Teaching Evidence-based Public Health to Public Health Practitioners
Introduction
The practice of public health is a large and diverse enterprise, encompassing the activities of 59 state and territorial health departments, over 3000 local health departments, and myriad federal agencies with both discrete and overlapping responsibilities. As noted in The Future of the Public's Health in the 21st Century (1), other central actors in the public health system include the health care delivery system and academe, as well as those engaged in the media, business and industry, and members of communities.
There are many reasons for the increasing complexity we see in the demands of the public health field: the diversity of local and state health departments and the communities they serve; new threats to the health of the population, ranging from infectious and chronic disease to climate change and biosecurity; technological innovation calling for new skills to use new tools; demographic transformations; and an ever-changing political climate that places new demands on the priority-and policy-setting decision system. Faced with increasing demands and limited resources, we must find new and increasingly effective ways to address the threats facing the public's health.
Too often, what we do in day-to-day public health practice lacks scientific evidence of effectiveness (2). There are both historical and current examples of widespread implementation of programs or policies lacking scientific grounding. The 1975 campaign to immunize the American population against the swine flu was advanced without adequate consideration of the scientific evidence (3). Even though the policy was halted shortly after implementation, it led to substantial legal liability for the US Government because of the potential link between swine flu vaccination and Guillain-Barre syndrome (4). Another prominent example is the Drug Abuse Resistance Education (D.A.R.E.) program, which is the most widely used school-based drug use prevention program in the United States reaching over 70% of elementary-school school children (5). Systematic reviews of methodologically sound D.A.R.E. program evaluations have shown the program to be ineffective (6).
It is estimated that the governmental public health workforce numbers over 430,000, with another 15,000 in voluntary agencies (7). The report entitled Who Will Keep the People Healthy? identified the public health workforce as cutting across multiple professions with highly varied preparation in the biological and social sciences and other technical fields (7). For example, only 44% of the public health workforce has formal public health education and only 22% of local public health officials have graduate degrees in public health (http://www.phppo.cdc.gov/owpp/WDI_Identify.asp).
In light of the increasing technical sophistication of public health problems, and the growing importance of applying an evidence-based approach to developing policy and interventions, there is a crucial need for educational offerings that create a common base of understanding of the fundamentals of public health practice.
Evidence-based public health (EBPH) has been defined as “…the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of program planning models” (8). To enhance uses of evidence in public health practice, a course entitled “Evidence Based Public Health” was originally developed in 1997 by the Saint Louis University School of Public Health (SLU-SPH) in collaboration with the Missouri Department of Health and Senior Services; it has since been expanded with the Centers for Disease Control and Prevention, the Chronic Disease Directors, the World Health Organization (i.e., the Countrywide Integrated Noncommunicable Diseases Intervention [CINDI] directors), and the Pan American Health Organization.
Section snippets
Course Description
The EBPH course was developed to train professionals to use a comprehensive approach for program development and evaluation from a scientific perspective. Development of effective programs and policies in public health depend on the application of principles of scientific reasoning and systematic uses of data and information systems. This process relies on several related disciplines including epidemiology, biostatistics, behavioral sciences, and health care management. The course teaches a
Course Evaluation
From 1998 through mid-2004, the EBPH course was offered a total of 20 times. There were 11 offerings to 253 participants from the Missouri Department of Health and Senior Services and local health agencies in Missouri. National courses were held five times with 146 participants from many US states and territories. The course has been held four times internationally in Russia and Europe. Based on the Missouri model, the course also has been adapted for use in Illinois, New Mexico, West Virginia,
Increasing the Reach
Several steps have been taken based on the workshop model for the EBPH course. The first of these was the 2003 publication of a book (Evidence-based Public Health) building on the structure and content of the class (9). This publication provides a critical resource, both for public health professionals who cannot attend a workshop, and for those who wish to deepen their grasp of the concepts and applications described in the course. The book is also a resource for other teachers and trainers
Summary
There are a number of challenges when attempting to translate scientific discoveries into public health action. We have a wealth of evidence on the etiology and magnitude of major health issues affecting populations. We also have a growing literature on the effectiveness of preventive interventions in clinical (10) and community settings 11, 12. The Internet and innovative new tools 13, 14 put epidemiologic data at the fingertips of practitioners. A key aim is to increase the use of scientific
References (14)
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Am J Prev Med
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Developing an evidence-based Guide to Community Preventive Services—Methods. The Task Force on Community Preventive Services
Am J Prev Med
(2000) The Future of the Public's Health in the 21st Century
(2003)Where is the evidence?
Annu Rev Public Health
(2001)Epidemiology and Health Policy
(1985)- et al.
Epidemiology and the law: Courts and confidence intervals
Am J Public Health
(1991) Public Policy: Youth Drug Education/The D.A.R.E. Program
(2003)
Cited by (31)
Challenges of biological realism and validation in simulation-based medical education
2006, Artificial Intelligence in MedicineImplementation of evidence-based medicine in a health promotion teaching block for Thai medical students
2017, Global Health PromotionAll models are wrong; Some are useful
2017, American Journal of Public HealthEvidence -based information needs of public health workers: A systematized review
2017, Journal of the Medical Library Association
This program was funded through Centers for Disease Control and Prevention contract U48/CCU710806 (Prevention Research Centers Program), the Chronic Disease Directors, and the Missouri Department of Health and Senior Services.