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• Evidence based public health ....'semantic ' licence?
  Zbys Fedorowicz
  Published on: 25 June 2004

• Published on: 25 June 2004

  Evidence based public health ....'semantic ' licence?

  • Zbys Fedorowicz, dental clinician
  • Other Contributors:
    • James V. Keenan

  Dear Editor

  The authors indicate their intention to clear up the definition of EBPH defining it "as a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods."[1] It was very reassuring to see the authors clearly include ‘lay-knowledge’ as a ‘type of evidence in public h...

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  Dear Editor

  The authors indicate their intention to clear up the definition of EBPH defining it "as a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods."[1] It was very reassuring to see the authors clearly include ‘lay-knowledge’ as a ‘type of evidence in public health decisions’ that may help shape Evidence Based Public Health (EBPH).

  The literature does not even provide a clear definition of Evidence Based Health Care (EBHC) and there is confusion between authors as to whether the concepts of EBHC and Evidence Based Medicine (EBM) are comparable and the terminology interchangeable. The most frequently used definition of EBHC is indeed synonymous with EBM and defined as "the conscious explicit and judicious use of current best evidence in making decisions about the care of individual patients," (Sackett 1996). The inadequacy of this definition, by apparently excluding the patient from the decision process, motivated its revision by Sackett to its ‘new improved’ version, "the integration of best research evidence with clinical expertise and patients values," (Sackett 2000) which highlights the contemporary view of the patient as a partner in the concept.

  How ironic that the majority of writers continue to refer to the original ‘time expired’ definition. Other authors, (Jadad 2000) have continued to use the 1996 EBM terminology in defining EBHC. Muir Gray attempted to differentiate EBM from EBHC, "EBM is the provision of appropriate healthcare for individual patients." Whereas in the UK, the responsibility for the healthcare of populations is clearly allocated to health authorities and to management, where the concept of evidence-based healthcare was invented," and "the development of EBHC was stimulated and facilitated by the NHS R&D program." Now all that remains is to clarify the differences between EBHC and EBPH or do we need evidence based public health care (EBPHC) to bridge the gap?

  Let Goodman sound a final warning note, "At its core, evidence based practice rests on a supposition which, while probably true, itself has unclear evidentiary support"

  Reference

  1. Lucie Rychetnik, Penelope Hawe, Elizabeth Waters, Alexandra Barratt, and Michael Frommer. A glossary for evidence based public health. J Epidemiol Community Health 2004; 58: 538-545.

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  Conflict of Interest:
  None declared.

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