The limitations of 'evidence-based' public health
The limitations of 'evidence-based' public health
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DOI：
10.1111/j.1365-2753.2006.00600.x
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发表时间：
2006-06-01
影响因子：
2.4
通讯作者：
Kemm, John
中科院分区：
文献类型：
--
作者：
Kemm, John
本文探讨了“循证”方法的概念如何从临床医学转移到公共卫生领域，并应用于健康促进和政策制定。在决策过程中，证据总是被广义地解释为包括所有类型的合理调查，经过一些辩论后，现在健康促进也是如此。以社区而不是个人作为干预单位和背景的重要性意味着经常随机对照试验不适合研究公共卫生干预措施。此外，“最佳解决方案”的概念忽略了决策过程的复杂性。证据“启发”政策制定者如何制定政策问题，而不是提供任何特定问题的答案。从公共卫生中应用循证政策的方式中可以吸取一些教训，这些教训可以有效地应用到医学中。
This paper examines how the concept of the 'evidence-based' approach has transferred from clinical medicine to public health and has been applied to health promotion and policy making. In policy making evidence has always been interpreted broadly to cover all types of reasoned enquiry and after some debate the same is now true for health promotion. Taking communities rather than individuals as the unit of intervention and the importance of context means that frequently randomized controlled trials are not appropriate for study of public health interventions. Further, the notion of a 'best solution' ignores the complexity of the decision making process. Evidence 'enlightens' policy makers shaping how policy problems are framed rather than providing the answer to any particular problem. There are lessons from the way that evidence-based policy is being applied in public health that could usefully be taken back into medicine.