The Art and Science of Evidence-Based Decision-Making ...Epidemiology Can Help!

Article excerpt

This article is based on an original paper Toward Effective Community-Based Action: Using Epidemiological Skills in Public Health Surveillance for Local Public Health written for Health Canada.

Publication of this insert was supported by the Centre for Surveillance Coordination at Health Canada.

The Canadian Public Health Association (CPHA) is a national, independent, voluntary association representing public health in Canada with links to the international public health community.

CPHA is pleased to be working in partnership with the Centre for Surveillance Coordination, Health Canada, to help increase the capacity of public health practitioners and decision-makers across Canada to better protect the health of Canadians.

An electronic version of this document is available at: http://www.hc-sc.gc.ca/pphb-dgspsp/csc-ccs/skills-e.html We encourage non-commercial reproduction of this document. Please acknowledge the source of the text as the Canadian Journal of Public Health 2002;93 (1)(Special insert):I 1-18.

This article explores how epidemiological skills and approaches can improve decision-making in public health. It emphasizes the need to enhance capacity at the local level and describes how the Health Canada Skills Enhancement for Health Surveillance Program can help public health organizations and practitioners improve their skills in epidemiology, surveillance and information management.

An Evolving Science Supports Decision-Making in Public Health

To some extent, public health decision-making is an art. Experience, knowledge of the community, timing, values and leadership style are inevitably part of the decision-making experience.

increasingly, however, public health practitioners and Boards of Health are charged with making "evidence-based" decisions that are based on a careful analysis of accurate data and proven research findings.

But how do we know that we have the right information? How do we know which research results are reliable and applicable? How do we know if our analysis of the data is sound? How do we convert what the research tells us into effective community action?

The science of epidemiology helps answer these questions. It gives us the tools we need to be better health detectives, better planners and better service providers. An epidemiological approach helps us make improved decisions about the types of public health programs, policies, planning and surveillance initiatives we need in our communities.

A helpful definition describes epidemiology as: the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.1

Modern epidemiology uses tested scientific methods to help us understand the patterns of disease and health and the root causes or determinants of health problems. These are the "who", "what", "where" and "why" questions that always surround a public health concern. Epidemiology helps us apply this information to prevent illness and injury, to protect people from harm and to control health problems.

Historically, epidemiology has been associated with the investigation of communicable diseases. As a consequence, it is often considered the domain of specialists with graduate training. Today, we still use epidemiology to explore the causes and patterns of communicable disease, but over the past 40 years, epidemiological concepts have been increasingly used to help us understand a wide range of health issues. These include injuries, health behaviours such as smoking and physical activity, chronic diseases such as diabetes and arthritis, child and family health, occupational health, birth defects, and environmental concerns such as air pollution and water safety. Thus, core competencies in epidemiology are useful to all public health practitioners who are making decisions and recommendations about programs and spending in public health. …