Evidence-based public health

Reiner Banken

Agence d'évaluation des technologies et des modes d'intervention en santé, 2021, avenue Union, bureau 1040, Montreal, Québec H3A 2S9, Canada (email: reiner.banken@aetmis.gouv.qc.ca)

Authors: Ross C. Brownson, Elizabeth A. Baker, Terry L. Leet, Kathleen N. Gillespie ]]> Publisher: Oxford University Press, New York; 2002
ISBN: 0 195143760; hardback; 256 pages;
price: US$ 39.95

In the preface, the authors state that the aim of their book is "to provide practical guidance on how to choose, carry out and evaluate evidence-based programs and policies in public health settings". Over the years I have seen many misguided efforts that have tried to apply rigid hierarchies of evidence to public health. In stark contrast this is probably the best reference book on evidence-based public health yet to have appeared.

The material for the book is based on training courses developed by the authors on evidence-based decision-making in public health. The very practical origins of the book are clear from its extremely coherent, logical and user-friendly structure. Its frequent use of examples, mostly from the USA, and its layout with inserted information boxes greatly facilitate the reader's comprehension of the material. The book consists of nine chapters, the first of which sets the structure for the rest of the book as it provides an overview of the 6-step "sequential framework for enhancing evidence-based public health" expounded by the authors: develop an initial statement of the issue; quantify the issue; search the scientific literature and organize information; develop and prioritize programme options; develop an action plan and implement interventions; evaluate the programme or policy. The individual steps in this framework are explained in detail in chapters 4-9. The book can be read by those who do not have any background in epidemiology, with chapters 2 and 3 providing the necessary basic understanding of causality, systemic reviews, meta-analysis and decision analysis. The authors also provide a very rigorous description of methods rooted in the social and management sciences: Delphi method, nominal group technique, scenario planning, SWOT analysis, among others.

One of the great strengths of the book stems from its pragmatic adaptation of the concepts used in evidence-based medicine to arrive at kindred concepts for evidence-based public health. Evidence-based public health relies more on observational than experimental studies, is based on a smaller amounts of evidence, involves a longer time from intervention to outcome, and requires public health decisions to be made by interdisciplinary teams, rather than individual physicians.

Although the book is very good when it deals with public health programmes, it is not as strong on health policy. Readers who are specifically interested in the macro level of evidence-based health policy may be better served by Lin & Gibson's Evidence based health policy: problems and possibilities (Oxford University Press, 2003). A further limitation of the book is that the examples and references are essentially from the US. While the basic tools, principles and skills it describes are useful for all public health practitioners, including those from developing countries, the book would have been even better had it been more tailored to an international readership. Taken as a whole, the book nevertheless provides a pragmatic, handson approach to evidence-based public health and a tool-box for public health practitioners and managers of public health programmes in all countries.