Professor of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University. Associate Professor of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University.
PREFACE
It can be used in the master's program or for the many new public health programs. We hope that this book will be a useful resource for bridging the gap between research and public health policy and practice.
ACKNOWLEDGMENTS
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As these disciplines converge, several concepts are fundamental to achieving a more evidence-based approach to public health practice. Information for public health decision-making is also more diffuse than evidence for clinical interventions.
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It is useful to consider several overarching, common features of evidence-based approaches to public health practice. Promoting more effective public health by identifying administrative evidence-based practices: A literature review.
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Evaluation of a train-the-trainer approach to improving capacity for evidence-based decision-making in public health. Barriers to evidence-based decision-making in public health: a national survey of chronic disease practitioners.
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Public health research is incremental, with a body of scientific evidence building up over years or decades. The importance of community action in motivating public health efforts was demonstrated in the Long Island Breast Cancer Study Project (LIBCSP). The US Preventive Services Task Force (USPSTF) was first convened in 1984 by the Public Health Service.
This case illustrates the intertwining of science, policy, timing, and health communication in evaluating the evidence for public health interventions. Setting public health and health care priorities in a climate of limited resources is a challenging task. HEN is an information service aimed primarily at public health and health care designers in the European region.
Development and use of the Community Preventive Services Guide: lessons learned about evidence-based public health. Evidence base for public health information policy at the Centers for Disease Control and Prevention. An overview of the major influences on current public health policy in developed countries in the second half of the 20th century.
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For example, an important part of the economic evaluation is the costs of the disease or illness for which the intervention is intended. The perspective of the analysis will determine which costs and benefits are included in the analysis. This chapter focuses on the social perspective and therefore lists all possible costs and benefits that can be taken into account.
The choice of the type of economic evaluation depends mainly on the benefits of the program. Finally, if the benefits of the programs being compared are identical, a CMA can be used. This is the resource cost of the program, also referred to as the opportunity cost.
Another complicating factor for public health is the choice of the relevant time period. An important final step in an economic evaluation is the reporting of the results, especially the ICER, in the literature. But the unpaid time can be decisive in determining the cost-effectiveness of the intervention.42.
The difference between the two totals is the cost of illness estimate for this condition. This tool provides state-level estimates of the cost of several chronic diseases in the United States.
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Partners were involved in all aspects of the development, implementation and analysis of the data. The decision about what to assess should be guided by the purpose of the assessment. It is particularly important to assess factors along the full range of the ecological factors that have an influence.
Too often, community assessment data is collected based on the skills of the individuals collecting the data. When conducting observations, it is important to consider the advantages and disadvantages of participation and the duration of the observation. In doing so, it is important to note the advantages and disadvantages of the data that has been collected, as well as the parts of the community that the data represents.
From there, a full understanding of the data is important in prioritizing the most important issues to work on and developing action plans. Due to the complexity of public health issues, it is important to obtain information at multiple levels of the ecological framework. Insiders and outsiders judge who 'the community' is. In: Israel BA, Eng E, Schulz AJ, Parker EA, eds.
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In all cases, it is essential that the initial case statement is clear, articulate and well understood by all members of the public health team as well as other relevant parties. One question along the way is, "Do we need more information?" The answer to this question is almost always "yes," so the challenge becomes where to find the most essential information efficiently. An example of the four components of an emissions statement, together with possible data sources, is shown in Table 6.2.
The section on background and epidemiological data generally presents what is known about the descriptive epidemiology of a public health issue. Figure 6.3 shows, for example, time trends in deaths from heart disease in five countries in Europe.9 These data show large differences per country; more than a threefold difference is seen in rates in Italy compared to those in the Russian Federation.9 The variations are significant when comparing Western Europe with Central and Eastern Europe. In all cases it is important to specify the source of the data so that the presentation of the problem is credible.
The term program is broadly defined to include any organized public health action, including direct service interventions, community mobilization efforts, policy development and implementation, outbreak investigations, health communication campaigns, health promotion programs, and applied research initiatives.8 The programmatic issue under consideration can best be presented as a series of questions that a public health team will try to answer. For an intervention, you might ask: "Are there effective intervention programs in the literature to address risk factor X among population Y?" A policy question would consider: "Can you document the positive effects of a health policy enacted and enforced in State X?" In the area of cost-effectiveness it might be: "What is the cost of intervention Z per life-year saved?"11 And a management question would ask: "What are the resources needed to enable us to effectively deliver a program start to address issue X?” The questions that determine the "how" of program or policy implementation begin to address Type 3 evidence, as described in chapter 1. An assessment of the external environment, based on strategic planning methods, will help to set the context for ' understand a program or policy.
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To evaluate the effectiveness of health programs and services in improving population health. This incidence rate must be compared to the prevalence rate, which captures the number of existing cases of the disease among surviving members of the population. Disease rates can be estimated if all cases of disease can be enumerated for the population at risk during a certain period, and the size of the population at risk (or the amount of person-time) can be determined.
Mortality rates can be estimated for local populations if the number of deaths and the size of the defined population are large enough to provide accurate rates. These registries provide data that can be used to calculate site-specific cancer incidence rates for a community if the number of cancer cases and the size of the defined population are large enough to provide precise rates. Study participants in both groups are followed prospectively, and disease (or health-related) outcomes are calculated for each group at the end of the observation period.
Ideally, results should be identical at baseline and in the period prior to conducting the study. Cohort and case-control studies are two observational study designs that can be used to evaluate the strength of the association between prior exposure and risk of disease in the study population. Cross-sectional studies are also used to help set research priorities based on considerations of disease burden.
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As noted in Chapter 1, there are many types and sources of evidence on public health programs and policies. Three levels of scientific literature reading were described: (1) browsing—skimming actual books and articles, looking for anything interesting, and browsing websites related to the topic; (2) informative reading – approaching the literature in search of an answer to a certain question; and (3) reading for research—reading to gain a comprehensive insight into the existing state of knowledge on a given topic.1 In practice, most of us obtain most of our information by browsing.2,3 However, to conduct a literature review for effectively building programs based on evidence, a more structured approach is important. The Annual Review of Public Health is an excellent source of review articles on a variety of topics (http://arjournals.annualreviews.org/loi/publhealth).
A limitation of narrative review articles is that they do not always follow systematic approaches, a practice that sometimes leads to selection bias and inconsistent results.4. Systematic review articles: These review articles involve a detailed, structured, and exhaustive search of original research articles with the aim of reducing selection bias and synthesizing all relevant articles on a given topic. 4– 6 Systematic reviews often present a quantitative synthesis of results, or meta-analysis, to produce a summary statistical estimate of an association or effect size. Guidelines: Practice guidelines are formal statements that provide advice to clinicians, public health practitioners, managed care organizations, and the public on how to improve the effectiveness and impact of clinical and public health interventions.
Review articles and guidelines often provide a useful shortcut for very busy practitioners who do not have the time to master the literature on multiple public health topics. Thirty years ago, a practitioner who wanted to find information on a particular topic would speak to a librarian and inform him or her of the type of information sought, perhaps provide a sample article and help select a few key words. Current practitioners with an Internet connection can now search for relevant information from the world's scientific literature and, with training and experience, discern relevance and quality to improve the practice of public health.
