Fielding and Briss define evidence-based public health as “the process of integrating science-based interventions with community preferences to improve the health of populations” (Fielding & Briss, 2006). They further point out that three types of scientific evidence can hold up evidence-based public health decisions. These are type 1 evidence which “defines causes of diseases and their magnitude, severity, and preventability, and helps determine what needs to be done” (Fielding & Briss, 2006).
Secondly, we have type 2 evidence. It shows “the specific interventions which do or do not work to promote health and help inform decisions about which interventions or policies should be done” (Fielding & Briss, 2006). The final type is type 3 evidence. It shows “the manner in which condition interventions are received and implemented” (Fielding & Briss, 2006). This type gives “informing decisions on things that should be done” (Fielding & Briss, 2006).
Several tools support an evidence-based decision-making process. Fielding and Briss (2006) identified three tools. These are, “health impact assessment, systematic reviews, and a portfolio of tools for assuring community fit and feasibility” (Fielding & Briss, 2006). Apart from the three, there are additional tools that can be used to support the approach. Cost-benefit analysis is an example. It entails quantifying the cost and benefit of each activity and gives a justification of the most cost-effective venture. Another tool is practice guidelines. This tool decodes research findings into public health practice.
It is imperative to note that the poor quality of health care in the United States outshines evidence-based decision-making. Several challenges hinder the success of the approach. These include limited resources. There is the slow growth of the approach due to scarce resources. Secondly is poor accessibility. There is the unavailability of evidence in a form that can be relied upon at the time of decision making. Therefore, this dilutes the relevance of the approach. Besides, this approach depends on available scientific research studies. Those involved in the implementation of this approach have a gap in identifying the group of patients who will gain from the studies and those who will not. Therefore, “payers and consumers confront the same knowledge gap and lack information for coverage decisions, cost-sharing, and treatment choices” (Fielding & Briss, 2006). Finally, there are inadequate research studies on the approach.
Success and Failures
Approval of drugs is an example of the successful use of evidence-based decision-making. “In the US, food, and drugs administration approval for marketing a new drug product is based on a well-defined pathway” (Fielding & Briss, 2006). Some areas of failure include the consumption of tobacco and coffee. There has been a rise in the consumption of tobacco and alcohol even after the use of this approach in the US. Other areas of success not mentioned by Fielding and Briss (2006) include a reduction in deaths resulting from motor vehicle-related accidents. Improvement in the quality of vehicles and change of personal behaviors contributes to the reduction in the number of deaths. On the other hand, an area of failure is nutrition-related problems such as obesity during childhood. Also, there are increasing cases of sexually transmitted diseases among other failures (Fielding & Briss, 2006).
Fielding, J. & Briss, P. (2006). Promoting Evidence-Based Public Health Policy: Can We Have Better Evidence And More Action? Health Affairs, 25(4), 969 – 978. Web.