threats to human health. Today's environmental issues call for bringing to public health an ecological approach whose actions address not only population health, but also ecological, social, and economic changes - i.e., an ecosocial approach to health. Here we examine the implications, for public health action, of adopting such an approach.


Author(s):  
John W. Frank ◽  
Geoffrey Lomax

At the OSHA hearings regarding the Proposed Ergonomics Standard, confusion occurred between appropriate scientific evidentiary criteria for initiating clinical interventions for individual patients as opposed to the evidence needed to justify public health protection interventions directed at controlling hazardous exposures for entire populations. We assert that clinical interventions have little relevance to the standard proposed at that time. We summarize for the record why this prerequisite is neither technically feasible nor ethically appropriate for public (population) health action to control hazards. Further, we advocate reasonable cause criteria for public health hazard control as the appropriate basis for deciding whether to proceed with implementing abatement policies, for a potential health threat to a population.


2020 ◽  
Author(s):  
Ignacio Garitano ◽  
Manuel Linares ◽  
Laura Santos ◽  
Ruth Gil ◽  
Elena Lapuente ◽  
...  

UNSTRUCTURED On 28th February a case of COVID-19 was declared in Araba-Álava province, Spain. In Spain, a confinement and movement restrictions were established by Spanish Government at 14th March 2020. We implemented a web-based tool to estimate number of cases during the pandemic. We present the results in Áraba-Álava province. We reached a response rate of 10,3% out a 331.549 population. We found that 22,4 % fulfilled the case definition. This tool rendered useful to inform public health action.


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