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Public health education and training
EVIDENCE IN PRACTICE AND EDUCATION OF PUBLIC HEALTH: FROM TRANSLATION TO EXCHANGE By: Ansgar Gerhardus
Summary: Evidence should inform decision-makers, practitioners and the public on what works in public health, under which conditions, and for whom. However, in real life, evidence often does not translate into public-health-practice. This article suggests that we abandon the concept of translation of evidence as a one-way-process that is independent from values, resources, interests and other contextual aspects. Instead, we suggest a model where evidence is generated within a deliberate exchange process between scientists and practitioners, taking values, resources and interests into account. Keywords: Evidence, Public Health, Evidence-based Public Health, Translation, Implementation
The concept of evidence
Ansgar Gerhardus is Professor and Head of the Department for Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Germany. Email: ansgar.gerhardus@unibremen.de
Eurohealth — Vol.22 | No.4 | 2016
assessment of pharmaceuticals. The ideal design for studying the effectiveness According to Winslow’s well-known of pharmaceuticals is most often the definition, public health is the “… the randomised controlled trial (RCT) where a science and the art of preventing disease, population of patients is randomly divided prolonging life and promoting physical into two (or sometimes more) groups: the health and efficiency through organised members of one group receive the drug to community effort…” 1 Evidence is usually be tested, the other serves as a control. As considered to be related to science, rather all other factors, such as the context and than to art. Evidence-based knowledge the mode of implementation are supposed should inform decision-makers, to be equal, the difference in outcomes practitioners and the public on what works, can be related directly to the different under which conditions, and for whom. active ingredients of the pharmaceutical. Only a few would oppose the claim that Based on the assumption that only the “any public-health-intervention should active ingredient is responsible for any be based on the best available evidence”. effect of the intervention, results from This leads to the question: Why does various studies performed under different evidence often not translate into publicconditions are pooled into systematic health-practice? reviews. Systematic reviews are arguably the most prominent feature of evidenceThe concept of evidence has entered the based medicine. health sector through clinical medicine and, more specifically, through the critical