ompared to evidence-based public health, evidence-based medicine is a more familiar phrase. Evidence-based medicine has become increasingly popular in the past decade, due in large part to the emergence of computerized database search technology and advanced statistical tools which allow researchers to quickly identify and summarize vast amounts of scientific information.Today, the concept of evidence-based public health is gaining momentum and has grown in popularity. However, the term "evidence-based" lacks clarification and is subject to a variety of interpretations. The evidence that supports evidence-based medicine or public health may include individual experience, anecdotal information, the content of a single scientific article, or the results of a sophisticated systematic review of scientific literature. The imprecise language used to describe evidence leads to confusion over what types of evidence are most appropriate in answering different types of questions.Evidence-based decision making in medicine and public health is often criticized for limiting the ability of seasoned clinicians and public health professionals to bring their practical experience to the problem solving process. Clinical practice guidelines, in particular, have been characterized as dangerous to decision making at the individual level. In addition, the extreme positions of those who advocate for evidenced-based decision making compound the problem, suggesting that no decision should be made without a strong, scientific evidence base, or that decisions should not be informed by experience or other factors.An assumption is often made that only one type of evidence is used for all decisions. This assumption stems from the use of the term "evidence-based" as a synonym for "best practices," "guidelines," or "practice guidelines." If evidencebased decision making relied only on these narrow categories of evidence, the critics of the process would be correct. The term "evidence-based", however, can be broadened to allow for different kinds of evidence to support different kinds of decisions. Public health officials must contemplate the types of decisions they are required to make and ensure they have the right types of evidence to make and support those decisions.Asking for evidence-based decision making in public health requires a shift in thinking. Evidence-based decision making has the potential to reap numerous rewards, including better performance, improved health outcomes, and a more efficient use of resources. In order to be effective, however, evidence-based procedures must permeate all levels of the public health infrastructure. The principles of evidence-based public health should be incorporated into academic coursework in schools of public health, policy, and administration. It is important to demand that public health organizations and agencies develop tools for evidence-based decision making, and that efforts to develop frameworks that recognize the importance of all types of evidence in decision making continue. m John Clym...
