Evidence-Based Health Policy

Turning Myth to Reality : 

Turning Myth to Reality Evidence-Based Health Policy

Evidence-Based Health Policy : 

Evidence-Based Health Policy “Knowing is not enough; we must apply.... Goethe, Image courtesy Wikipedia The Journal of Law, Medicine & Ethics; Fall 2002; 30 (3)

Case Studies : 

Case Studies Scurvy Fluoride Mammography Image source: http://www.digitalassetstorage.com/case_studies/case_studies.html

Scurvy : 

Scurvy Determined in 1747 that scurvy could be prevented by adding citrus to rations James Lind, Image courtesy Wikipedia The Journal of Law, Medicine & Ethics; Fall 2002; 30 (3)

Scurvy : 

Scurvy Not implemented for 42 more years by British Navy Image credit: http://www.napoleonguide.com/pixs_britishships.htm

How do you make policy? : 

How do you make policy? Reactionary (PATRIOT Act) Luck|Accident (Ryan White) Visionary (Model Laws) Image courtesy Cedric Dark

Model Public Health Laws : 

Model Public Health Laws Sample legislative language proposed by various groups 107 found Only 6% based on readily identifiable evidence AJPH 2009; 99 (9): 1576-1583.

Evidence-Based Policy :A Working Definition : 

Evidence-Based Policy :A Working Definition “to improve public health outcomes, evidence-based policy is developed through a continuous process that uses the best available quantitative and qualitative evidence” AJPH 2009; 99 (9): 1576-1583.

Fluoridation : 

Fluoridation Fluoridation hailed as Top 10 Greatest Achievements in Public Health (20th Century) Dental cavities affect 60-90% of school children Image credit: http://spoutingoff.files.wordpress.com/2008/09/water_faucet.jpg

Fluoridation of Drinking Water : 

Fluoridation of Drinking Water Began in 1945 Reaches an estimated 144 million persons in the United States (1999) Fluoridation safely and inexpensively ($0.94 per person per year) Reduction in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%) CDC. MMWR 1999; 48(12);241-243.

Fluoride : 

Fluoride A communist plot? Forced medication? Is the evidence even helpful? Image courtesy Wikipedia

Types of Evidence : 

Types of Evidence Quantitative Solo Studies Systematic Reviews Qualitative Narratives AJPH 2009; 99 (9): 1576-1583.

Types of Evidence : 

Types of Evidence Randomized controlled trials? Natural experiments? (Pre-post) Comparative / Observational studies? (community A vs. B) Meta-analysis, cost-effectiveness analysis, situational modeling, and decision analysis?

Mammography & The USPSTF : 

Mammography & The USPSTF Recommends against routine screening mammography in women aged 40 to 49 years (Grade C recommendation) Recommends biennial screening mammography for women between the ages of 50 and 74 years (Grade B recommendation)

Science vs. Politics : 

Science vs. Politics

Mammography: Science vs. Politics : 

Mammography: Science vs. Politics Evidence suggested screening at age 50 and not age 40 Politics dictated overruling the “science”

The Mikulski Amendment : 

The Mikulski Amendment ‘‘(5) for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.”

Mammograms & The USPSTF : 

Mammograms & The USPSTF “Without this amendment, there would be no guarantee that women under 50 would be covered for mammograms, no guarantee of an annual women’s health exam that would include screenings for heart disease, and no guarantee that women would have access to this preventive care at no cost.” Image: mikulski.senate.gov

Turning evidence into policy : 

Turning evidence into policy “Evidence is a necessary but not sufficient element of good policy.” Journal of Public Health Policy (2009) 30, S33–S37.

The Role of Evidence : 

The Role of Evidence Demonstrate that a burden exists Demonstrate the priority Explain relevance to local (voting) district Show a benefit or a harm Personalize the issue for stakeholders Estimate costs

Process Issues : 

Process Issues Prepare data for quick and proactive dissemination (Fast Facts) Seek new ways of communicating data (Twitter, Facebook, District relevance) AJPH 2009; 99 (9): 1576-1583.

Content Issues : 

Content Issues Identify elements that lead to evidence based policy (active ingredients) Effectively use existing tools (data types, research methods) AJPH 2009; 99 (9): 1576-1583.

Outcome Issues : 

Outcome Issues Develop systems for policy surveillance Rely on numerous forms of evidence for tracking outcomes (health outcomes, tax data, polls) AJPH 2009; 99 (9): 1576-1583.

Some tips : 

Some tips You are working with people Learn about their world Speak their “language” and don’t expect them to understand yours Address their needs (what kind of evidence is helpful?) Who do they need to convince? Establish common ground

Evidence-Based Health Policy : 

Evidence-Based Health Policy www.PolicyPrescriptions.org Health Policy Guide RAND: Compare RWJF: Synthesis Project The Community Guide U.S. Preventive Services Task Force The Journal of Law, Medicine & Ethics; Fall 2002; 30 (3)

Evidence-Based Health Policy : 

Evidence-Based Health Policy “Knowing is not enough; we must apply.... ....Willing is not enough; we must do.” Goethe, Image courtesy Wikipedia The Journal of Law, Medicine & Ethics; Fall 2002; 30 (3)

Turning Myth to Reality : 

Turning Myth to Reality Evidence-Based Health Policy Cedric K. Dark, MD, MPH Founder and Executive Editor